{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T16:41:23Z","timestamp":1794242483829,"version":"4.9.0"},"reference-count":69,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2026,5,24]],"date-time":"2026-05-24T00:00:00Z","timestamp":1779580800000},"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":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>An expanding body of literature is available on arthroscopy for femoroacetabular impingement syndrome (FAIS). Studies have attempted to relate Tonnis grade to postoperative outcomes but do not often provide a complete picture of the clinical, radiographic, and failure outcomes for a given Tonnis cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To systematically review and meta-analyze the impact of preoperative arthritic changes, as measured by Tonnis grade, on clinical, radiographic, and survivorship outcomes in patients undergoing hip arthroscopy for FAIS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Systematic review; Level of evidence, 4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>PubMed, EMBASE, and Web of Science Core Collection databases were queried for investigations associating preoperative Tonnis grade with postoperative outcomes after hip arthroscopy for FAIS. Eligible articles compared patient-reported outcomes (PROs), radiographic arthritis progression, or rate of secondary surgical interventions between patients with various Tonnis arthritis grades. Continuous random-effects models were used to compare PROs between arthritic grades as represented by standardized mean difference (SMD), whereas restricted maximum likelihood random-effects models compared event rates of Tonnis grade progression and secondary surgical interventions, reported as odds ratio (OR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total 29 investigations were included in this systematic review, of which 16 studies provided sufficient quantitative data for meta-analysis. The 3972 hips included were followed for a mean of 68.4 months (range, 24.0-150.0 months); the mean age was 39.6 years (range, 20.3-63.3 years). Meta-analysis revealed similar results between Tonnis 0 and 1 cohorts for modified Harris Hip Score (SMD = 0.05, 95% CI [\u20130.33, 0.42];\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 73.35%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .80), Hip Outcome Score (HOS)\u2013Activities of Daily Living (SMD = \u22120.16, 95% CI [\u20130.36, 0.04];\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 0.00%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .12), HOS\u2013Sports Subscale (SMD = \u22120.36, 95% CI [\u20130.97, 0.25];\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 89.14%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .25), and Tonnis progression (OR = 2.66, 95% CI [0.51-13.95];\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 58.80%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .25). The Tonnis 2 cohort was found to have similar mHHS to Tonnis 0 (SMD = \u22120.22, 95% CI [\u20130.60, 0.17];\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 52.52%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .27) and Tonnis 1 (SMD = \u22120.24, 95% CI [\u20130.48, 0.01];\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 0.00%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .06). Tonnis 0, 1, and 2 cohorts were found to have similar rates of revision arthroscopy (OR = 1.65, 95% CI [0.63-4.28];\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 0.00%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .31). Increasing Tonnis grade was found to have increased rates of conversion to total hip arthroplasty, except for Tonnis 2 and 3 having similar rates of conversion (OR = 5.27, 95% CI [0.91-30.51];\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 0.00%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .06).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>A systematic review of 29 studies identified relevant data, and meta-analysis of 16 studies that provided sufficient quantitative data revealed that compared with Tonnis grade 0 and 1 hips, Tonnis grade 2 hips had similar symptomatic improvement, reflected by select PROs, but decreased joint survivorship, reflected by significantly higher rates of conversion to total hip arthroplasty.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465261443978","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T04:59:32Z","timestamp":1779685172000},"page":"3045-3060","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Arthroscopy for Femoroacetabular Impingement in Tonnis Grade 2 Arthritic Hips Results in Similar Clinical and Radiographic Outcomes but Lower Survivorship Than Tonnis Grades 0 and 1: A Systematic Review and Meta-analysis"],"prefix":"10.1177","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6288-2120","authenticated-orcid":false,"given":"Laura","family":"Krivicich","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4669-0097","authenticated-orcid":false,"given":"Alexis","family":"Driscoll","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madison","family":"Hayes-Lattin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Oregon Health &amp; Science University, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Guenthner","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1306-4201","authenticated-orcid":false,"given":"Yi-Meng","family":"Yen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9928-0879","authenticated-orcid":false,"given":"Matthew","family":"Salzler","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,24]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2022.01.024"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2018.08.053"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.91B2.21137"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465211068109"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465241234937"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2010.11.008"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-017-0644-y"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2018.03.021"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/jhps\/hny011"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/CORR.0000000000001778"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465241265721"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.15.00644"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516638087"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-013-3218-x"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/jhps\/hnx015"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546517739824"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/21925682221110527"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-014-2893-9"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546517706957"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546520968896"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2014.11.008"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465231210958"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2020.10.035"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2022.07.022"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2020.10.012"},{"issue":"417","key":"e_1_3_3_27_2","first-page":"112","article-title":"Femoroacetabular impingement: a cause for osteoarthritis of the hip","volume":"2003","author":"Ganz R","unstructured":"Ganz R, Parvizi J, Beck M, et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003(417):112-120.","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2009.12.002"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2014.07.008"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546519888894"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2015.03.004"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-016-5115-6"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516652615"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546517730583"},{"key":"e_1_3_3_35_2","article-title":"Cam morphology and the development of femoroacetabular impingement syndrome and hip osteoarthritis","author":"Heerey J","year":"2025","unstructured":"Heerey J, Kemp J, van Klij P, et al. Cam morphology and the development of femoroacetabular impingement syndrome and hip osteoarthritis. Nat Rev Rheumatol. 2025.","journal-title":"Nat Rev Rheumatol"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1186"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-019-05520-4"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2009.09.003"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465231188114"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1177\/23259671221075653"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000246542.49574.2c"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000534679.75870.5f"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1177\/23259671221109012"},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-010-1741-6"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eats.2017.06.011"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.1177\/1947603510364233"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-021-04249-5"},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-017-0391-8"},{"key":"e_1_3_3_49_2","doi-asserted-by":"publisher","DOI":"10.11613\/BM.2012.031"},{"key":"e_1_3_3_50_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546517749219"},{"key":"e_1_3_3_51_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00256-022-04270-8"},{"key":"e_1_3_3_52_2","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0000000000000768"},{"key":"e_1_3_3_53_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546519843936"},{"key":"e_1_3_3_54_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546515587719"},{"key":"e_1_3_3_55_2","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page MJ","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.","journal-title":"BMJ"},{"key":"e_1_3_3_56_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2018.05.034"},{"key":"e_1_3_3_57_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-012-2779-4"},{"key":"e_1_3_3_58_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465241232154"},{"key":"e_1_3_3_59_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2024.08.012"},{"key":"e_1_3_3_60_2","article-title":"Femoroacetabular impingement: defining the condition and its role in the pathophysiology of osteoarthritis","volume":"21","author":"Sankar WN","year":"2013","unstructured":"Sankar WN, Nevitt M, Parvizi J, et al. Femoroacetabular impingement: defining the condition and its role in the pathophysiology of osteoarthritis. J Am Acad Orthop Surg. 2013;21(suppl 1):S7-S15.","journal-title":"J Am Acad Orthop Surg"},{"key":"e_1_3_3_61_2","doi-asserted-by":"publisher","DOI":"10.1093\/jhps\/hnv079"},{"key":"e_1_3_3_62_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-021-06484-0"},{"key":"e_1_3_3_63_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465221107354"},{"key":"e_1_3_3_64_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1445-2197.2003.02748.x"},{"key":"e_1_3_3_65_2","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne JA","year":"2016","unstructured":"Sterne JA, Hernan MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.","journal-title":"BMJ"},{"key":"e_1_3_3_66_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2020.05.021"},{"key":"e_1_3_3_67_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199912000-00014"},{"key":"e_1_3_3_68_2","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12563"},{"key":"e_1_3_3_69_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.106B8.BJJ-2023-1478.R2"},{"key":"e_1_3_3_70_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2021.01.024"}],"container-title":["The American Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03635465261443978","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/03635465261443978","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03635465261443978","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T10:06:53Z","timestamp":1792577213000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/03635465261443978"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,24]]},"references-count":69,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1177\/03635465261443978"],"URL":"https:\/\/doi.org\/10.1177\/03635465261443978","relation":{},"ISSN":["0363-5465","1552-3365"],"issn-type":[{"value":"0363-5465","type":"print"},{"value":"1552-3365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,24]]}}}