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Hip Microinstability: Understanding a Newly Defined Hip Pathology in Young Athletes

      Abstract: Microinstability is an increasingly recognized diagnosis in young athletes presenting with hip pain. Causes of microinstability may include abnormality of the hip bony anatomy, acetabular labral tears, joint capsule laxity or injury, and muscle dysfunction. Borderline hip dysplasia is an increasingly recognized factor predisposing to microinstability. The capsuloligamentous structures of the hip, particularly the iliofemoral ligament, provide important restraints to femoral head motion, and iatrogenic defects can predispose patients to instability after surgery. Injury to the acetabular labrum may disrupt its important hip-stabilizing properties including the suction seal and improved acetabular depth. Hip muscle weakness or imbalance may result in increased femoral head motion within the acetabulum. The diagnosis of hip microinstability can be challenging, and the history is often nonspecific. Physical examination maneuvers include the anterior apprehension, prone instability, axial distraction, and abduction-hyperextension-external rotation tests. Radiographic features may include borderline hip dysplasia, femoral head-neck junction cliff sign, and an elevated femoral-epiphyseal acetabular roof index. Magnetic resonance arthrography may demonstrate a capsular defect, capsular thinning, or labral pathology. Diagnostic intra-articular injection of anesthetic can confirm the intra-articular nature of the pathology. Management of hip microinstability focuses on strengthening the dynamic stabilizers of the hip through focused physical therapy. Surgery may be considered in recalcitrant cases where symptoms persist despite optimization of hip stabilizer strength. In such cases, addressing the primary source of instability through labral repair or reconstruction and capsular repair or plication can be considered. In highly selected cases, surgery can result in excellent outcomes.
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      Bibliography

        • 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
        • Hoppe D.J.
        • Truntzer J.N.
        • Shapiro L.M.
        • Abrams G.D.
        • Safran M.R.
        Diagnostic accuracy of 3 physical examination tests in the assessment of hip microinstability.
        Orthop J Sport Med. 2017; 5: 1-6
        • O’Neill D.C.
        • Mortensen A.J.
        • Cannamela P.C.
        • Aoki S.K.
        Clinical and radiographic presentation of capsular iatrogenic hip instability after previous hip arthroscopy.
        Am J Sports Med. 2020; 48: 2927-2932
        • Ortiz-Declet V.
        • Mu B.
        • Chen A.W.
        • et al.
        Should the capsule be repaired or plicated after hip arthroscopy for labral tears associated with femoroacetabular impingement or instability? A systematic review.
        Arthroscopy. 2018; 34: 303-318
        • Packer J.D.
        • Cowan J.B.
        • Rebolledo B.J.
        • Shibata K.R.
        • Riley G.M.
        • Finlay A.K.
        • Safran M.R.
        The Cliff sign: A new radiographic sign of hip instability.
        Orthop J Sports Med. 2018; 6: 1-7
        • Packer J.D.
        • Foster M.J.
        • Riley G.M.
        • et al.
        Capsular thinning on magnetic resonance arthrography is associated with intra-operative hip joint laxity in women.
        J Hip Preserv Surg. 2020; 7: 298-304
        • Truntzer J.N.
        • Hoppe D.J.
        • Shapiro L.M.
        • Safran M.R.
        Can the FEAR index be used to predict microinstability in patients undergoing hip arthroscopic surgery?.
        Am J Sports Med. 2019; 47: 3158-3165
        • Wylie J.D.
        • Beckmann J.T.
        • Maak T.G.
        • Aoki S.K.
        Arthroscopic capsular repair for symptomatic hip instability after previous hip arthroscopic surgery.
        Am J Sports Med. 2016; 44: 39-45