Augmented Ulnar Collateral Ligament Repair With Structural Bioinductive Scaffold: A Biomechanical Study.

BACKGROUND: Elbow ulnar collateral ligament (UCL) repair with suture brace augmentation shows good time-zero biomechanical strength and a more rapid return to play compared with UCL reconstruction. However, there are concerns about overconstraint or stress shielding with nonabsorbable suture tape. Recently, a collagen-based bioinductive absorbable structural scaffold has been approved by the Food and Drug Administration for augmentation of soft tissue repair. PURPOSE/HYPOTHESIS: This study aimed to assess the initial biomechanical performance of UCL repair augmented with this scaffold. We hypothesized that adding the bioinductive absorbable structural scaffold to primary UCL repair would impart additional time-zero restraint to the valgus opening. STUDY DESIGN: Controlled laboratory study. METHODS: Eight cadaveric elbow specimens-from midforearm to midhumerus-were utilized. In the native state, elbows underwent valgus stress testing at 30o, 60o, and 90o of flexion, with a cyclical valgus rotational torque. Changes in valgus rotation from 2- to 5-N·m torque were recorded as valgus gapping. Testing was then performed in 4 states: (1) native intact UCL-with dissection through skin, fascia, and muscle down to an intact UCL complex; (2) UCL-transected-distal transection of the ligament off the sublime tubercle; (3) augmented repair with bioinductive absorbable scaffold; and (4) repair alone without scaffold. The order of testing of repair states was alternated to account for possible plastic deformation during testing. RESULTS: The UCL-transected state showed the greatest increase in valgus gapping of all states at all flexion angles. Repair alone showed similar valgus gapping to that of the UCL-transected state at 30° (P = .62) and 60° of flexion (P = .11). Bioinductive absorbable scaffold-augmented repair showed less valgus gapping compared with repair alone at all flexion angles (P = .021, P = .024, and P = .024 at 30°, 60°, and 90°, respectively). Scaffold-augmented repair showed greater gapping compared with the native state at 30° (P = .021) and 90° (P = .039) but not at 60° of flexion (P = .059). There was no difference when testing augmented repair or repair alone first. CONCLUSION: UCL repair augmented with a bioinductive, biocomposite absorbable structural scaffold imparts additional biomechanical strength to UCL repair alone, without overconstraint beyond the native state. Further comparative studies are warranted. CLINICAL RELEVANCE: As augmented primary UCL repair becomes more commonly performed, use of an absorbable bioinductive scaffold may allow for improved time-zero mechanical strength, and thus more rapid rehabilitation, while avoiding long-term overconstraint or stress shielding.

Bifocal avulsion fracture and fixation of the patellar tendon: a case report.

Acute distal patella tendon avulsion from the tibial tubercle (TT) is a relatively rare injury that is usually described in the adolescents or elderly population in their 7th or 8th decades. Bifocal avulsion fractures of the patella tendon from the TT and the distal pole of the patella are exceptionally rare in adults. In this case report, we present a 52-year-old healthy old male who was treated for bifocal avulsion of the patellar tendon with open reduction and internal fixation augmented with two ULTRATAPE sutures. To our knowledge, this is the first case report to describe this injury in a healthy middle-aged patient.

A modified minimally invasive osteotomy for hallux valgus enables reduction of malpositioned sesamoid bones.

BACKGROUND: The current minimally invasive distal metatarsal osteotomy for hallux valgus (HV) is V-shaped, which prevents the correction of the rotational metatarsal head deformity and reduction of the sesamoid bones. We sought to determine the optimal method for sesamoid bone reduction during HV surgery. METHODS: We reviewed the medical records of 53 patients who underwent HV surgery between 2017 and 2019 using one of three techniques: open chevron osteotomy (n = 19), minimally invasive V-shaped osteotomy (n = 18), and a modified straight minimally invasive osteotomy (n = 16). The sesamoid position was graded using the Hardy and Clapham method on weight-bearing radiographs. RESULTS: When compared to open chevron and V-shaped osteotomies, the modified osteotomy resulted in significantly lower postoperative sesamoid position scores (3.74 ± 1.48, 4.61 ± 1.09, and 1.44 ± 0.81, respectively, P < 0.001). Furthermore, the mean change in postoperative sesamoid position score was greater (P < 0.001). CONCLUSION: The modified minimally invasive osteotomy was superior to the other two techniques in correcting HV deformity in all planes, including sesamoid reduction.

The Effect of Warfarin Use on Postoperative Outcomes after Femoral Neck Surgery.

Introduction: Anticoagulation use in the elderly is common for patients undergoing femoral neck hip surgery. However, its use presents a challenge to balance it with associated comorbidities and benefits for the patients. As such, we attempted to compare the risk factors, perioperative outcomes, and postoperative outcomes of patients who used warfarin preoperatively and patients who used therapeutic enoxaparin. Methods: From 2003 through 2014, we queried our database to determine the cohorts of patients who used warfarin preoperatively and the patients who used therapeutic enoxaparin. Risk factors included age, gender, Body Mass Index (BMI) > 30, Atrial Fibrillation (AF), Chronic Heart Failure (CHF), and Chronic Renal Failure (CRF). Postoperative outcomes were also collected at each of the patients' follow-up visits, including number of hospitalization days, delays to theatre, and mortality rate. Results: The minimum follow-up was 24 months and the average follow-up was 39 months (range: 24-60 months). In the warfarin cohort, there were 140 patients and 2055 patients in the therapeutic enoxaparin cohort. Number of hospitalization days (8.7 vs. 9.8, p = 0.02), mortality rate (58.7% vs. 71.4%, p = 0.003), and delays to theatre (1.70 vs. 2.86, p < 0.0001) were significantly longer for the anticoagulant cohort than the therapeutic enoxaparin cohort. Warfarin use best predicted number of hospitalization days (p = 0.00) and delays to theatre (p = 0.01), while CHF was the best predictor of mortality rate (p = 0.00). Postoperative complications, such as Pulmonary Embolism (PE) (p = 0.90), Deep Vein Thrombosis (DVT) (p = 0.31), and Cerebrovascular Accidents (CVA) (p = 0.72), pain levels (p = 0.95), full weight-bearing status (p = 0.08), and rehabilitation use (p = 0.34) were similar between the cohorts. Conclusion: Warfarin use is associated with increased number of hospitalization days and delays to theatre, but does not affect the postoperative outcome, including DVT, CVA, and pain levels compared to therapeutic enoxaparin use. Warfarin use proved to be the best predictor of hospitalization days and delays to theatre while CHF predicted mortality rate.

Orthobiologic Techniques for Surgical Augmentation.

General awareness and clinical utilization of orthobiologic therapy has increased sharply in the recent years. Orthobiologics can be defined as "biological materials and substrates that promote bone, ligament, muscle, and tendon healing." There are 3 major strategies by which orthobiologics are thought to augment tissue repair or native biologic potential: factor-based, cell-based, and biomechanical augmentation. The purpose of this review is to synthesize the recent literature on orthobiologic techniques for surgical augmentation, with focus on several key areas including meniscus repair, osteochondral grafting, and rotator cuff repair.

Comparison of Platelet-Rich Plasma Treatment and Partial Plantar Fasciotomy Surgery in Patients with Chronic Plantar Fasciitis: A Randomized, Prospective Study.

Platelet-Rich Plasma (PRP) injection has become a desirable alternative to Partial Plantar Fasciotomy (PPF) surgery and steroid injection for patients with chronic plantar fasciitis (CPF) due to its potential for shorter recovery times, reduced complications, and similar activity scores. As such, we compared PRP treatment to PPF surgery in patients with CPF. Between January 2015 and January 2017, patients were randomly divided into two groups, a PRP treatment group, and a PPF group. All procedures were performed by a single foot and ankle fellowship-trained specialist surgeon. Visual Analog Score (VAS) and Roles-Maudsley Scale (RM) were collected during the preoperative visit and 3, 6, and 12 months postoperatively. The patients were also closely followed by a physiotherapist. There were 16 patients in each group after four patients refused to participate. Patients in the PPF had low Roles-Maudsley Scale (RM) scores compared to the PRP group one-year after treatment (3.77 vs. 2.72, p < 0.0001). Both procedures showed a reduction in RM scores during the follow-up year (9 to 1.62 for PPF and 8.7 to 2.4 for PRP). There was no significant change in VAS pain between the two groups (p = 0.366). Patients treated with PRP injection reported a significant increase in their activity scores, shorter recovery time, and lower complication rates compared to PPF treatment. Moreover, with respect to existing literature, PRP may be as efficient as steroid injection with lower complication rates, including response to physical therapy. Therefore, PRP treatment may be a viable option before surgery as an earlier line treatment for CPF. Level of Clinical Evidence: II.

Less is better than more with resection of periacetabular tumors - A retrospective 16 years study and literature review.

Introduction: Wide resections of periacetabular tumors create a sizeable bony defect that inevitably results in severe loss of function. Reconstruction of such defects usually requires using large metal implants, a feature associated with considerable surgery extension and complications. The aim of this study is to report resection with no reconstruction of the bony defect. In this retrospective study, we reviewed a consecutive series of 16 patients diagnosed with malignant periacetabular tumors and underwent en-bloc resection without reconstructing their remaining bone defect. Methods: Records were reviewed of 16 consecutive patients diagnosed with malignant periacetabular tumors and underwent en-bloc resection without reconstructing their remaining bony defect. Measurements included: the duration of surgery, blood loss, hemoglobin levels and the need for blood transfusions, data on other hospitalization characteristics, and intraoperative and postoperative complications. Results: Sixteen patients with malignant periacetabular bone tumors and extensive bone destruction underwent wide periacetabular tumor resection with a mean follow-up of 75 months and a mean age of 53 years. The average HOOS score was 46 (range: 20 to 76), and the mean MSTS score was 13% (range: 0 to 15). The mean operative time was 4.1 h, and the mean blood loss was 1200 ml. At their most recent follow-up, patients had a mean shortening of their operated extremity of 4.8 cm, and all could ambulate with assisting devices. Conclusion: Wide resection of periacetabular tumors without reconstruction provides acceptable levels of function and was associated with shorter surgical time, less blood loss and fewer postoperative complications compared to resection with reconstruction. Therefore, this approach may be considered a viable surgical option in patients with an extensive malignant periacetabular. Level III: Retrospective study.

Thousand shades of gray - The role of imaging display in diagnosis of occult scaphoid fractures - A pilot study.

Introduction: Most hospitals and clinics utilize commercial grade displays for viewing wrist radiographs. There is no evidence regarding the role of the imaging display used to evaluate the radiographs. The aim of this study was to compare the rates of scaphoid fracture diagnosis by commercial grade and medical grade displays. Methods: Wrist radiographs of patients that had clinical signs of scaphoid fracture without findings on plain radiography (suspected scaphoid fractures) were retrospectively collected from ER department and interpreted for radiographic signs of fracture by four orthopedics seniors commercial grade and medical grade displays. The difference in fracture diagnosis rates were studied. Inter- and intra-observer variability were also studied. Results: Study population comprised of 175 high quality wrist radiographs were interpreted. Mean 48.25 (27%) scaphoid fractures were observed on commercial grade display compared to 66 (38.2%) on medical grade display (p = 0.076). The total inter-observer agreement could be defined as a moderate agreement (κ = 0.527, Accuracy = 0.77). Total agreement between all observers were observed in 86 (49.1%) cases compared to 89 (50.9%) cases when reviewing X-rays on commercial and medical displays, respectively. Discussion: The scaphoid fracture detection rate on medical grade display was not statistically higher compared to non-medical grade displays, but we did find a tendency toward medical grade display. We found that in a substantial number of cases, our observers recognize signs of fracture that were initially evaluated as "suspected fracture" by the ER physicians. As a pilot study, we found evidence that support the need for a prospective study designed to compare the observations to a gold standard modality, such as MRI. We believe utilizing medical grade displays can increase the rate of diagnosis in cases of clinically suspected scaphoid fractures and better manage the clinical scenario of a suspected scaphoid fracture.

Radiographic Bone Healing in Minimally Invasive Floating Metatarsal Osteotomy for Neuropathic Plantar Metatarsal Head Ulcers - A Retrospective Cohort Study.

Minimally invasive floating metatarsal osteotomy is an option for treating neuropathic ulcers under the metatarsal heads. This study presents the radiographic results of the floating metatarsal osteotomy. We reviewed files and radiographs at least 4 months after a floating metatarsal osteotomy in patients with diabetic neuropathy. In 71 osteotomies in 54 patients with late onset diabetes (mean age 61 ± 9, mean HbA1c 7.9 ± 1.9%), the primary ulcer healed within 3.5 ± 1.4 weeks. Of 66 osteotomies where radiographs were available 10 had non-union (15%, all asymptomatic), 15 (23%) had hypertrophic callus formation and 41 (62%) had normal union. One patient developed an ulcer under the hypertrophic callus. This necessitated callus resection. Asymptomatic non-union may happen in 15% of floating osteotomies, but the osteotomies appear to be relatively safe and effective for neuropathic plantar metatarsal head ulcers. Hypertropic callus causing local re-ulceration is rare and can be managed surgically.

Arthroscopic Treatment of Mild/Borderline Hip Dysplasia with Concomitant Femoroacetabular Impingement-Literature Review.

PURPOSE OF REVIEW: This literature review aims to survey the current knowledge about the management FAI in the setting of borderline hip dysplasia. RECENT FINDINGS: With better understanding, hip arthroscopy has recently been advocated for treating mild or borderline hip dysplasia (BDH) with concomitant femoroacetabular impingement (FAI) despite early studies that condemned its use. Recent outcome data have demonstrated that hip arthroscopy is a viable option in BDH, with and without FAI, and has been gaining wider acceptance. Hip arthroscopy can address the concomitant soft tissue and bony intra-articular pathologies and obviate the necessity for other surgeries. Moreover, hip arthroscopy may be used as an adjuvant treatment to other procedures such as a periacetabular osteotomy (PAO). Hip arthroscopy for BDH is an evolving procedure with promising short- and mid-term outcomes. The combination of BDH and FAI is becoming recognized as a problem in its own right, requiring dedicated treatment.

Bipolar hemiarthroplasty may reduce cerebrovascular accidents and improve early weight-bearing in the elderly after femoral neck fracture.

ABSTRACT: Cerebrovascular accidents (CVA) in the elderly population after femoral neck fracture remain great concern for physicians. Specifically, surgical fixation techniques, such as bipolar hemiarthroplasty (HA) and internal fixation play a significant role in influencing the occurrence of postoperative CVA in the elderly population.In order to identify 2 cohorts, we used a rigid selection process based on our institution's database. The cohorts were comprised of a HA cohort and a cannulated screw cohort, of which underwent femoral neck surgery, performed by 3 fellowship trained surgeons from 2003 to 2014. Risk factors were documented and measured, including Coumadin use and hypertension, and postoperative complications such as CVA and death rate were also recorded. A P-value of <.05 was determined to be statistically significant.A power analysis was performed and achieved a power of 0.95. We found a non-significant reduction in CVA for bipolar HA (3.6% CVA vs 0.0% in the non-CVA group, P = .48) and a non-significant increase in CVA for cannulated screw use (7.6% CVA vs 14.4% in the non-CVA group, P = .11). In addition, we found a significant difference in terms of weight-bearing status at 6-weeks postoperatively (0.95 vs 2.0, P < .0001), favoring the bipolar HA group.Among the advantages of bipolar HA surgery, surgeons should consider its value in reducing the occurrence of postoperative CVA. Furthermore, patients who underwent bipolar HA had improved weight-bearing status postoperatively compared with cannulated screw fixation.

[NOVEL CONCEPTS AND CHANGES IN TOTAL JOINT ARTHROPLASTY IN THE 21ST CENTURY].

INTRODUCTION: Total joint arthroplasty (TJA) is amongst the most common elective orthopedic surgeries. Since their introduction in 1951 there have been changes not only in prosthesis design and surgical approaches, but also in patient management, anesthesia, drug regimen and robotic arm assistance. These changes led to advancement in patient safety and shorter hospitalization. Today TJA is accessible for a wider age and function range of patients, which has led to an exponential growth in the number of procedures conducted.

The effect of postoperative weight-bearing status on mortality rate following proximal femoral fractures surgery.

INTRODUCTION: Proximal femur fractures are associated with an increased mortality rate in the elderly. Early weight-bearing presents as a modifiable factor that may reduce negative postoperative outcomes and complications. As such, we aimed to compare non-weight-bearing, partial-weight-bearing and full weight-bearing cohorts, in terms of risk factors and postoperative outcomes and complications. METHODS: We retrospectively reviewed our database to identify the three cohorts based on the postoperative weight-bearing status the day of surgery from 2003 to 20014. We collected data on numerous risk factors, including age, cerebrovascular accident (CVA), pulmonary embolism (PE), surgical fixation method and diagnosis type. We also collected data on postoperative outcomes, including the number of days of hospitalization, pain levels, and mortality rate. We performed a univariate and multivariate analysis; P < 0.05 was the significant threshold. RESULTS: There were 186 patients in the non-weight-bearing group, 127 patients in the partial-weight-bearing group and 1791 patients in the full weight-bearing group. We found a significant difference in the type of diagnosis between cohorts (P < 0.001 in univariate, P < 0.001 in multivariate), but not in fixation type (P < 0.001 in univariate, but P = 0.76 in multivariate). The full weight-bearing group was diagnosed most with pertrochanteric fracture, 48.0%, and used Richard's nailing predominantly. Finally, we found that age was not a significant determinant of mortality rate but only weight-bearing cohort (P = 0.13 vs. P < 0.001, respectively). CONCLUSION: We recommend early weight-bearing, which may act to decrease the mortality rate compared to non-weight-bearing and partial weight-bearing. In addition, appropriate expectations and standardizations should be set since age and type of diagnosis act as significant predictors of weight-bearing status.

Expandable Proximal Femoral Nail versus Gamma Proximal Femoral Nail for the treatment of hip reverse oblique fractures.

BACKGROUND: Reverse oblique intertrochanteric fractures are classified by the AO/OTA as 31A3 and account for 2-23% of all trochanteric fractures. The Gamma 3-Proximal Femoral Nail (GPFN) and the Expendable Proximal Femoral Nail (EPFN) are among the various devises used to treat this fracture. The aim of this study was to compare outcomes and complication rates in patients with AO/OTA 31A1-3 fractures, treated by either a GPFN or an EPFN. PATIENTS AND METHODS: A total of 67 patients (40 in the GPFN group and 27 in the EPFN group, average age 78.8 years) were treated in our institution between July 2008 and February 2016. Data on postoperative radiological variables, including peg location and tip-apex distance (TAD), as well as orthopedic complications, such as union rate, surgical wound infection and cut-outs rates were also recorded, along with the incidence of non-orthopedic complications and more surgical data. Functional results were evaluated and quantified using the Modified Harris Hip Score (MHHS) and by the Short Form 12 Mental Health Composite questionnaire (SF-12 MHC) in order to assess the quality of life. RESULTS: The total prevalence of postoperative orthopedic complications including postoperative infection showed a significant difference with a p-value of 0.016 in favor of the EPFN group. Nonetheless, the frequency of revision did not differ between the two groups, being 0.134. The main orthopedic complication in both groups was head cut-out of the GPFN lag screw and the EPFN expendable peg, which was 20% and 7.4%, respectively, and required a revision surgery using a long nail or total hip replacement (THR). However, the average TAD did not significantly differ between groups which might be due to a relatively low cohort to reach a significant difference. Nonunion rate of 5% occurred solely in the GPFN group, with similar results of intraoperative open reduction between both groups. The EPFN group achieved better scores in both questionnaires (p = 0.027 and p = 0.046, respectively). Both the MHHS and SF-12 MCS values significantly differed between groups, with the EPFN group achieving better scores than the GPFN group in both questionnaires (p = 0.027 and p < 0.05, respectively). CONCLUSIONS: According to this study, the EPFN yields better results in comparison with the GPFN, with relatively less complications rate, for the treatment of unstable reverse oblique pertrochanteric fracture. In light of this results, we conclude that the EPFN might be as good as GPFN for the treatment of reverse oblique intertrochanteric fractures. LEVEL OF EVIDENCE: Level III retrospective study. The local institutional review board of the Tel Aviv Medical Center approved this study and all the surgeries were done exclusively in this institution.

Amputation versus Primary Nonoperative Management of Chronic Osteomyelitis Involving a Pedal Digit in Diabetic Patients.

BACKGROUND: The preferred primary treatment of toe osteomyelitis in diabetic patients is controversial. We compared the outcome of primary nonoperative antibiotic treatment versus digital amputation in patients with diabetes-related chronic digital osteomyelitis. METHODS: We conducted a retrospective medical record review of patients treated for digital osteomyelitis at a single center. Patients were divided into two groups according to initial treatment: 1) nonoperative treatment with intravenous antibiotics and 2) amputation of the involved toe or ray. Duration of hospitalization, number of rehospitalizations, and rate of below- or above-the-knee major amputations were evaluated. RESULTS: The nonoperative group comprised 39 patients and the operative group included 21 patients. The mean ± SD total duration of hospitalization was 24.05 ± 15.43 and 20.67 ± 15.97 days, respectively (P = .43). The mean ± SD number of rehospitalizations after infection recurrence was 2.62 ± 1.63 and 1.67 ± 1.24, respectively (P = .02). During follow-up, the involved digit was eventually amputated in 13 of the 39 nonoperatively treated patients (33.3%). The rate of major amputation (above- or below-knee amputation was four of 39 (10.3%) and three of 21 (14.3%), respectively (P = .69). CONCLUSIONS: Despite a higher rate of rehospitalizations and a high failure rate, in patients with mild and limited digital foot osteomyelitis in the absence of sepsis it may be reasonable to offer a primary nonoperative treatment for digital osteomyelitis of the foot.

Proximal Derotation Phalangeal Osteotomy for Medial First Toe Diabetic Ulcer.

BACKGROUND: Foot ulcers are a common complication in diabetic patients. Mild callus formation due to a plantar pressure can lead to an ulcer formation with potentially hazardous sequelae. Eliminating the pressure from the ulcer is essential for a proper healing process. Proximal derotation phalangeal osteotomy is a relatively simple procedure that can redistribute the planter pressure points over the hallux. METHODS: Thirteen patients underwent proximal derotation phalangeal osteotomy to relieve the bony pressure causing an ulcer in the first toe, which was refractory to non-operative treatment. Twelve patients had diabetes type 2 and one had Charcot-Marie-Tooth disease. RESULTS: Ulcers were completely resolved in all 13 patients in an average time of 4.3 (range 2-8) weeks. Four patients (31%) had mild complications that resolved well. No further surgery was required at 1-year follow-up. CONCLUSION: Proximal derotation phalangeal osteotomy enabled ulcer healing in refractory cases. LEVEL OF EVIDENCE: Level III retrospective study.

The Efficacy of Labral Reconstruction: A Systematic Review.

BACKGROUND: With a greater understanding of the importance of the acetabular labrum in the function of the hip, labral repair is preferred over debridement. However, in some scenarios, preservation or repair of the labrum is not possible, and labral reconstruction procedures have been growing in popularity as an alternative to labral resection. PURPOSE: To provide an up-to-date analysis of the literature to determine the overall efficacy of labral reconstruction when compared with labral repair or resection. STUDY DESIGN: Systematic review; Level of evidence, 3. METHODS: PubMed, Embase, and MEDLINE databases were searched for literature regarding labral reconstruction in the hip before July 21, 2020. The results were screened and evaluated by 2 reviewers, and a third reviewer resolved any discrepancies. The final studies were evaluated using the MINORS (Methodological Index for Non-randomized Studies) score. RESULTS: There were 7 comparative studies that fit the inclusion criteria, with 228 hips from 197 patients. The mean follow-up was 34.6 months, and the mean age of all patients was 38.34 years. There were slightly more female patients than male patients (105 vs 92). Arthroscopic reconstruction was performed in 86% of studies (6/7); open surgical techniques, in 14% (1/7). A variety of grafts was used in the reconstructions. The indications for labral reconstruction and outcome measures varied in these publications. Nine patients were lost follow-up, and 6 patients converted to total hip replacement postlabral reconstruction. The assessment of these comparative studies illustrated statistically equivalent results between labral reconstruction and labral repair. Comparisons of labral reconstruction with labral resection also showed statistically equivalent postoperative patient-reported outcome scores; however, the rates of conversion to total hip arthroplasty were significantly higher in the population undergoing resection. CONCLUSION: The review of current available comparative literature, which consists entirely of level 3 studies, suggests that labral reconstruction does improve postoperative outcomes but does not demonstrate superiority over repair. There may, however, be benefit to performing labral reconstruction over resection owing to the higher rate of conversion to total hip arthroplasty in the labral resection group.

Midterm Outcomes and Satisfaction After Hip Arthroscopy Are Associated With Postoperative Rehabilitation Factors.

BACKGROUND: Arthroscopic hip-preservation surgery is commonly performed to address nonarthritic sources of hip pain in young, active individuals. However, there is little evidence to support postoperative rehabilitation protocols, including the most appropriate frequency and length of individual formal physical therapy sessions. There is also a lack of information to look at patients' perceived value of their home program/self-practice in relation to outcomes. PURPOSE: To investigate postoperative rehabilitation factors after hip arthroscopy related to formal physical therapy and home program/self-practice and their correlation with patient outcomes and satisfaction. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 125 patients who underwent hip arthroscopy for femoroacetabular impingement syndrome and a labral tear (75 men) were included. The mean age was 34.6 ± 14.4 years, and the mean follow-up time was 4.9 ± 1.6 years. Hip Outcome Score-Activities of Daily Living subscale (HOS-ADL) scores, overall satisfaction scores, and factors related to supervised physical therapy and home program/self-practice were collected. Correlations between continuous variables and differences in the length of individual formal physical therapy and patients' rating of the importance of their home program/self-practice between those who would and those who would not undergo surgery again were assessed. RESULTS: The frequency and length of individual formal physical therapy sessions were significantly correlated with postoperative HOS-ADL scores (r = 0.22, P = .014; and r = 0.24, P = .007, respectively) and level of satisfaction (r = 0.24, P = .007; and r = 0.21, P = .02, respectively). The length of individual formal physical therapy sessions was significantly greater in those who noted they would undergo surgery again (35.3 vs 26.3; P = .033). A significant correlation was identified between the rating of the importance of their home program/self-practice and postoperative HOS-ADL scores (r = 0.29; P = .001) and their level of satisfaction (r = 0.23; P = .009). There was a significant difference in the rating of the importance of their home program/self-practice between those who would undergo surgery again and those who would not (8.9 vs 7.8; P = .007). CONCLUSION: Surgeons and physical therapists should emphasize the value of home program/self-practice when it comes to outcomes and may want to encourage their patients to participate in more frequent, longer, formal physical therapy sessions.