Outcomes of Hip Arthroscopy in Competitive Athletes


      To evaluate the minimum 2-year postoperative clinical outcomes and the rate of return to sports in athletes who underwent capsular plication for the treatment of ligamentous laxity and/or borderline dysplasia during hip arthroscopy for the treatment of femoroacetabular impingement and labral pathology.


      Since 2008, data were prospectively collected on patients who underwent hip arthroscopy for the treatment of femoroacetabular impingement and/or labral tears. Inclusion criteria were as follows: athlete at the high school, collegiate, or professional levels preoperatively, underwent capsular plication, and preoperatively recorded patient-reported outcome scores including modified Harris hip score (mHHS), nonarthritic athletic hip score (NAHS), hip outcome score—sports-specific subscale (HOS-SSS), and visual analog scale (VAS). Exclusion criteria were as follows: <16 years old, preoperative Tönnis grade >1, and previous hip conditions. Sports activity and competitive levels were collected at a minimum of 2 years postoperatively.


      Fifty-one hips (49 patients) met the inclusion criteria, and 41 hips (39 patients) had minimum 2-year follow-up (80.4% follow-up). Mean mHHS increased from 67.1 preoperatively to 83.5 (P < .0001). Mean NAHS increased from 66.8 to 88.8 (P < .0001). Mean HOS-SSS improved from 46.8 to 80.1 (P < .0001). Mean VAS decreased from 5.1 to 1.7 (P < .0001). Thirty-five (85.4%) hip arthroscopies allowed the patients to return to sports at follow-up. Thirty-four (82.9%) hip arthroscopies allowed the patients to maintain their competitive physical abilities at follow-up.


      Patient-reported outcomes and VAS in athletes significantly improved at a minimum of 2 years after capsular plication as a part of hip arthroscopy addressing varying pathologies. In addition, most patients returned to sports at similar or higher competitive levels. These results suggest that capsular plication is a favorable treatment option in athletes with ligamentous laxity and/or borderline dysplasia.

      Level of Evidence

      Level IV, therapeutic case series.
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        • Telleria J.J.M.
        • Lindsey D.P.
        • Giori N.J.
        • Safran M.R.
        A quantitative assessment of the insertional footprints of the hip joint capsular ligaments and their spanning fibers for reconstruction.
        Clin Anat. 2014; 27: 489-497
        • Bharam S.
        Labral tears, extra-articular injuries, and hip arthroscopy in the athlete.
        Clin Sports Med. 2006; 25 (ix): 279-292
        • Bellabarba C.
        • Sheinkop M.B.
        • Kuo K.N.
        Idiopathic hip instability. An unrecognized cause of coxa saltans in the adult.
        Clin Orthop Relat Res. 1998; : 261-271
        • Chandrasekaran S.
        • Vemula S.P.
        • Martin T.J.
        • Suarez-Ahedo C.
        • Lodhia P.
        • Domb B.G.
        Arthroscopic technique of capsular plication for the treatment of hip instability.
        Arthrosc Tech. 2015; 4: e163-e167
        • Hammoud S.
        • Bedi A.
        • Voos J.E.
        • Mauro C.S.
        • Kelly B.T.
        The recognition and evaluation of patterns of compensatory injury in patients with mechanical hip pain.
        Sports Health. 2014; 6: 108-118
        • Powers C.M.
        The influence of abnormal hip mechanics on knee injury: A biomechanical perspective.
        J Orthop Sports Phys Ther. 2010; 40: 42-51
        • Shindle M.K.
        • Ranawat A.S.
        • Kelly B.T.
        Diagnosis and management of traumatic and atraumatic hip instability in the athletic patient.
        Clin Sports Med. 2006; 25 (ix-x): 309-326
        • Feeley B.T.
        • Powell J.W.
        • Muller M.S.
        • Barnes R.P.
        • Warren R.F.
        • Kelly B.T.
        Hip injuries and labral tears in the national football league.
        Am J Sports Med. 2008; 36: 2187-2195
        • Byrd J.W.T.
        Hip arthroscopy in the athlete.
        Oper Tech Sports Med. 2012; 20: 310-319
        • Byrd J.W.T.
        • Jones K.S.
        Prospective analysis of hip arthroscopy with 10-year followup.
        Clin Orthop Relat Res. 2010; 468: 741-746
        • Shu B.
        • Safran M.R.
        Hip instability: Anatomic and clinical considerations of traumatic and atraumatic instability.
        Clin Sports Med. 2011; 30: 349-367
        • Byrd J.W.T.
        Evaluation of the hip: History and physical examination.
        North Am J Sports Phys Ther. 2007; 2: 231-240
        • Clohisy J.C.
        • Knaus E.R.
        • Hunt D.M.
        • Lesher J.M.
        • Harris-Hayes M.
        • Prather H.
        Clinical presentation of patients with symptomatic anterior hip impingement.
        Clin Orthop Relat Res. 2009; 467: 638-644
        • Byrd J.W.T.
        Evaluation and management of the snapping iliopsoas tendon.
        Instr Course Lect. 2006; 55: 347-355
        • Kutty S.
        • Schneider P.
        • Faris P.
        • et al.
        Reliability and predictability of the centre-edge angle in the assessment of pincer femoroacetabular impingement.
        Int Orthop. 2012; 36: 505-510
        • Sutter R.
        • Dietrich T.J.
        • Zingg P.O.
        • Pfirrmann C.W.A.
        How useful is the alpha angle for discriminating between symptomatic patients with cam-type femoroacetabular impingement and asymptomatic volunteers?.
        Radiology. 2012; 264: 514-521
        • Callaghan J.J.
        • Rosenberg A.G.
        • Rubash H.E.
        The adult hip.
        Lippincott Williams & Wilkins, Philadelphia2007
        • Outerbridge R.E.
        The etiology of chondromalacia patellae.
        J Bone Joint Surg Br. 1961; 43: 752-757
        • Seldes R.M.
        • Tan V.
        • Hunt J.
        • Katz M.
        • Winiarsky R.
        • Fitzgerald R.H.
        Anatomy, histologic features, and vascularity of the adult acetabular labrum.
        Clin Orthop Relat Res. 2001; : 232-240
        • van Arkel R.J.
        • Amis A.A.
        • Cobb J.P.
        • Jeffers J.R.T.
        The capsular ligaments provide more hip rotational restraint than the acetabular labrum and the ligamentum teres.
        J Bone Joint Br. 2015; 97: 484-491
        • Byrd J.W.T.
        • Jones K.S.
        Adhesive capsulitis of the hip.
        Arthroscopy. 2006; 22: 89-94
        • Guilleminet
        [Capsulectomy in the treatment of coxarthritis].
        Mém Académie Chir Fr. 1950; 76: 128-138
        • Martin H.D.
        • Savage A.
        • Braly B.A.
        • Palmer I.J.
        • Beall D.P.
        • Kelly B.
        The function of the hip capsular ligaments: A quantitative report.
        Arthroscopy. 2008; 24: 188-195
        • Philippon M.J.
        • Stubbs A.J.
        • Schenker M.L.
        • Maxwell R.B.
        • Ganz R.
        • Leunig M.
        Arthroscopic management of femoroacetabular impingement: Osteoplasty technique and literature review.
        Am J Sports Med. 2007; 35: 1571-1580
        • Philippon M.J.
        • Briggs K.K.
        • Yen Y.-M.
        • Kuppersmith D.A.
        Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: Minimum two-year follow-up.
        J Bone Joint Surg Br. 2009; 91: 16-23
        • Philippon M.J.
        • Schroder E.
        • Souza B.G.
        • Briggs K.K.
        Hip arthroscopy for femoroacetabular impingement in patients aged 50 years or older.
        Arthroscopy. 2012; 28: 59-65
        • Benali Y.
        • Katthagen B.D.
        Hip subluxation as a complication of arthroscopic debridement.
        Arthroscopy. 2009; 25: 405-407
        • Matsuda D.K.
        Acute iatrogenic dislocation following hip impingement arthroscopic surgery.
        Arthroscopy. 2009; 25: 400-404
        • Ranawat A.S.
        • McClincy M.
        • Sekiya J.K.
        Anterior dislocation of the hip after arthroscopy in a patient with capsular laxity of the hip. A case report.
        J Bone Joint Surg Am. 2009; 91: 192-197
        • Goldstein W.M.
        • Gleason T.F.
        • Kopplin M.
        • Branson J.J.
        Prevalence of dislocation after total hip arthroplasty through a posterolateral approach with partial capsulotomy and capsulorrhaphy.
        J Bone Joint Surg Am. 2001; 83: 2-7
        • Tsai S.-J.
        • Wang C.-T.
        • Jiang C.-C.
        The effect of posterior capsule repair upon post-operative hip dislocation following primary total hip arthroplasty.
        BMC Musculoskelet Disord. 2008; 9: 29
        • Van Warmerdam J.M.
        • McGann W.A.
        • Donnelly J.R.
        • Kim J.
        • Welch R.B.
        Achilles allograft reconstruction for recurrent dislocation in total hip arthroplasty.
        J Arthroplasty. 2011; 26: 941-948
        • Myers C.A.
        • Register B.C.
        • Lertwanich P.
        • et al.
        Role of the acetabular labrum and the iliofemoral ligament in hip stability: An in vitro biplane fluoroscopy study.
        Am J Sports Med. 2011; 39: 85S-91S
        • Domb B.G.
        • Stake C.E.
        • Lindner D.
        • El-Bitar Y.
        • Jackson T.J.
        Arthroscopic capsular plication and labral preservation in borderline hip dysplasia: Two-year clinical outcomes of a surgical approach to a challenging problem.
        Am J Sports Med. 2013; 41: 2591-2598
        • Domb B.G.
        • Philippon M.J.
        • Giordano B.D.
        Arthroscopic capsulotomy, capsular repair, and capsular plication of the hip: Relation to atraumatic instability.
        Arthroscopy. 2013; 29: 162-173
        • Ilizaliturri V.M.
        Complications of arthroscopic femoroacetabular impingement treatment: A review.
        Clin Orthop Relat Res. 2009; 467: 760-768