{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T11:30:45Z","timestamp":1791199845293,"version":"4.2.0"},"reference-count":38,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2019,9,6]],"date-time":"2019-09-06T00:00:00Z","timestamp":1567728000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Femoroacetabular impingement (FAI) and acetabular dysplasia lead to acetabular cartilage damage that commonly results in the chondral flaps seen during hip arthroscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To compare the acetabular chondral flap morphology seen during hip arthroscopy (\u201coutside-in\u201d vs \u201cinside-out\u201d) with clinical and radiographic parameters underlying FAI and hip dysplasia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Patients who underwent hip arthroscopy by the senior author between 2013 and 2017 with a finding of Outerbridge grade IV acetabular chondral flap were included. Each procedure was retrospectively reviewed on video and chondral flaps were categorized as inside-out or outside-in. An inside-out designation was made for flaps exhibiting an intact chondrolabral junction with a detached sleeve of chondrolabral tissue from the central acetabulum, and an outside-in designation was made for centrally anchored flaps exhibiting a break in the chondrolabral junction. Radiographic markers of hip impingement\/dysplasia were noted for each patient during assignment into 1 of 2 radiographic groups: group 1, lateral center edge angle (LCEA) &gt;20 with FAI, and group 2, LCEA \u226420 with or without cam FAI. Associations between chondral flap morphology and clinical diagnosis were tested using a chi-square test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Overall, 95 patients (103 hips) were included (group 1, 78 hips; group 2, 25 hips). Among hips in group 2, 24 had concurrent cam FAI. There was a significant relationship between chondral flap type and radiographic diagnosis ( P &lt; .001). Among group 1 hips, 78% exhibited outside-in type chondral flaps, 12% exhibited combined outside-in and inside-out flaps, and 10% exhibited inside-out flaps. Group 2 hips showed 72% inside-out type chondral flaps, 16% combined, and 12% outside-in. Hips exhibiting outside-in type flaps were significantly more likely to be in group 1 (positive predictive value [PPV], 91%; negative predictive value [NPV], 69%). Similarly, hips exhibiting inside-out type flaps were significantly more likely to be in group 2 (PPV, 56%; NPV, 95%). Altogether, 90% of group 1 hips exhibited an outside-in lesion and 88% of group 2 hips exhibited an inside-out lesion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Acetabular chondral flap type visualized during hip arthroscopy correlates with radiographic markers of hip impingement and hip instability. Outside-in flaps are highly predictive of FAI, whereas inside-out flaps are highly predictive of acetabular dysplasia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0363546519871065","type":"journal-article","created":{"date-parts":[[2019,9,6]],"date-time":"2019-09-06T12:50:46Z","timestamp":1567774246000},"page":"2978-2984","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":54,"title":["The \u201cOutside-In\u201d Lesion of Hip Impingement and the \u201cInside-Out\u201d Lesion of Hip Dysplasia: Two Distinct Patterns of Acetabular Chondral Injury"],"prefix":"10.1177","volume":"47","author":[{"given":"Matthew J.","family":"Kraeutler","sequence":"first","affiliation":[{"name":"St Joseph\u2019s University Medical Center, Paterson, New Jersey, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse A.","family":"Goodrich","sequence":"additional","affiliation":[{"name":"University of Colorado Boulder, Department of Integrative Physiology, Boulder, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Fioravanti","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tigran","family":"Garabekyan","sequence":"additional","affiliation":[{"name":"Southern California Hip Institute, North Hollywood, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omer","family":"Mei-Dan","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,9,6]]},"reference":[{"key":"bibr1-0363546519871065","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.G.01198"},{"key":"bibr2-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1093\/jhps\/hnw034"},{"key":"bibr3-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.87B7.15203"},{"key":"bibr4-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-008-0680-y"},{"key":"bibr5-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-008-0481-3"},{"key":"bibr6-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-007-0060-z"},{"key":"bibr7-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000096804.78689.c2"},{"key":"bibr8-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516634058"},{"key":"bibr9-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1177\/2325967115572573"},{"key":"bibr10-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2015.01.010"},{"key":"bibr11-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-014-0093-4"},{"key":"bibr12-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1055\/s-0033-1348090"},{"key":"bibr13-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2008.01.010"},{"key":"bibr14-0363546519871065","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.01770"},{"key":"bibr15-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.73B3.1670443"},{"key":"bibr16-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1177\/0363546517708983"},{"key":"bibr17-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2018.02.036"},{"key":"bibr18-0363546519871065","doi-asserted-by":"publisher","DOI":"10.32098\/mltj.03.2016.10"},{"key":"bibr19-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2018.10.133"},{"key":"bibr20-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1093\/jhps\/hny045"},{"key":"bibr21-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-200401000-00011"},{"key":"bibr22-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1177\/0363546517741704"},{"key":"bibr23-0363546519871065","volume-title":"J Bone Joint Surg Am","author":"Mei-Dan O"},{"key":"bibr24-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1503\/cjs.003513"},{"key":"bibr25-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000153992.17554.67"},{"key":"bibr26-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.72B2.2312554"},{"key":"bibr27-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1093\/jhps\/hnv084"},{"key":"bibr28-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1177\/2325967117723608"},{"key":"bibr29-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2014.03.054"},{"key":"bibr30-0363546519871065","doi-asserted-by":"publisher","DOI":"10.1177\/0363546511412320"},{"key":"bibr31-0363546519871065","doi-asserted-by":"crossref","unstructured":"Sekiya JK, Martin RL, Lesniak BP. 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