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ObjectiveHip arthroscopy in the setting of hip dysplasia is controversial in the orthopaedic community, as the outcome literature has been variable and inconclusive. We hypothesise that outcomes of hip arthroscopy may be diminished in the setting of hip dysplasia, but outcomes may be acceptable in milder or borderline cases of hip dysplasia.MethodsA systematic search was performed in duplicate for studies investigating the outcome of hip arthroscopy in the setting of hip dysplasia up to July 2015. Study parameters including sample size, definition of dysplasia, outcomes measures, and re-operation rates were obtained. Furthermore, the levels of evidence of studies were collected and quality assessment was performed.ResultsThe systematic review identified 18 studies investigating hip arthroscopy in the setting of hip dysplasia, with 889 included patients. Criteria used by the studies to diagnose hip dysplasia and borderline hip dysplasia included centre edge angle in 72% of studies but the range of angles were quite variable. Although 89% of studies reported improved post-operative outcome scores in the setting of hip dysplasia, revision rates were considerable (14.1%), with 9.6% requiring conversion to total hip arthroplasty.ConclusionThe available orthopaedic literature suggests that although improved outcomes are seen in hip arthroscopy in the setting of hip dysplasia, there is a high rate of re-operation and conversion to total hip arthroplasty. Furthermore, the criteria used to define hip dysplasia vary considerably among published studies.Cite this article: M. Yeung, M. Kowalczuk, N. Simunovic, O. R. Ayeni. Hip arthroscopy in the setting of hip dysplasia: A systematic review. Bone Joint Res 2016;5:225–231. DOI: 10.1302/2046-3758.56.2000533.

Femoroacetabular impingement (FAI) has been linked to specific patterns of cartilage damage. The goal of this systematic review is to answer the following questions: (1) Does FAI contribute to the development and progression of hip osteoarthritis (OA)? (2) If FAI does contribute to the development and progression of hip OA, does CAM-type or pincer-type impingement play a greater role? A search of the electronic databases, MEDLINE and EMBASE, was performed to identify relevant studies performed between January 1, 2000 and January 1, 2015 that link the pathophysiology of OA to FAI. Methodological quality of included studies was assessed by 2 reviewers using the Methodological Index for Non-Randomized Studies criteria. An intraclass correlation coefficient with 95% confidence intervals was used to determine agreement between reviewers on quality scores. Overall 35 studies were identified that met inclusion criteria. Certain morphologic features of CAM-type FAI, particularly elevated alpha angle, do seem to predispose select patients to radiographic progression of hip OA. In comparison with pincer-type impingement, the association between CAM-type impingement and hip OA is better understood. Long-term surgical outcome studies will further delineate the role of FAI in the development and progression of hip OA.

Systematic review, Level IV.

The medial patellofemoral ligament (MPFL) plays a key role in lateral patellofemoral stability, and there has been significant clinical and research interest in MPFL reconstruction (MPFLR) in recent years. The primary objective of this systematic review of clinical studies is to investigate the reported indications for an isolated MPFLR and secondarily to examine some of the reasons reported for not performing an isolated MPFLR. A comprehensive search of the MEDLINE, EMBASE, PUBMED, and Cochrane databases was conducted to identify surgical studies investigating MPFLR. Study information including author, publication date, sample size, patient age, follow-up period, procedure performed, surgical indications and contraindications, and study design were extracted. The most common indication for isolated MPFLR was recurrent patellofemoral instability (82.1%). Common reasons given for not performing an isolated MPFLR included bony malalignment (51.8%), trochlear dysplasia (30.4%), and patella alta (23.2%). This systematic review identified recurrent patellofemoral instability as the primary indication for an isolated MPFLR; however, a large number of the studies did not provide clear criteria for when an isolated MPFLR should be performed. Similarly, there was significant variability in the reasons given for not performing an isolated MPFLR.