http://www.nsmoc.com/

In this video, Dr. Byrd discusses hip arthroscopy in athletes during a Grand Rounds at the Department of Orthopaedic Surgery at Massachusetts General Hospital. As one of the early pioneers of hip arthroscopy, Dr. Byrd started collecting outcomes in the early 1990's. After a 10 year follow-up Dr. Byrd published a study title, "Hip Arthroscopy for Labral Pathology: Prospective Analysis with 10-Year Follow-up". The study found that 83% of patients had successful outcomes. It is important to note that the patients that Dr. Byrd was operating on in the 1990's was a different population than what he is treating today. The patients that he was operating on in the early 90's were patients that were using hip arthroscopy as a last result. In today's patients we are seeing younger patients who need a more simplistic approach to treatment.

In 1994, Dr. Byrd published his work on hip arthroscopy utilizing the supine position. The following year, they published the first study on the anatomy of the hip. A few years later, Dr. Byrd published a study on "Lateral Impact Injury: A Source of Occult Hip Pathology", which found there was a propensity for physically fit young adult males who participated in contact/collision sports. There was little adipose tissue over the trochanter. They have dense bone structure and the force delivered to the medial joint with resultant articular fracture.

After being unsure of the impact of hip arthroscopy, Dr. Byrd operated on the first African American athlete to win a Gold medal in the winter Olympics in 2002, showing that it takes time for things to come full circle.

In 1998, Dr. Byrd was working as the head team physician for the then Tennessee Oilers. It was brought to his attention that many NFL athletes had problems with hip pain, but it was not being properly identified, or misinterpreted as groin pain.

Dr. Byrd tells people that the two smartest things that he did was (1) marry his wife and (2) he started keeping track of his patient outcomes early on. In 2001, Dr. Byrd published the study the first study on "Hip Arthroscopy in Athletes". The mean improvement was 35 points and 93% demonstrated a greater than 10 point improvement. The study found that collegiate, elite and professional athletes had higher baseline scores - this is due to the near physiologic limits of the body and less room for improvement. Athletes that had traumatic onset did the best and those with insidious onset didn't do as well. As far as procedures, loose body removal, debridement ligamentum teres and impinging osteophytes fared best.

In 2009, Dr. Byrd published his study on "Hip Arthroscopy in Athletes: 10-Year Follow-up". This study found that the mean improvement was 45 points with 87% returning to sports. 33% converted to THA at an average of 6 years.

There are three types of FAI - pincer, CAM and a combined type. FAI ia a childhood developmental abnormality. Sometimes it is encountered as an incidental inconsequential radiographic observation. It can lead to second degree joint damage (labrum and articular cartilage) and early age onset of osteoarthritis.

One of Dr. Byrd's articles "Femoroacetabular Impingement in Athletes: Current Concepts" covers the management and concept of FAI as we understand it today. The pincer type FAI is on the acetabular side. In hip flexion, the labrum gets crushed on the acetabular side and can occur for a variety of different reasons. The radiographic indication includes a cross over sign.

The CAM lesion is a femoral sided problem and occurs when the femoral head rotates up in the acetabular joint and damages first the articular surface of the acetabular. In radiographic images, there is a loss of sphericity of the femoral head. The Alpha angle is an effort to quantitate severity of deformity.

In 2009, Dr. Byrd published a study on "Arthroscopic Femoroplasty in the Management of CAM-Type Femoroacetabular Impingement". This study found that there was a bimodal age distribution; 2 peak ages: 43 years old, which typically involves an early age onset of osteoarthritis and the other at 20 years old, which are young adults pushing the hip beyond reduced physiologic limits.

In another study conducted by Dr. Byrd, he found that 87% of radiographs and 90% of athletes demonstrated at least one radiographic feature of FAI. In 2011, Dr. Byrd published a study on FAI in athletes. 200 athletes with FAI were assessed with 100% minimum follow-up on 1 year. 96% had acetabular articular damage, 20% combined femoral damage and 89% had labral tears. The median improvement was 24 points. Femoral head changes are not as successful as acetabular changes. A portion of these athletes underwent microfracture. 90% of athletes returned to their sports 95% professional and 85% collegiate.

As far as a rehab strategy, 4 weeks is 50% weightbearing. 3 months structured rehab with functional progression over 1-3 months, and return to sport is 4-6 months.