Arthroscopic Treatment of Hip Pain in Adolescent Patients With Borderline Dysplasia of the Hip: Minimum 2-Year Follow-Up


      To examine arthroscopic treatment of hip pain in patients with borderline hip dysplasia (lateral center edge angle [LCEA] between 20° and 25°).


      From 2008 to 2013, patients below 18 years of age who underwent arthroscopic hip surgery with an LCEA between 20° and 25° were retrospectively matched 1:1 to a control group without dysplasia (LCEA ≥25°) based on age, gender, femoroplasty, labral treatment, and capsular plication. Indications for surgery included failure to improve with nonoperative treatments and anti-inflammatory medications after 3 months. Patient-reported outcome data were collected using modified Harris hip score, hip outcome score—activities of daily living subscale, hip outcome score—sports-specific subscale, nonarthritic athletic hip score, and visual analog scale.


      From 2008 to 2013, 168 patients below the age of 18 underwent arthroscopic hip surgery. Twenty-one patients met inclusion criteria and were matched 1:1 to a control group. Follow-up was achieved for 17 patients in both groups (81%). Mean follow-up time, age, and LCEA were 2.19 years, 15.5 years, and 22.3° for the dysplastic group and 2.16 years, 16.0 years, and 31.2° for the control group, respectively. Preoperative patient-reported outcomes between groups were not statistically different. At the latest follow-up, both groups showed statistically significant improvement over baseline in modified Harris hip score, hip outcome score—activities of daily living subscale, hip outcome score—sports-specific subscale, nonarthritic athletic hip score, and visual analog scale (P < .001). Latest follow-up scores were not statistically different between groups.


      This study shows favorable 2-year outcomes in adolescent patients with borderline dysplasia undergoing labral treatment and capsular plication. Outcomes in the borderline dysplastic patients were as good as those of a control group. Although adolescents with borderline dysplasia have traditionally been a challenging group of patients to treat, these results suggest that an arthroscopic approach that addresses both labral pathology and instability may be beneficial.

      Level of Evidence

      Level IV, therapeutic case series.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Boykin R.E.
        • Anz A.W.
        • Bushnell B.D.
        • Kocher M.S.
        • Stubbs A.J.
        • Philippon M.J.
        Hip instability.
        J Am Acad Orthop Surg. 2011; 19: 340-349
        • 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
        • Landa J.
        • Benke M.
        • Feldman D.S.
        The limbus and the neolimbus in developmental dysplasia of the hip.
        Clin Orthop Relat Res. 2008; 466: 776-781
        • Shu B.
        • Safran M.R.
        Hip instability: Anatomic and clinical considerations of traumatic and atraumatic instability.
        Clin Sports Med. 2011; 30: 349-367
        • Aronson J.
        Osteoarthritis of the young adult hip: Etiology and treatment.
        Instr Course Lect. 1986; 35: 119-128
        • Klaue K.
        • Durnin C.W.
        • Ganz R.
        The acetabular rim syndrome. A clinical presentation of dysplasia of the hip.
        J Bone Joint Surg Br. 1991; 73: 423-429
        • Bowman Jr., K.F.
        • Fox J.
        • Sekiya J.K.
        A clinically relevant review of hip biomechanics.
        Arthroscopy. 2010; 26: 1118-1129
        • Byrd J.W.
        • Jones K.S.
        Prospective analysis of hip arthroscopy with 10-year followup.
        Clin Orthop Relat Res. 2010; 468: 741-746
        • Byrd J.W.
        • Jones K.S.
        Arthroscopic management of femoroacetabular impingement: Minimum 2-year follow-up.
        Arthroscopy. 2011; 27: 1379-1388
        • Nho S.J.
        • Magennis E.M.
        • Singh C.K.
        • Kelly B.T.
        Outcomes after the arthroscopic treatment of femoroacetabular impingement in a mixed group of high-level athletes.
        Am J Sports Med. 2011; 39: 14S-19S
        • Philippon M.J.
        • Yen Y.M.
        • Briggs K.K.
        • Kuppersmith D.A.
        • Maxwell R.B.
        Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient: A preliminary report.
        J Pediatr Orthop. 2008; 28: 705-710
        • Byrd J.W.
        • Jones K.S.
        Hip arthroscopy in the presence of dysplasia.
        Arthroscopy. 2003; 19: 1055-1060
        • Parvizi J.
        • Bican O.
        • Bender B.
        • et al.
        Arthroscopy for labral tears in patients with developmental dysplasia of the hip: A cautionary note.
        J Arthroplasty. 2009; 24: 110-113
        • Kalore N.V.
        • Jiranek W.A.
        Save the torn labrum in hips with borderline acetabular coverage.
        Clin Orthop Relat Res. 2012; 470: 3406-3413
        • 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
        • Jayasekera N.
        • Aprato A.
        • Villar R.N.
        Hip arthroscopy in the presence of acetabular dysplasia.
        Open Orthop J. 2015; 9: 185-187
        • 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
        • Clohisy J.C.
        • Carlisle J.C.
        • Beaule P.E.
        • et al.
        A systematic approach to the plain radiographic evaluation of the young adult hip.
        J Bone Joint Surg Am. 2008; 90: 47-66
        • Domb B.G.
        • Stake C.E.
        • Finley Z.J.
        • Chen T.
        • Giordano B.D.
        Influence of capsular repair versus unrepaired capsulotomy on 2-year clinical outcomes after arthroscopic hip preservation surgery.
        Arthroscopy. 2015; 31: 643-650
        • Byrd J.W.
        • Jones K.S.
        Prospective analysis of hip arthroscopy with 2-year follow-up.
        Arthroscopy. 2000; 16: 578-587
        • Christensen C.P.
        • Althausen P.L.
        • Mittleman M.A.
        • Lee J.A.
        • McCarthy J.C.
        The nonarthritic hip score: Reliable and validated.
        Clin Orthop Relat Res. 2003; : 75-83
        • Martin R.L.
        • Philippon M.J.
        Evidence of validity for the hip outcome score in hip arthroscopy.
        Arthroscopy. 2007; 23: 822-826
        • Tijssen M.
        • van Cingel R.
        • van Melick N.
        • de Visser E.
        Patient-reported outcome questionnaires for hip arthroscopy: A systematic review of the psychometric evidence.
        BMC Musculoskelet Disord. 2011; 12: 117
        • Lodhia P.
        • Slobogean G.P.
        • Noonan V.K.
        • Gilbart M.K.
        Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology: A systematic review of the clinimetric evidence.
        Arthroscopy. 2011; 27: 279-286
        • Murphy S.B.
        • Ganz R.
        • Muller M.E.
        The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome.
        J Bone Joint Surg Am. 1995; 77: 985-989
        • Sekiya J.K.
        • Willobee J.A.
        • Miller M.D.
        • Hickman A.J.
        • Willobee A.
        Arthroscopic multi-pleated capsular plication compared with open inferior capsular shift for reduction of shoulder volume in a cadaveric model.
        Arthroscopy. 2007; 23: 1145-1151
        • Bedi A.
        • Galano G.
        • Walsh C.
        • Kelly B.T.
        Capsular management during hip arthroscopy: From femoroacetabular impingement to instability.
        Arthroscopy. 2011; 27: 1720-1731
        • Kocher M.S.
        • Kim Y.J.
        • Millis M.B.
        • et al.
        Hip arthroscopy in children and adolescents.
        J Pediatr Orthop. 2005; 25: 680-686
        • Philippon M.J.
        • Ejnisman L.
        • Ellis H.B.
        • Briggs K.K.
        Outcomes 2 to 5 years following hip arthroscopy for femoroacetabular impingement in the patient aged 11 to 16 years.
        Arthroscopy. 2012; 28: 1255-1261
        • Fabricant P.D.
        • Bedi A.
        • De La Torre K.
        • Kelly B.T.
        Clinical outcomes after arthroscopic psoas lengthening: The effect of femoral version.
        Arthroscopy. 2012; 28: 965-971