Revision Hip Arthroscopy in High-Level Athletes: Minimum 2-Year Outcomes Comparison to a Propensity-Matched Primary Hip Arthroscopy Control Group

2021 ◽  
pp. 036354652110417
Author(s):  
Peter F. Monahan ◽  
Andrew E. Jimenez ◽  
Jade S. Owens ◽  
Benjamin R. Saks ◽  
David R. Maldonado ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Hip Arthroscopy ◽  
Matched Control ◽  
Return To Sport ◽  
Harris Hip Score ◽  
Control Group ◽  
Matched Control Group ◽  
Functional Scores ◽  
High Level

Background: Outcomes of revision hip arthroscopy in the athletic population have not been well established. Purpose: (1) To report clinical outcomes for high-level athletes undergoing revision hip arthroscopy in the setting of femoroacetabular impingement syndrome (FAIS) or labral tears and (2) to compare these outcomes against a propensity-matched group of high-level athletes undergoing primary hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Data for professional, college, and high school athletes were prospectively collected and retrospectively reviewed between January 2012 and October 2018. Patients were included if they underwent revision or primary hip arthroscopy and had preoperative and minimum 2-year patient-reported outcome (PRO) scores for modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. The findings and outcomes of revision athletes were compared with a propensity-matched control group of high-level athletes undergoing primary hip arthroscopy. Results: A total of 32 hips (29 patients) undergoing revision hip arthroscopy and 92 hips (88 patients) undergoing primary hip arthroscopy were included in our final analysis with a median follow-up time of 29.5 months (95% CI, 27.2-32.1 months) and 36.5 months (95% CI, 33.5-37.7 months), respectively. Athletes undergoing revision surgery showed significant improvement in all recorded PRO measurements and achieved patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) for mHHS at high rates (80.6% and 83.9%, respectively). When compared with a propensity-matched primary control group, patients undergoing revision surgery demonstrated lower preoperative and postoperative scores for mHHS, NAHS, and HOS-SSS, but the magnitude of improvement in functional scores was similar between groups. Athletes undergoing revision surgery achieved PASS for HOS-SSS at lower rates than the control group ( P = .005), and they were less likely to attempt to return to sport compared with the control group (62.5% vs 87.0%; P < .01). Conclusion: Revision hip arthroscopy is a viable treatment option to improve PROs in high-level athletes at minimum 2-year follow-up. The study group showed significant improvement in functional scores and a high rate of successful outcomes. They experienced similar magnitude of improvement as that of a propensity-matched control group; however, they achieved lower postoperative PRO scores and attempted to return to sport at lower rates.

Revision Hip Arthroscopy in the Borderline Dysplastic Population: Reporting Outcomes With Minimum 2-Year Follow-up, With a Subanalysis Against a Propensity-Matched Nondysplastic Control Group

2020 ◽  
Vol 49 (1) ◽  
pp. 66-75 ◽  
Author(s):  
David R. Maldonado ◽  
Cynthia Kyin ◽  
Jacob Shapira ◽  
Philip J. Rosinsky ◽  
Mitchell B. Meghpara ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Hip Arthroscopy ◽  
Matched Control ◽  
Arthroscopic Surgery ◽  
Harris Hip Score ◽  
Control Group ◽  
Study Group ◽  
Matched Control Group ◽  
Patient Reported

Background: Hip arthroscopy in patients with borderline dysplasia continues to be surrounded by controversy. Even more controversial is the management of the failed hip arthroscopy in this population. There is a paucity of studies in contemporary literature regarding outcomes after arthroscopic revision surgery. Purpose: (1) To report minimum 2-year patient-reported outcome (PRO) scores in patients with borderline dysplasia who underwent revision hip arthroscopy and (2) to compare these PRO scores with those of a propensity-matched control group without dysplasia who underwent revision hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected between August 2009 and November 2017. Inclusion criteria were revision arthroscopic surgery, capsular plication, and baseline and minimum 2-year follow-up for the following PROs: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Patients with Tönnis grade >1 or previous hip conditions were excluded. Two groups were created: a study group with borderline dysplasia (lateral center-edge angle [LCEA], 18°-25°) and a control group without dysplasia (LCEA, 25°-40°). Groups were propensity-matched in a 1:3 ratio for sex, age, body mass index, and follow-up time. Results: A total of 22 revision borderline dysplastic hips (21 patients) had a minimum 2-year follow-up during the study period. Patients in this group reported significant improvements for all PROs from baseline and achieved the minimal clinically important difference (MCID) for the mHHS at a rate of 70%. Moreover, 21 borderline dysplastic hips (21 patients) were matched to 63 control hips (63 patients). Mean LCEA for the study and control groups was 22.6 ± 1.7 and 32.0 ± 5.0, respectively. Both groups reported similar improvement in all PROs. The rate for achieving the MCID for the mHHS and VAS was similar between groups; however, the control group had higher rates of meeting the MCID for the HOS-SSS and NAHS ( P = .042 and P = .025, respectively). The rates of conversion to hip arthroplasty were 7.9% (n = 5) in the control group and 23.8% (n = 5) in the borderline dysplasia propensity-matched group ( P = .052). The rate of re-revision arthroscopy was 11.1% (n = 7) in the control group and 19.0% (n = 4) on the borderline dysplasia group ( P = .350). Conclusion: After revision hip arthroscopy, significant improvement was obtained for all PROs in patients with borderline dysplasia at a minimum 2-year follow-up. Moreover, outcomes, patient satisfaction, the rate for achieving the MCID for the mHHS and VAS, and the rate for secondary surgery were similar to those of a propensity-matched control group without dysplasia. Nevertheless, there was a nonsignificant trend toward higher secondary procedures in the study group; therefore, arthroscopic revision surgery in the borderline patients should be approached with measured prognosis.

Hips With Acetabular Retroversion Can Be Safely Treated With Advanced Arthroscopic Techniques Without Anteverting Periacetabular Osteotomy: Midterm Outcomes With Propensity-Matched Control Group

2020 ◽  
Vol 48 (7) ◽  
pp. 1636-1646 ◽  
Author(s):  
David R. Maldonado ◽  
Jeffery W. Chen ◽  
Cynthia Kyin ◽  
Philip J. Rosinsky ◽  
Jacob Shapira ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Matched Control ◽  
Periacetabular Osteotomy ◽  
Acetabular Retroversion ◽  
Harris Hip Score ◽  
Control Group ◽  
Matched Control Group ◽  
Labral Tears ◽  
Patient Reported

Background: Different options, from reverse (anteverting) periacetabular osteotomy to hip arthroscopy, have been proposed for surgical treatment of femoroacetabular impingement syndrome (FAIS) in the setting of acetabular retroversion. Purpose: (1) To report and analyze midterm patient-reported outcome scores (PROs) in patients with FAIS and labral tears in the setting of acetabular retroversion after isolated hip arthroscopy and (2) to compare these PROs with those of a propensity-matched control group without acetabular retroversion. Study Design: Cohort study; Level of evidence, 3. Methods: Prospectively collected data were retrospectively reviewed for patients who underwent hip arthroscopy for FAIS and labral tear treatment between June 2008 and March 2014. Inclusion criteria were as follows: acetabular retroversion, pre- and postoperative PROs for modified Harris Hip Score (mHHS), Non-arthritic Hip Score, Hip Outcome Score–Sports Specific Scale (HOS-SSS), and visual analog scale (VAS). Propensity score matching was utilized to identify a control group without acetabular retroversion matched 1:1 with similar age, sex, body mass index, acetabular and femoral head Outerbridge grade, preoperative lateral center-edge angle, and labral treatment. Patient acceptable symptomatic state (PASS) and/or minimal clinically important difference (MCID) for the mHHS, HOS-SSS, International Hip Outcome Tool–12, and VAS was calculated. Results: A total of 205 hips with acetabular retroversion were matched to a control group. The groups showed no difference in demographic variables. The retroversion group was composed of 139 female and 66 male hips, with a mean ± SD age of 23.81 ± 7.28 years and follow-up time of 65.24 ± 20.31 months. Intraoperative diagnostic data and procedures performed were similar between groups, except more femoroplasties were performed in the retroversion group. Significant improvements for the mHHS, Non-arthritic Hip Score, HOS-SSS, and VAS were seen for both groups at a mean 5-year follow-up. The proportion of patients who reached the PASS and MCID were similar. Conclusion: In the setting of FAIS and labral tears, patients with acetabular retroversion can be safely treated with advanced hip arthroscopic techniques without reverse (anteverting) periacetabular osteotomy in a high-volume surgeon’s hands. Patients with acetabular retroversion demonstrated favorable PROs at midterm follow-up. Furthermore, the proportion of patients reaching the MCID and PASS for several PROs were comparable with those of a propensity-matched control group without acetabular retroversion.

Minimum 5-Year Outcomes for Revision Hip Arthroscopy With a Prospective Subanalysis Against a Propensity-Matched Control Primary Group

2021 ◽  
pp. 036354652110130
Author(s):  
David R. Maldonado ◽  
Cynthia Kyin ◽  
Philip J. Rosinsky ◽  
Jacob Shapira ◽  
Samantha C. Diulus ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Hip Arthroscopy ◽  
Matched Control ◽  
Harris Hip Score ◽  
Control Group ◽  
Primary Group ◽  
Matched Control Group ◽  
Before And After

Background: There is a paucity of midterm outcome data on hip revision arthroscopic surgery. Purpose: (1) To report minimum 5-year patient-reported outcome measurement scores (PROMSs) in patients who underwent revision hip arthroscopy, (2) to compare minimum 5-year PROMSs with a propensity-matched control group that underwent primary hip arthroscopy, and (3) to compare the rate of achieving the minimal clinically important difference (MCID) at minimum 5-year follow-up between the revision group and the propensity-matched control primary group. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected between June 2008 and April 2014. Patients were included who underwent revision hip arthroscopy with preoperative and minimum 5-year follow-up scores for the modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Patients with Tönnis grade >1 or with hip conditions such as avascular necrosis, Legg-Calve-Perthes disease, Ehlers-Danlos syndrome, and pigmented villonodular synovitis were excluded. A subanalysis was performed against a propensity-matched control group that underwent primary surgery. Groups were propensity matched in a 1:2 ratio for sex, age, body mass index, and follow-up time. Results: A total of 127 revision arthroscopies (113 patients) were included, and the mean ± SD follow-up time was 72.8 ± 23.3 months. The revision group was 74.0% female, and the average age and body mass index were 34.9 ± 12.4 years and 24.8 ± 4.2, respectively. The revision group demonstrated improvement for all PROMSs and reached the MCID for the mHHS (66.1%), HOS-SSS (68.4%), NAHS (66.9%), and VAS (80.0%). All revision cases were propensity matched to 254 primary arthroscopy cases. PROMSs in the revision group were lower than those of the control group before and after surgery. Delta values were similar between groups for all PROMSs. There were no differences in rates of achieving the MCID. The relative risk of arthroplasty conversion was 2.6 (95% CI, 1.5-4.6) for the revision group as compared with the primary group. Conclusion: Significant improvement in all PROMSs, including the VAS, and high patient satisfaction at minimum 5-year follow-up were reported after revision hip arthroscopy. A high proportion of patients in the revision cohort reached the MCID for the mHHS, HOS-SSS, NAHS, and VAS, with similar rates and magnitudes of improvement relative to the control group. As expected, these data indicate that patients undergoing primary hip arthroscopy have higher PROMSs before and after surgery and lower rates of conversion to arthroplasty.

Comparing Midterm Outcomes of High-Level Athletes Versus Nonathletes Undergoing Primary Hip Arthroscopy: A Propensity-Matched Comparison With Minimum 5-Year Follow-up

2021 ◽  
pp. 036354652110417
Author(s):  
Andrew E. Jimenez ◽  
Peter F. Monahan ◽  
David R. Maldonado ◽  
Benjamin R. Saks ◽  
Hari K. Ankem ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Statistical Significance ◽  
Arthroscopic Surgery ◽  
Harris Hip Score ◽  
Control Group ◽  
Level Of Evidence ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
High Level

Background: High-level athletes (HLAs) have been shown to have better short-term outcomes than nonathletes (NAs) after hip arthroscopy. Purpose: (1) To report midterm outcomes of HLAs after primary hip arthroscopy and (2) to compare their results with a propensity-matched cohort of NA patients. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed between February 2008 and November 2015 for HLAs (professional, college, or high school) who underwent primary hip arthroscopy in the setting of femoroacetabular impingement syndrome (FAIS). HLAs were included if they had preoperative, minimum 2-year, and minimum 5-year follow-up data for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Hip Outcome Score Sports-Specific Subscale (HOS-SSS). Radiographic and intraoperative findings, surgical procedures, patient-reported outcomes (PROs), patient acceptable symptomatic state (PASS), minimal clinically important difference (MCID), and return to sport were reported. The HLA study group was propensity-matched to a control group of NA patients for comparison. Results: A total 65 HLA patients (67 hips) were included in the final analysis with mean follow-up time of 74.6 ± 16.7 months. HLAs showed significant improvement in all PROs recorded, achieved high rates of MCID and PASS for mHHS (74.6% and 79.4%, respectively) and HOS-SSS (67.7% and 66.1%, respectively), and returned to sport at high rates (80.4%). When compared with the propensity-matched NA control group, HLAs reported higher baseline but comparable postoperative scores for the mHHS and NAHS. HLA patients achieved MCID and PASS for mHHS at similar rates as NA patients, but the HLA patients achieved PASS for HOS-SSS at higher rates that trended toward statistical significance (66.1% vs 48.4%; P = .07). NA patients underwent revision arthroscopic surgery at similar rates as HLA patients (14.9% vs 9.0%, respectively; P = .424). Conclusion: Primary hip arthroscopy results in favorable midterm outcomes in HLAs. When compared with a propensity-matched NA control group, HLAs demonstrated a tendency toward higher rates of achieving PASS for HOS-SSS but similar arthroscopic revision rates at minimum 5-year follow-up.

scholarly journals Return to Sport Rates and Functional Outcomes Following Bilateral Hip Arthroscopy in High-Level Athletes

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0043
Author(s):  
Benjamin Domb ◽  
Cynthia Kyin ◽  
Jacob Shapira ◽  
David Maldonado ◽  
Ajay Lall ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Patient Reported Outcomes ◽  
Return To Sport ◽  
Harris Hip Score ◽  
Complication Rates ◽  
Professional Athlete ◽  
Patient Reported ◽  
High Level ◽  
Modified Harris Hip Score

Objectives: To determine the rate of return to sport (RTS) in high-level athletes undergoing bilateral hip arthroscopy and report minimum 1-year patient-reported outcomes (PROs) for this cohort. We hypothesized that RTS rates, as well as sport-specific PROs, will be lower than the rates and scores previously reported in the literature for unilateral hip arthroscopy. Methods: Data were prospectively collected on all patients undergoing hip arthroscopy at our institution from November 2011 to July 2018. Patients were included if they underwent bilateral hip arthroscopy and were either a high school, collegiate, or professional athlete prior to their first surgery. RTS was defined as a patient’s return to competitive participation in their respective sport. Additional PROs, including modified Harris Hip Score (mHHS), nonarthritic hip score (NAHS), and Hip Outcome Score-Sports Specific Subscale (HOS-SSS), as well as complication rates and future surgeries were documented and compared for all patients. Results: A total of 87 patients met inclusion criteria, for which follow-up was available for 82 (94.3%). At latest follow-up, 44 (53.7%) patients returned to sport. Of patients returning, 56% did so at the same level or higher. The most common reasons for not returning to sport were due to graduation/lifestyle change (47.4%) and hip symptoms (44.7%). Patients returning to sport had significantly higher PROs at latest follow-up relative to those who did not return, including for mHHS (93.7 vs. 87.5), NAHS (94.4 vs. 88.2), HOS-SSS (90.9 vs. 78.2) (P < 0.05). Rates of achieving PASS and MCID for mHHS were not significantly different. However, for HOS-SSS, patients who returned had significantly higher rates of achieving the MCID and PASS. Conclusion: Rates of RTS after bilateral hip arthroscopy are lower than those after unilateral hip arthroscopy. When comparing patients that returned to sports and those who did not return, we show that although both groups show a significant improvement in PROs following surgery, those that returned to sport achieved significantly higher scores in all outcome measures. In addition, patients returning to sports showed a significantly higher rate of attaining MCID and PASS scores for the HOS-SSS, possibly attesting to the validity of this score and its thresholds.

Return to Sports and Minimum 2-Year Outcomes of Hip Arthroscopy in Elite Athletes With and Without Coexisting Low Back Pain: A Propensity-Matched Comparison

2021 ◽  
pp. 036354652110569
Author(s):  
Andrew E. Jimenez ◽  
Jade S. Owens ◽  
Peter F. Monahan ◽  
David R. Maldonado ◽  
Benjamin R. Saks ◽  
...  
Keyword(s):  
Back Pain ◽  
Hip Arthroscopy ◽  
Matched Control ◽  
Elite Athletes ◽  
Control Group ◽  
Return To Sports ◽  
Low Back ◽  
Inclusion Criteria ◽  
Matched Control Group

Background: Patient-reported outcomes (PROs) and return to sports (RTS) after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) have not been established in elite athletes with coexisting low back pain (LBP). Purpose: (1) To report minimum 2-year PROs and RTS rates after primary hip arthroscopy for FAIS in elite athletes with coexisting LBP and (2) to compare clinical results with a propensity-matched control group of elite athletes without back pain. Study Design: Cohort study; Level of evidence, 3. Methods: Data were reviewed for elite athletes (college and professional) who underwent hip arthroscopy for FAIS and had coexisting LBP between October 2009 and October 2018. Inclusion criteria were preoperative and minimum 2-year follow-up for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Sports Specific Subscale (HOS-SSS), and visual analog scale for pain. Exclusion criteria were Tönnis grade >1, hip dysplasia (lateral center-edge angle <18°), and previous ipsilateral hip or spine surgery or conditions. Rates of achieving the minimal clinically importance difference (MCID), patient acceptable symptomatic state (PASS), and maximum outcome improvement satisfaction threshold were recorded in addition to RTS. For the subanalysis, the elite athlete study group was propensity matched to an elite athlete control group without back pain. Results: A total of 48 elite athletes with LBP who underwent primary hip arthroscopy met inclusion criteria, and follow-up was available for 42 (87.5%) at 53.2 ± 31.6 months (mean ± SD). Elite athletes with coexisting LBP demonstrated significant improvements in all recorded PROs and achieved the MCID and PASS for the HOS-SSS at rates of 82.5% and 67.5%, respectively. They also returned to sports at a high rate (75.8%), and 79% of them did not report LBP postoperatively. PROs, rates of achieving the MCID and PASS for the HOS-SSS, and RTS rates were similar between the study group and propensity-matched control group. Conclusion: Elite athletes with coexisting LBP who undergo primary hip arthroscopy for FAIS may expect favorable PROs, rates of achieving the MCID and PASS for the HOS-SSS, and RTS rates at minimum 2-year follow-up. These results were comparable to those of a propensity-matched control group of elite athletes without back pain. In athletes with hip-spine syndrome, successful treatment of their hip pathology may help resolve their back pain.

scholarly journals Limited lumbopelvic mobility does not influence short-term outcomes after primary hip arthroscopy: a propensity-matched controlled study

2021 ◽  
Author(s):  
Andrew E Jimenez ◽  
James D Fox ◽  
Kara Miecznikowski ◽  
David R Maldonado ◽  
Benjamin R Saks ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Matched Control ◽  
Harris Hip Score ◽  
Controlled Study ◽  
Control Group ◽  
Sacral Slope ◽  
Short Term ◽  
Matched Control Group ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported

ABSTRACT There is a paucity of literature investigating the effect of lumbopelvic mobility on patient-reported outcome scores (PROs) after primary hip arthroscopy. The purpose of this study was (i) to report minimum 1-year PROs in patients with limited lumbopelvic mobility (LM) who underwent primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and (ii) to compare clinical results with a propensity-matched control group of patients with normal lumbopelvic mobility (NM). Data were reviewed for surgeries performed between November 2019 and March 2020. Patients were considered eligible if they received a primary hip arthroscopy for FAIS in the setting of LM (seated to standing change in sacral slope ≤ 10°). LM patients were propensity-matched to a control group of patients with normal lumbopelvic motion (seated to standing change in sacral slope &gt; 10°) for comparison. A total of 17 LM and 34 propensity-matched NM patients were included in the study. LM patients showed significant improvement in all outcome measures and achieved the minimum clinically important difference (MCID) and patient acceptable symptomatic state (PASS) at high rates for modified Harris Hip Score (MCID: 94% and PASS: 82%) and International Hip Outcome Tool-12 (iHOT-12; MCID: 94% and iHOT-12: 76%). When LM patients were compared to a propensity-matched control group of NM patients, they demonstrated similar postoperative PROs and rates of achieving MCID/PASS. LM patients who undergo primary hip arthroscopy may expect favorable short-term PROs at minimum 1-year follow-up. These results were comparable to a control group of NM patients.

Achieving Successful Outcomes in High-Level Athletes With Borderline Hip Dysplasia Undergoing Hip Arthroscopy With Capsular Plication and Labral Preservation: A Propensity-Matched Controlled Study

2021 ◽  
pp. 036354652110210
Author(s):  
Andrew E. Jimenez ◽  
Peter F. Monahan ◽  
Kara B. Miecznikowski ◽  
Benjamin R. Saks ◽  
Hari K. Ankem ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Matched Control ◽  
Control Group ◽  
Acetabular Coverage ◽  
Center Edge ◽  
Labral Pathology ◽  
High Level ◽  
Lateral Center Edge Angle ◽  
Center Edge Angle

Background: Return to sports (RTS) rates and patient-reported outcomes (PROs) after hip arthroscopy in athletes with borderline dysplasia (BD) have not been established. Purpose: (1) To report minimum 2-year PROs and RTS rates in high-level athletes with BD who underwent hip arthroscopy for labral pathology in the setting of microinstability and (2) to compare clinical results with those of a matched control group of athletes with normal acetabular coverage. Study Design: Cohort study; Level of evidence, 3. Methods: Data were reviewed for surgery performed between January 2012 and July 2018. Patients were considered eligible if they received a primary hip arthroscopy in the setting of BD (lateral center-edge angle, 18°-25°) and competed in professional, collegiate, or high school sports. Inclusion criteria included preoperative and minimum 2-year follow-up scores for the modified Harris Hip Score, Non-arthritic Hip Score, Hip Outcome Score–Sport Specific Subscale, and visual analog scale for pain. Athletes with BD were matched to a control group of athletes with normal acetabular coverage (lateral center-edge angle, 25°-40°). Results: A total of 65 patients with BD were included in the study with a mean ± standard deviation follow-up of 47.5 ± 20.4 months. Athletes with BD showed significant improvement in all outcome measures recorded, demonstrated high RTS rates (80.7%), and achieved the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) for the Hip Outcome Score–Sport Specific Subscale at high rates (MCID, 90.8%; PASS, 75.4%). When compared with a propensity-matched control group with normal acetabular coverage, capsular plication was performed more commonly in the BD group (93.8% vs 82.7%; P = .037). PROs and RTS, PASS, and MCID rates were similar between the BD and control groups ( P > .05). Conclusion: High-level athletes with BD who undergo primary hip arthroscopy for labral pathology in the setting of microinstability may expect favorable PROs and RTS rates at minimum 2-year follow-up. These results were comparable with those of a control group of athletes with normal coverage.

Return to Sports and Minimum 2-Year Outcomes of Primary Arthroscopic Hip Labral Reconstruction for Irreparable Tears in High-Level Athletes With a Propensity-Matched Benchmarking Against a Labral Repair Control Group

2021 ◽  
pp. 036354652110325
Author(s):  
Andrew E. Jimenez ◽  
Peter F. Monahan ◽  
Jade S. Owens ◽  
David R. Maldonado ◽  
Benjamin R. Saks ◽  
...  
Keyword(s):  
Return To Sport ◽  
Labral Repair ◽  
Harris Hip Score ◽  
Control Group ◽  
Return To Sports ◽  
Level Of Evidence ◽  
Labral Tears ◽  
Patient Reported ◽  
High Level

Background: Labral reconstruction has shown promise for the treatment of irreparable labral tears in high-level athletes. The literature is scarce regarding outcomes and timing of return to sports (RTS) in these patients. Purpose: (1) To report minimum 2-year patient-reported outcome (PRO) scores and RTS characteristics for high-level athletes undergoing primary labral reconstruction for irreparable labral tears and (2) to compare clinical results with a matched control group of athletes undergoing labral repair. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed for high school, college, and professional athletes who underwent a primary arthroscopic labral reconstruction between January 2010 and June 2018. Minimum 2-year PROs were compared for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and Hip Outcome Score–Sport Specific Subscale (HOS-SSS), as well as the visual analog scale (VAS) pain score, patient satisfaction, and RTS. The percentages of patients achieving the Patient Acceptable Symptom State (PASS) and minimal clinically important difference (MCID) for the mHHS (PASS, >74 points; MCID, >8 points) and HOS-SSS (PASS, >75 points; MCID, >6 points) were also recorded. These patients were propensity score matched in a 1:3 ratio to other high-level athletes undergoing labral repair. Results: A total of 17 high-level athletes with primary arthroscopic labral reconstruction were included with a median follow-up time of 37.1 months (95% CI, 37.2-60.3 months). They demonstrated significant improvement from preoperatively to the latest follow-up for mHHS, NAHS, HOS-SSS, and VAS for pain ( P < .05). Further, patients achieved PASS/MCID for mHHS at high rates (PASS, 84.2%; MCID, 68.4%). Athletes were able to return to sport-specific training at a median of 3.33 months (95% CI, 3.07-4.71 months) and RTS at a median of 6.2 months (95% CI, 5.08-11.98 months). Fourteen (82.4%) of reconstructions and 29 (82.8%) of repairs either returned to sport or decided not to do so for reasons unrelated to the hip. PROs, RTS rate, and PASS/MCID rates were similar between the labral reconstruction group and a control labral repair group ( P > .05). Conclusion: Primary arthroscopic labral reconstruction for irreparable labral tears was associated with significant improvement in PROs and high rates of RTS in high-level athletes. These results were comparable with those of a control group of athletes undergoing labral repair.

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