AANA25 Hip Access Pass-CONCURRENT SESSION 1G: Optimizing Outcomes: Live Your Best Life

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Video Summary

The session at Scripps Clinic focused on hip arthroscopy outcomes in obese patients and advancements in ACL reconstruction techniques, particularly using quadriceps tendon (quad) autografts. Dr. Renicki presented a 10-year retrospective study showing that while hip arthroscopy improves symptoms regardless of BMI, obese patients had significantly worse long-term outcomes, higher rates of complications like superficial infections, and increased conversion to total hip arthroplasty. Overweight patients had higher revision surgery rates. These findings underscore the importance of preoperative counseling and consideration of BMI as a modifiable risk factor.<br /><br />Dr. Haim discussed various patient-specific (age, cartilage status, BMI, mental health) and operative factors (labral repair, bone morphology, capsular management) influencing hip arthroscopy success, emphasizing careful surgical technique and patient selection.<br /><br />Regarding ACL reconstruction, Dr. Brinkman shared data comparing quad tendon autografts with and without lateral extra-articular tenodesis (LET). LET reduced clinical failure rates and residual pivot shift, although hematoma rates were higher with LET. Quad autografts are gaining popularity due to comparable biomechanical properties and potentially less donor site morbidity than bone-patellar-bone (BTB) grafts.<br /><br />Dr. Mulcahy highlighted technical aspects of quad tendon harvest, stressing preparation, knee positioning, and careful graft release to optimize outcomes. Dr. Schrapalla reviewed the rising use of quad grafts, their robust characteristics, and pros such as less anterior knee pain compared to BTB. However, quad grafts are associated with risks like arthrofibrosis (cyclops lesions) and notably prolonged quadriceps weakness postoperatively.<br /><br />Dr. Ryu emphasized the importance of preoperative rehabilitation and mental health management to improve ACL surgery outcomes and reduce failure. Blood flow restriction therapy postoperatively may help mitigate quad weakness.<br /><br />The panel discussed case examples, weighing graft choices based on patient factors like age, activity level, and risk of arthrofibrosis. They stressed individualized decision-making, the importance of prehab, early quad activation, and cautious return-to-sport clearance given persistent quadriceps deficits often seen with quad grafts. Overall, the session underscored careful patient selection, surgical technique, and rehabilitation strategies to optimize outcomes in hip arthroscopy and ACL reconstruction.

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Keywords

hip arthroscopy

obese patients

ACL reconstruction

quadriceps tendon autografts

BMI impact

labral repair

lateral extra-articular tenodesis

quad tendon harvest technique

arthrofibrosis risk

preoperative rehabilitation