va rating for hip impingement

Outcomes after the arthroscopic treatment of femoroacetabular impingement in a mixed group of high-level athletes. 2012;28(9):1255-1261. The committee stated that it considered all the evidence, including the comprehensive report,public comments, and utilization data,and gave greatest weight to the evidence it determined, based on objective factors, to be the most valid and reliable. Owing to the marked increase in the number of hip arthroscopies, there is a need to summarize evidence from RCTs on the effectiveness of hip arthroscopic surgery for patients with FAI. All authors read and approved the final manuscript. Of the hips, 13 underwent primary arthroscopy and 3 underwent revision. Trends in femoroacetabular impingement research over 11 years. 2020;7:61. In cam- and mixed-type FAI hips, the mean angle significantly decreased from 66.7 8.28 pre-operatively to 44.9 3.78 post-operatively (95 % CI: 19.6 to 22.8; p < 0.001). Am J Sports Med. Arthroscopy. Draft Policy Document. Femoro-acetabular impingement syndrome has been reported to be associated with progressive osteoarthritis of the hip. Levy et al (2015) stated that the most commonly reported reasons for persistent hip pain after hip arthroscopy are residual FAI, dysplasia and dysplasia variants, or extra-articular impingement. Clohisy JC, Kim YJ, Lurie J, et al. The LCEAs were significantly greater in veterans than in civilians (P=0.04), and veterans also demonstrated a significantly greater prevalence of pincer and mixed-type deformities than civilians (P=0.025 and P=0.004, respectively). Byrd JW, Jones KS. First, the small sample size might have affected the significant difference between the 2 surgical procedures. The purpose of this study was to compare the frequency of femoroacetabular impingement (FAI) between matched groups of military veterans and civilian patients with end-stage hip osteoarthritis (OA). In a cohort study, Domb et al (2014) compared the clinical outcomes of arthroscopic labral reconstruction (RECON) with those of arthroscopic segmental labral resection (RESEC) in patients with FAI of the hip. In summary, there is currently sufficient evidence to support the short- and mid-termeffectiveness of surgery (open or arthroscopic) for the treatment of individuals withFAI syndrome. An editorial (Lubowitz, et al, 2016)commenting on a systematic review of microfracture with FAI surgery noted that we are unable to determine from these studies whether improvements in pain are due to the microfracture or the FAI surgery. } Mei-Dan O, Garabekyan T, McConkey M, Pascual-Garrido C. Arthroscopic anterior capsular reconstruction of the hip for recurrent instability. text-decoration: line-through; This author (KNJ) received training in radiographic measurements from a board-certified orthopedic surgeon with fellowship training in hip preservation and reconstruction (STD). White and Herzog (2015) stated that in the last 10 years, the understanding of the anatomy and function of the hip joint has continuously evolved, and surgical options for the hip have significantly progressed. There were 5 eligible studies (3 case series, 1 prospective cohort, and 1 retrospective chart review) with a total of 128 patients, and an average 11/16 quality on the MINORS score included in this review. Endoscopic surgery has gained popularity as an option for non-responsive patients because of its non-invasive characteristics, faster recovery and encouraging results. Ruder JA, Magennis E, Ranawat AS, Kelly BT. The treatment should be for at least 12 weeks in the past year with at least 6 weeks being formal physiotherapy (in-person not virtual); Member is 15 years of age or older or skeletally mature (as indicated byepiphyseal closure); Absence of advanced osteoarthritis change on pre-operative Xray (Tonnis grade 2 or more) or severe cartilage injury (Outerbridge grade III or IV); Absence of joint space narrowing on plain radiograph of the pelvis. 2011;31:528. Tannast M, Siebenrock KA, Anderson SE. Orthopedics. The authors concluded that central compartment releases resulted in the highest rate of recurrence due to incomplete release. Furthermore, they stated that long-term follow-up will beneeded to evaluate if use of this technique results in improved functional outcomes and a reduction in the prevalence of symptomatic osteoarthritis in affected patients. Arthroscopic hip surgery may be medically necessary for the following additionalindications: Note: Aetna considers psoas tendon release an integral part of femoroacetabular impingement syndrome surgery. Subspinal impingement: Clinical outcomes of arthroscopic decompression with one year minimum follow up. This condition can be treated with corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, rest and surgery. } Save the torn labrum in hips with borderline acetabular coverage. High-level athletes who underwent arthroscopic treatment of femoroacetabular impingement (rim trimming, labral refixation or debridement, femoral osteochondroplasty) with a minimum of 1-year follow-up were retrospectively identified. Nawabi DH, Degen RM, Fields KG, et al. Copyright Aetna Inc. All rights reserved. Forty-seven patients with an average age of 22.8 6.2 years met the study criteria with a mean follow-up of 27.0 5.5 months. Bardakos NV, Villar RN. Google Scholar. In a systematic review, Coulomb et al (2022) examined the technique, results and complications of arthroscopic iliopsoas tenotomies either on native hips or THA. The systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using a PRISMA check-list. VA rates hip replacements under 38 CFR 4.71a, Schedule of Ratings - Musculoskeletal System, Diagnostic Code 5054 as follows: 100% - for four months following implantation of prosthesis or resurfacing 90% - following implantation of prosthesis with painful motion or weakness such as to require the use of crutches Domb and co-workers (2019) stated that labral reconstruction has demonstrated short-term benefit for the treatment of irreparable labral tears. Civilian and military veteran patients were matched 1:2, based on sex, age (5 y), and body mass index (BMI) (5kg/m2). Another aspect was that the radiological analysis was performed by only 1 surgeon without any inter- or intra-observer agreement analysis of the radiological findings, potentially limiting the accuracy of the radiological values registered. I quit running entirely (except for PT tests) & went to a civilian chiropractor many times for the hip (& low back pain) after basic training, but never reported it via VA or LOD, etc. Assessment of Disability Related to Femoroacetabular Impingement 2013;41(11):2591-2598. Clinical outcomes of hip arthroscopic surgery in patients with femoral retroversion: A matched study to patients with normal femoral anteversion. Imaging findings of femoroacetabular impingement syndrome. Twenty-one military veterans were successfully matched 1:2 with civilian patients, resulting in a final sample of 63 patients (21 military veterans and 42 matched civilian patients). Am J Sports Med. Also purchased orthotics from a chiro for foot aches/pain. A total of 7 cases showed mechanical impingement (6 involving the anterior edge of the cup, and 1 a cement fragment); the other 3 involved large femoral components (2 large head diameter models, 1 resurfacing). HIP Int. Femoroacetabular impingement (FAI) is a hip condition characterized by abnormal bone growth on the articulating surfaces of the femoral neck and acetabulum. These investigators retrospectively reviewed the clinical and radiographical results of 52 patients (60 hips) withFAI who underwent arthrotomy and surgical dislocation of the hip to allow trimming of the acetabular rim and femoral osteochondroplasty. Observational studies have demonstrated substantial improvements in symptoms with femoroacetabular surgery; however, observational studies may overestimate the actual degree of improvement from surgery. Ganz R, Gill TJ, Gautier E, et al. Level of Evidence = IV. The mean pre-operative alpha angle was 66.3 9.9 in the BD group and 61.7 13.0 in the control group (p = 0.151). border-radius: 4px; Cochrane Collaboration's Risk of Bias Tool and Newcastle-Ottawa Scale were used to assess risk of bias. The minimum follow-up was 1 year (average of1.5 years; range of1 to 2.5 years). Hip Impingement: Causes, Symptoms, Treatment, and More - Healthline 2006;22(1):95-106. A total of 7 studies were identified for inclusion with a total of 402 patients (173 females, age range of 16 to 72; follow-up range of 12 to 120 months). .arrowPurpleSmall, a:hover.arrowPurpleSmall { Mei-Dan et al (2015) noted that symptomatic anterior instability of the hip is typically iatrogenic in nature and poses a challenging problem for the orthopedist. White et al (2016) presented minimum 2-year outcomes in patients who underwent a modified technique for arthroscopic labral reconstruction using ilio-tibial band allograft tissue and a front-to-back fixation. Four patients underwent repeat arthroscopy. Subsequent total hip arthroplasty was performed in 4 patients (9 %). A total of 40 patients were identified. Cross MB, Shindle MK, Kelly BT. Peterlein CD, Schiel M, Timmesfeld N, et al. This file drawer effect may be responsible for a publication bias. Osteoarthritis. The authors found that, although patients with less than 50 % joint space narrowing or greater than 2 mm joint space remaining on pre-operative radiographs had improved scores throughout the study,they observed no score improvements at any time with advanced pre-operative joint space narrowing. Pre-operatively, every patient underwent a diagnostic ultrasonography (US)-guided peritendinous injection and a CT scan. Chandrasekaran et al (2015) stated that atraumatic instability or micro-instability of the hip is a recognized cause of groin pain and hip instability. Femoroacetabular impingement (FAI) occurs as a result of friction in the hip joint caused by abnormal contact between the femoral head and the rim of the acetabulum (hip socket). 2011;21(1):51-56. One patient presented as having habitual dislocation of the hip 4.4 years after surgery. Alpha angles were measured from preoperative frog-leg lateral radiographs, The figure below describes the lateral center-edge angle (LCEA) of Wiberg distributions for civilian and military veteran groups. Five patients had isolated pincer impingement, 2 had isolated cam impingement, and 9 had mixed pathology. An increasing number of studies relating to FAI have been produced in the 10 years since its recognition. Cam and pincer femoroacetabular impingement: Characteristic MR arthrographic findings in 50 patients. In a systematic review and meta-analysis, these investigators provided a comprehensive review of current literature for arthroscopic hip labral reconstruction, with a focus on determining if outcomes differ between autograft or allograft tissue. KNJ collected and analyzed the data and was a major contributor to the writing of the manuscript. The main symptoms are "pain" in the groin, especially when walking or flexing the hip, and decreased range . 2008;24(10):113545. The mean age at the time of arthroscopy was 15 years old (range of 11 to 16 years). The low complications rate made this the treatment of choice in case of failure of non-operative management. Bull Hosp Jt Dis (2013). Clin Rehabil. Lim et al (2020) stated that recently, a hyper-trophic labrum has been reported in the absence of hip dysplasia, which could possibly contribute to an acetabular labral tear. A controlled study of FAI surgerycompared FAI surgery withresection of the torn labrumto FAI surgery with reattachment of the labrum to the acetabular rim (Espinosa et al, 2006). Functional outcomes and 8-year survival after hip arthroscopy in patients with degenerative hip disease. Open surgery is performed when large defects are present. However, the risk was deemed to be small. z-index: 99; There were 54 male and 42 female patients with up to 3 years' follow-up (mean of 9.9 months). Part of First, the number of patients per cluster was small; thus, the results must be confirmed with larger group sizes. Follow-up ranged from24 months to 49 months (average of 30 months). Tateishi and co-workers (2020) evaluated the additional effect of AIIS decompression on knee extensor and hip flexor strength and compared functional outcomes after arthroscopic FAI correction with and without AIIS decompression. The authors declare that they have no competing interests. Arthritis Care Res. White BJ, Patterson J, Scoles AM, et al. Ferreira GE, O'Keeffe M, Maher CG, et al. Wiberg G. The anatomy and roentgenographic appearance of a normal hip joint. Pooled weighted mean MHHS values after arthroscopic surgery for FAI showed improvements at the mid-term from 60.5 points (range of 56.6 to 83.6) to 80.5 points (range of 72.1 to 98.0) out of a possible 100 points. Diemen, The Netherlands: CVZ; February 25, 2010. Another limitation of this study was the small sample size. All improvements in both groups were statistically significant at the last post-operative follow-up (p < 0.001). Isolated cam impingement was identified in 17 hips, pincer impingement was found in 28, and both types were noted in 55. A total of 18peer-reviewed treatment outcome studies met the inclusion criteria with minimum 1-year follow-up of the surgical treatment of skeletal pathoanatomy and associated chondrolabral pathology in skeletally mature patients with FAI. 12009101120. Hip and Thigh Condition Ratings Military Disability Made Easy As a result, labral injury, chondral delamination, and more diffuse, non-focal . Open hip surgery with surgical dislocation is the gold standard for treating femoral deformities and the damaged acetabular labral complex; however, less invasive techniques such as hip arthroscopy and arthroscopy combined with limited anterior hip arthrotomy may provide comparable outcomes with less surgical morbidity. The authors reporteda modest improvementin Western Ontario and McMaster Universities Arthritis Index (WOMAC) score from preoperatively to 2 years post-operatively (mean of 82 points pre-operatively to mean of 89 points post-operatively). In this Technical Note, these researchers presented computer-assisted hip arthroscopic surgery for FAI, including pre-operative planning by virtual osteochondroplasty and intra-operative computer navigation assistance. Standaert CJ, Manner PA, Herring SA. Hip arthroscopy for femoroacetabular impingement in patients aged 50 years or older. 2014;42(8):1785-1790. The patient-reported satisfaction scores at the last post-operative follow-up were 8.4 and 7.9 in the study and control groups, respectively (p = 0.351). In addition, the sample size was relatively small (n = 29 for patients who underwent arthroscopic FAI surgery with AIIS decompression) and the follow-up was short term (6 months). The authors stated that the drawbacks of this systematic review included the level of evidence of the retrospective level III and IV studies included, which were also limited to short and mid-term outcomes of relatively small patient sample sizes. https://doi.org/10.1186/s40779-019-0218-5, DOI: https://doi.org/10.1186/s40779-019-0218-5. 2006;55:337-346. Outcomes were evaluated pre-operatively and post-operatively with the mHHS, the 12-Item Short Form Health Survey (SF-12), and a VAS for pain. Espinosa and co-workers (2006) examined if labral re-fixation after treatment of FAI affects the clinical and radiographical results. Two labrums were stable and required no treatment. They stated that AIIS decompression for FAI correction improved post-operative PRO scores without altering the muscle strength of hip flexor and knee extensor. The combination of increased physical demands and a protracted time to diagnosis and treatment highlights the need for better education and recognition of FAI in military members. Rego PA, Mascarenhas V, Oliveira FS, et al. It has been suggested that thesurgical trauma sustained during the open procedure for the treatment of FAI syndrome may make it difficult for high-level/professional athletes to return to professional sports. Wettstein and Dienst (2006)stated that the early results after hip arthroscopy for the treatment of FAI syndrome are very promising. Arthroscopic treatment of femoroacetabular impingement of the hip:A new technique to access the joint. Seven patients were treated with suture anchor repair of the labrum and 9 with partial labral debridement. Orthop J Sports Med. Military personnel over the age of 40 have been reported to be twice as likely to develop OA than the general population [10]. Arthroscopy. Diagnostic Code 5000: Osteomyelitis, acute, subacute, or chronic: In a case series study, Philippon et al (2010) examined the indications for and outcomes of arthroscopic labral reconstruction in the hip by use of ilio-tibial band (ITB) autograft. Huang R, Diaz C, Parvizi J. Acetabular labral tears: Focused review of anatomy, diagnosis, and current management. Furthermore, in this study population, no capsular repair was performed because little evidence was available for capsular closure during the investigated period of time. 2020;28(9):2756-2762. Findings and Coverage Decision. Patients with bilateral hip arthroscopy, avascular necrosis and previous hip surgery were excluded; 10 patients refused to participate, leaving 112 in the study (62 women and 50 men). Clohisy JC, St John LC, Schutz AL. The mean ( standard deviation) length of follow-up for this cohort was 27.5 5.5 months (range of 17 to 39) and the average age was 20 years (range of 14 to 39). Twenty-one veterans were matched 1:2 with civilian patients. The cam-type deformity of the proximal femur arises in childhood in response to vigorous sporting activity. Indications and outcomes of arthroscopic labral reconstruction of the hip: A systematic review. While you can't receive a VA rating specifically for abnormal or antalgic gait, you may still be owed additional compensation if your limp is due to activities you engaged in during service and has caused other issues in your legs, feet, or back. Meftah M, Rodriguez JA, Panagopoulos G, Alexiades MM. Eur J Radiol. The mean time from the onset of symptoms to labral reconstruction was 36 months (range of 1 month to 12 years). The authors concluded that outside-in arthroscopic iliopsoas release provided a high rate of success with no complications in this study, even in patients with moderate acetabular component prominence. These investigators detailed the step-by-step surgical technique of arthroscopic capsular plication, in addition to the indications, pearls, and pitfalls of the technique. In a case-series study of 213 treated hips including 19 patients who underwent simultaneous inter-trochanteric osteotomy with a minimum follow-up of 2 years, Ganzand colleagues(2001) reported that most patients had an improved range ofmotion as well asa reduction in pain following surgical dislocation of the hip. VA Disability Hip Pain Secondary to Knee Pain - VA Claims Insider Historically, arthroscopic treatment of severe dysplasia (lateral center-edge angle [LCEA] less than 18) resulted in poor outcomes and iatrogenic instability. Surgeons may have been alerted by prior clinical findings, and radiologists may have lacked information as to what anatomic abnormality to look for. Ayeni et al (2012) systematically reviewed the clinical literatureto determine the consistently reported indications for arthroscopic management of femoroacetabular impingement (FAI). Philippon MJ, Briggs KK, Hay CJ, et al. Non-surgical treatment may be effective in approximately 50 % of cases. This study also had several strengths, including the use of age- and sex-matched study groups, the use of multiple validated hip-specific outcome scores, and the use of both 6-month and 1-year data for all patients, allowing for comparisons and trending of outcomes over time. This procedure can be performed in a natural hip or after total hip arthroplasty. Posttraumatic osteoarthritis: a first estimate of incidence, prevalence, and burden of disease. MR imaging of femoroacetabular impingement. This work was not supported by any grants. Clusters 2 and 3 differed significantly from clusters 1 and 4 (p = 0.02). Orthopedics. There were statistically significant improvements in the mean MHHS score (pre-operative, 68.6 12.8; post-operative, 88.5 17.7;p = 0.002) as well as the HOS score (pre-operative, 78.8 11.3; post-operative, 91.4 14.0;p = 0.03). The VA will also consider your ability to work and whether or not you are able to perform the tasks of daily living. Kutty S, Schneider P, Faris P, et al. There were no complications. Inclusion criteria were arthroscopic ilio-tibial band allograft labral reconstruction performed by a single surgeon, age greaterthan or equal to 16 years at the time of arthroscopy, and a minimum of 2 years of follow-up. However, degenerative tears are usually a sign of earlyosteoarthritis and there is a lack of adequate evidence that arthroscopic repair of degenerative tears improves clinical outcomes. Standaert et al (2008) stated that although a connection between anatomical abnormalities of the hip and the development of osteoarthritis has been recognized for some time, there are limited data on the natural history of FAI and no long-term studies on the effect of surgical treatment. A post hoc power analysis for the primary hypothesis that FAI would be significantly more common in military veterans than in civilians was conducted. All patients underwent clinical (Postel-Merle d'Aubigne (PMA), WOMAC), imaging (X-ray, CT, scintigraphy) and biological assessment. Patients with borderline dysplasia are generally not candidates for peri-acetabular osteotomy because of the invasive nature of the procedure. 2013;41(10):230813. Survivorship after autograft reconstruction ranged from 75.7 % to 100 %, as compared with 86.3 % to 90.0 % in the allograft cohort. The failure rate or conversion to THA decreased compared with the previous review (20 % versus 9.5 % [conversion to THA was 5.7 % and revision surgery rate was 3. Bessa et al (2020) noted that the acetabular labrum plays a major role in hip function and stability. The authors concluded that favorable outcomes could be expected after the treatment of impingement in patients with BD when labral refixation and capsular closure were performed, with comparable outcomes to non-dysplastic patients. Within this selection group, there were multiple publications that specifically addressed more than 1 of the inclusion criteria. There were a 1.5 % complication rate. They stated that the current study demonstrated favorable results at 2-year follow-up for an arthroscopic approach that includes labral repair augmented by capsular plication with inferior shift. The authors found that the arthroscopic method had surgical outcomes equal to or better than the other methods with a lower rate of major complications when performed by experienced surgeons. The most commonly used outcome score was the MHHS for objective assessment of surgical success. Unsurprisingly, only repairing the acetabular labrum remains controversial, and the outcome is unpredictable. color: blue After exposing the femoral head and acetabulum, the surgeon can debride extra bone that contributes to the impingement. Return to sport and athletic function in an active population after primary arthroscopic labral reconstruction of the hip. All patients were diagnosed with FAI and underwent labral reconstruction; 94 patients were assessed at follow-up (73.4 % survivorship) between a reported mean range of 10 and 49 months. In the autograft cohort, failures included 0 % to 13.2 % conversion to THA and 0 % to 11.0 % revision hip arthroscopy. Cam impingement is the result an abnormal morphology of the proximal femur,usually at the femoral head-neck junction; while pincer impingement is the result of an abnormal morphology or orientation of the acetabulum (Kassajian et al, 2007). In the nested matched-pair analysis, 17 patients who underwent PLRECON were matched to a control group of 51 patients who underwent PLREPAIR. At the final follow-up, all patients reported no click and no pain, and showed well-contained hips by radiographs. Cite this article. Clohisy et al (2013) stated that FAI surgery is at the development level, with only case series supporting the intervention. The three types of FAI include excessive acetabular covering (pincer type), nonspherical femoral head (cam type) or a combination of the two. Rehabilitation significantly improved muscle strength. With current literature suggesting that disability is the end result for approximately 40% of military personnel with FAI undergoing hip arthroscopy, further research is needed to determine what factors are influencing this outcome [13]. In patients with 10 mm or larger of prominence, symptoms resolved in 3 out of 4 cases. Outcome measures were completed by patients within 1 week prior to surgery and between 22 and 26 months post-operatively. Radiographical signs of osteoarthritis were significantly more prevalent in group 1 than in group 2 at1-year (p = 0.02) and at2-year (p = 0.009) follow-up. 2011;39 Suppl:14S-19S. Filed an NOD for that award and have had C&P and civilian ortho exams putting my ROM at "anything over midway between hip and shoulder" results in severe pain. The CRD (2011) concluded that given the potential biases in the review by Matsuda et al(searching, data extraction and quality assessment), inclusion of weak study designs, limited statistical data and wide variation in the included studies,Matsuda et al'sconclusions should be treated with caution. Demographic data, pre-operative as well as post-operative pain, mHHS and NAHS scores, strength and patient satisfaction data were collected and analyzed. At arthroscopy, 23 patients underwent osteoplasty only for cam impingement,3 underwent rim trimming only for pincer impingement, and 86 underwent both procedures for mixed-type impingement. Domb BG, Battaglia MR, Perets I, et al. Future studies are necessary to determine whether earlier intervention may prevent or delay the progression to end-stage OA and the need for total hip arthroplasty. They identified 3 RCTs (n = 650 participants). The use of arthroscopic capsular plication in this cohort of patients has shown good to excellent results. They were followed for a median of 25 months (13 to 37 months). 2016;32(1):201-201. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: Minimum two-year follow-up. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) method, the PubMed and Medline databases were searched in March 2019 for studies that reported on surgical outcomes in hips with concomitant mid acetabular dysplasia and FAI. Moreover, these researchers stated that a higher level of evidence is still needed to support these findings. Beall DP, Sweet CF, Martin HD, et al. The failure rate or conversion to THA rate in all available patients was 20 %. 4 Things You Need to Know About Filing For a Shoulder Pain VA Rating Beaule et al (2009) stated that FAI is a recognized cause of hip pain and osteoarthritis in young adults. Procedures that maintain and preserve proper hip anatomy, such as labral repair and femoro-acetabular impingement (FAI) correction, have shown superior results, in terms of pain reduction, increased function, and ability to return to activities. Am J Sports Med. Int J Sports Phys Ther. These researchers stated that further follow-up in larger cohorts is needed to prove the durability and safety of hip arthroscopy in this challenging group and to further examine potential sex-related differences in outcome. .headerBar { Intra-operatively, grade 2 anterior inferior iliac spine was found in 27 patients and grade 3 anterior inferior iliac spine was found in 7 patients; MHHS, HOS, and HOSS scores increased from median (range) pre-operative scores of 55 (11 to 90), 48 (20 to 91) and 20 (0 to 80) to 95 (27 to 100), 94 (30 to 100) and 91 (5 to 100), respectively (p<0.0001, p=0.001, p<0.0001, respectively). Muscle force was recovered at a mean 3.25 months (0.5 to 6); 8 patients were very satisfied, 1 satisfied and 1 moderately satisfied. The guidance stated that, while this was considered adequate for the present recommendation, further studies would be useful. Additional research is necessary to clarify the relationship between activity level and FAI progression and to determine the most appropriate intervention to improve return to active duty in military personnel with FAI. The average age of the patients was 38 years (range of 14 to 84 years), with 27 males and 23 females. The intraclass correlation coefficients (ICCs) for intraobserver variability were established prior to the start of this study. 2007;63(1):29-35. Overall, 18 hips (13.7 %) required revision procedures at a mean of 17 months (range of 1 to 37) after the labral reconstruction. 2013;471(8):2517-2522. Third, these researchers acknowledged there was a selection bias inherent in some of the reviewed studies, as the surgeons decision-making process in performing a tenotomy versus revision was only elucidated in 3 studies. J Orthop Trauma. The indications for surgery were FAI, or sub-spinal impingement.
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