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Again, if an incomplete osteotomy is performed posterolaterally, the opening gap is increased anteriorly, leading to an unnecessary increase in posterior tibial slope; for biplanar osteotomy, retrotubercular osteotomy should be performed close to the patellar tendon and not be advanced to the posterolateral side of the hinge.Hip arthroscopy for the treatment of femoroacetabular impingement syndrome requires access to the central compartment of the hip, which is more easily obtained with hip distraction. However, surgeons must balance improved surgical access with the risks of postoperative complications. Hip joint venting describes the disruption of the suction seal by introducing a large-gauge needle into the joint space and injecting air or fluid into the joint. Joint venting performed before initiating axial traction may reduce the force required to obtain central compartment access while mitigating postoperative complications.Advancements in hip arthroscopy are astounding. Circumferential labral reconstruction, labral augmentation, and capsular reconstruction are valuable tools. Beyond the “comfort zone” of the hip intra-articular realm, new frontiers include the peritrochanteric space, and a similarity to the subacromial space of the shoulder makes the transition attainable. In contrast, the subgluteal space is seen as outside the box. Sciatic nerve entrapment (SNE), ischiofemoral impingement (IFI), and tears of the proximal origin of the hamstring are among the subgluteal space pathologies. Clinical assessment of deep gluteal syndrome, defined as nondiscogenic sciatic nerve entrapment, can be particularly difficult but is critical and one of the skills that we as hip sports surgeons need to master. The respective treatments for SNE, IFI, and hamstring tears are nerve decompression, lesser trochanteric resection, and hamstring repair. Complications can occur, most commonly temporary injury of the sciatic nerve and permanent injury of the posterior femoral cutaneous nerve. While all located in the deep gluteal space, SNE, IFI, and proximal hamstring tears are unique entities. When thinking outside the box, it’s important to consider the complicated contents of Pandora’s box.Surgical management of iliopsoas pathology that fails conservative treatment is controversial. Potential complications following iliopsoas tenotomy include recurrent painful internal snapping, postoperative pain, and hip flexor weakness. Concerns are even greater in dysplastic patients, in whom the iliopsoas may play a role as an anteromedial hip stabilizer. Although data demonstrate arthroscopic iliopsoas tenotomy for painful internal snapping as safe and effective, its use has declined for the reasons stated above. On the other hand, procedures such as capsular plication with inferior shift and anatomic labral repair, augmentation, and reconstruction have made it possible to restore the primary stabilizers in many cases of hip instability. In these cases, iliopsoas fractional lengthening (IFL) with avoidance of collateral damage to the musculature or capsule can successfully treat painful internal snapping hip. We recommend iliopsoas lengthening when (1) there is painful internal snapping, (2) IFL can be performed without collateral damage, (3) the primary soft tissue stabilizers can be restored or augmented, and (4) there is no bony morphology likely to cause continued instability.The optimal classification system in arthroscopic and related surgery research and clinical practice should be clinically relevant, descriptive, reproducible, simple, inexpensive, safe, and widely applicable. For the hip, classification systems that characterize intra-articular disorders like femoroacetabular impingement (FAI) syndrome, dysplasia, labral tears, and articular cartilage disease predominate the literature. Recently, awareness of peritrochanteric and other extra-articular disorders has increasingly led to greater recognition, diagnosis, and treatment of what has been historically known as “just bursitis”. These disorders are far more complex and include greater trochanteric pain syndrome, the spectrum of gluteal tendon pathology, greater trochanteric bursitis, snapping iliotibial band (external coxa saltans), and greater trochanteric-ischial impingement. The utility of an intraoperative greater trochanteric pain syndrome classification system has now been proven using prospectively collected data, assimilating a decade-long eligibility period following open or endoscopic treatment of peritrochanteric disorders with a minimum two-year follow-up using validated patient-reported outcome scores. This classification guides prognosis and treatment, exactly as an optimal orthopedic classification system should do.Pathology of the lumbar spine and hip commonly occur concurrently. The hip-spine connection has been well documented in the hip arthroplasty literature but until recently has been largely ignored in the setting of hip arthroscopy. Physical examination and diagnostic workup of the lumbosacral junction are warranted to further our understanding of the effects of lumbosacral motion and pathology in patients with concomitant femoroacetabular impingement syndrome. An understanding of this relationship will better allow surgeons to counsel and preoperatively optimize patients undergoing evaluation and treatment of femoroacetabular impingement syndrome. Several studies have reported that patients with a previous lumbar arthrodesis undergoing hip arthroplasty have lower patient-reported outcomes and greater revision rates compared with patients without previous lumbar surgery, and similar to its effect on outcomes after hip arthroplasty, lumbar spine disease can compromise outcomes after hip arthroscopy. Sodiumorthovanadate On the other side of the coin, hip arthroplasty has been shown to improve low back pain in patients with concomitant hip osteoarthritis. Can the arthroscopic treatment of nonarthritic hip pathology offer a similar result? We won’t know unless we look.Needle arthroscopy (using a 1- to 1.9-mm diameter arthroscope) is not new, and new interest is a result of the expense and inconvenience of magnetic resonance imaging (MRI), including time out of work, prolonged diagnostic dilemmas, and finite advanced imaging resources. Improvements in the image quality with the modern needle arthroscope have made it a viable option for use as a diagnostic tool in the operative setting, and eventually, if surgeons are able to create strict criteria for proper diagnostic use of the needle arthroscope, it may become an excellent tool for in-office use despite financial or legal hurdles. Specific clinical scenarios for use of an diagnostic needle arthroscopy instead of an MRI (and typically immediately followed by therapeutic arthroscopy in the same setting) include (1) a patient with a clinically obvious meniscus tear with a locked knee, (2) a patient with an outdated but previously positive MRI with recurrent injury such as a recurrent shoulder or patella dislocations, (3) a patient who is ineligible for an MRI such as those with pacemakers or spinal implants who have clear and obvious clinical findings to suggest intra-articular pathology, and (4) a patient who is over the age of 50 years with positive rotator cuff testing after a shoulder dislocation in which I have a high degree of suspicion of a rotator cuff tear.