Editorial Commentary: Successful Hip Arthroscopy for Patients With Hypermobility Requires a Patient-centric Approach, Meticulous Capsular Management, and Preservation of the Fibrous Capsular Ligaments.

Successful arthroscopic hip surgery for patients with generalized ligamentous laxity requires dedicated attention to preoperative patient counseling, including consideration of each patient's functional status and goals, careful evaluation of patient symptomatology, and meticulous capsular management. Maximal preservation of the fibrous capsular ligaments that stabilize the hip is of particular importance. It is incorrect to assume all hip patients with an elevated Beighton score should be categorically treated a certain way. There is a complex interplay of morphologic features, such as acetabular version, femoral orientation, capsular volume, and subspine morphology, that play a role in the symptomatology for every hip patient, hypermobility notwithstanding. Moreover, consideration must be given to the variable degree of phenotypic expression of the hypermobility syndromes.

Editorial Commentary: Prolonged Delays in Staging Bilateral Hip Arthroscopic Surgery for Femoroacetabular Impingement May Result in Inferior Patient Outcomes: Two Halves of One Problem.

Patients with symptomatic femoroacetabular impingement frequently have contralateral symptoms and, thus, alterations to the biomechanics of both hips. It has become increasingly clear that prolonged delays in staging bilateral hip arthroscopic surgery may result in inferior patient outcomes. There is an interchange between primary surgical recovery and altered biomechanics stemming from the untreated hip. At a certain point, the persistence of microinstability and/or femoroacetabular impingement in one hip becomes a limitation to the recovery of the other. Still, individual patient variability remains a critical factor when considering bilateral surgeries. Some patients cannot tolerate 2 surgeries in proximity. The time frame for bilateral surgery should be based on individual patient factors and functional goals.

Editorial Commentary: Successful Revision Hip Arthroscopy Requires Accurate Diagnosis of the Cause of Failure: "One-Size-Fits-All Surgery Is Not Appropriate".

As hip arthroscopy increases in scope and quantity, treatment options for patients who did not respond to primary surgery expand as well. As our techniques improve and become more nuanced, it is crucial that our understanding of individual patients' root cause pathology keeps pace to ensure that the right patients get the right surgery.

Editorial Commentary: Arthroscopic Surgery Is Not Minor Surgery: Shared Decision Requires Comprehensive Informed Consent.

Arthroscopic surgery of the shoulder has revolutionized the way we address intra-articular and tendinous injuries about the joint. Nevertheless, despite the apparent minimally invasive nature of our trade, there remain potential long-term consequences to every operation. This is especially true if future arthroplasty is indicated, as the risk of prosthetic joint infection is increased in patients having a previous procedure. True partnership with our patients necessitates that they have a clear understanding of the full implications of any surgery, no matter how small it may seem. True informed consent necessitates that our patients understand not only the immediate implications of the current operation but the potential effects on a future operation. This can only be accomplished by effective and honest communication about the full scope of the risk undertaken when an arthroscopic surgery is performed.

Editorial Commentary: Hip Borderline Dysplasia Patients May Have Acetabular Undercoverage and Larger Labra.

The compensatory labrum needs to considered in patients with mechanical hip pain. It is no longer adequate to broadly characterize patients with femoracetabular impingement as either cam or pincher patients. Effective treatment of the syndrome requires in-depth assessment version, head-neck offset, subspine, and capsule-labral morphology, especially in patients with borderline dysplasia. A larger acetabular labrum is associated with hip dysplasia, and labral length correlates with lateral center-edge angle and acetabular roof obliquity. Symptomatic hips show larger labra. Labral size and acetabular undercoverage are part of the spectrum in patients with borderline dysplasia and evidence of impingement. Quantitative and advanced 3-dimensional imaging is a critical evaluation tool.

Concurrent validity of a patient self-administered examination and a clinical examination for femoroacetabular impingement syndrome.

OBJECTIVE: Telehealth has been established as a viable option for improved access and timeliness of care. Physician-guided patient self-evaluation may improve the viability of telehealth evaluation; however, there are little data evaluating the efficacy of self-administered examination (SAE). This study aims to compare the diagnostic accuracy of a patient SAE to a traditional standardised clinical examination (SCE) for evaluation of femoroacetabular impingement syndrome (FAIS). METHODS: 75 patients seeking care for hip-related pain were included for participation. All patients underwent both SAE and SCE and were randomised to the order of the examinations. Diagnostic accuracy statistics were calculated for both examination group for a final diagnosis of FAIS. Mean diagnostic accuracy results for each group were then compared using Mann-Whitney U non-parametric tests. RESULTS: The diagnostic accuracy of individual SAE and SCE manoeuvres varied widely. Both SAE and SCE demonstrated no to moderate change in post-test probability for the diagnosis of FAIS. Although low, SAE demonstrated a statistically greater mean diagnostic accuracy compared with the SCE (53.6% vs 45.5%, p=0.02). CONCLUSION: Diagnostic accuracy was statistically significantly higher for the self-exam than for the traditional clinical exam although the difference may not be clinically relevant. Although the mean accuracy remains relatively low for both exams, these values are consistent with hip exam for FAIS reported in the literature. Having established the validity of an SAE, future investigations will need to evaluate implementation in a telehealth setting.

Editorial Commentary: Advances in 3-Dimensional Imaging are the Key to Improving our Surgical Precision in Hip Arthroscopy and Beyond.

Advances in high-resolution magnetic resonance imaging have driven a wealth of knowledge in orthopaedic basic science. The application of these novel techniques to clinical practice is the next logical step for enhancing our understanding of intra-articular pathology and morphology. The specific diagnostic challenge presented by hip labral and chondral pathology is a particular point of interest, given the increasing popularity of hip arthroscopy. As our field continues to progress in complexity, the integration of new, higher-resolution imaging sequences such as multiple-echo recombined gradient echo and double-echo steady state provide the potential to enhance preoperative planning and ultimately the effectiveness of our arthroscopic techniques.