Original Article
Competitive Athletes Who Underwent Hip Arthroscopy With Capsular Repair Showed Greater Improvement in Patient-Reported Outcome Scores Compared With Those Who Did Not Undergo Repair

https://doi.org/10.1016/j.arthro.2022.04.010Get rights and content

Purpose

To compare minimum 2-year postoperative patient-reported outcome (PRO) scores and return to sport between competitive athletes undergoing primary hip arthroscopy for femoroacetabular impingement syndrome with interportal capsulotomy repair and competitive athletes with an unrepaired interportal capsulotomy.

Methods

Data on all consecutive competitive athletes who underwent primary hip arthroscopy for femoroacetabular impingement syndrome between February 2012 and December 2018 were collected. Athletes were divided into 2 groups: those who underwent repair and those without repair. Athletes were considered eligible if they participated in sports within 1 year prior to surgery. Patients were eligible if the return-to-sport status and the following preoperative and minimum 2-year postoperative PROs were available: modified Harris Hip Score, Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), and visual analog scale (VAS) score for pain. Patients were excluded if they underwent prior hip surgery, had Workers’ Compensation, were unwilling to consent, had a Tönnis grade greater than 1, or had a previous hip condition. The percentages of patients achieving the minimal clinically important difference (MCID) and maximum outcome improvement satisfaction threshold were recorded. Athletes who underwent interportal capsulotomy repair were propensity score matched in a ratio of 2:1 to athletes without interportal capsulotomy repair according to age, sex, body mass index, sport level, and acetabular labrum articular disruption grade.

Results

Forty-nine athletes (53 hips) without repair with an average follow-up time of 36.5 ± 10.2 months and age of 32.1 ± 13.3 years were matched to 79 athletes (84 hips) with repair with an average follow-up time of 41.3 ± 9.4 months and age of 30.1 ± 12.1 years. Athletes in the repaired group showed significantly greater improvements in the NAHS, HOS-SSS, and VAS score and significantly higher rates of achievement of the MCID for the HOS-SSS compared with athletes in the unrepaired group.

Conclusions

Competitive athletes who underwent primary hip arthroscopy with interportal capsulotomy repair showed a significantly greater magnitude of improvement in PRO scores (NAHS, HOS-SSS, and VAS score) and rates of achieving the MCID (HOS-SSS) compared with a propensity score–matched control group of competitive athletes with an unrepaired interportal capsulotomy.

Level of Evidence

Level III, retrospective comparative therapeutic trial.

Section snippets

Patient Selection Criteria

All data for this research study were retrospectively reviewed and prospectively collected from competitive athletes (professional, collegiate, high school, and organized amateur) undergoing primary hip arthroscopy for FAIS during the study period between February 2012 and December 2018. Eligible patients completed preoperative and minimum 2-year postoperative questionnaires for the following PRO scores: modified Harris Hip Score (mHHS),8 Nonarthritic Hip Score (NAHS),9 Hip Outcome

Demographic Characteristics

Three thousand twenty-nine hip arthroscopy cases were performed during the study period, and 2,419 cases were eligible for 2-year follow-up. Of these cases, 246 were excluded because they were revision cases, 306 were excluded for having previous hip conditions, and 21 were excluded for having a Tönnis grade greater than 1. In addition, we excluded 115 cases because patients had Workers’ Compensation and 1,291 cases because patients were not competitive athletes. Finally, 22 cases were excluded

Discussion

The main findings of this study were that competitive athletes who underwent primary hip arthroscopy for FAIS with interportal capsulotomy repair showed significantly greater improvements in the NAHS, HOS-SSS, and VAS score at minimum 2-year follow-up compared with athletes who underwent primary hip arthroscopy for FAIS with an unrepaired interportal capsulotomy. Furthermore, repaired athletes showed higher rates of achieving the MCID for the HOS-SSS compared with unrepaired athletes. Finally,

Conclusions

Competitive athletes who underwent primary hip arthroscopy with interportal capsulotomy repair showed a significantly greater magnitude of improvement in PRO scores (NAHS, HOS-SSS, and VAS score) and rates of achieving the MCID (HOS-SSS) compared with a propensity score–matched control group of competitive athletes with an unrepaired interportal capsulotomy.

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    See commentary on page 3041

    The authors report the following potential conflicts of interest or sources of funding: D.R.M. receives travel and lodging support from Arthrex, Stryker, and Smith & Nephew, outside the submitted work; receives food and beverage payments from Arthrex, Stryker, Smith & Nephew, and Össur, outside the submitted work; and is an editorial board member of Arthroscopy. B.G.D. reports that the American Orthopedic Foundation provides grant support that pays staff and expenses related to all research. In addition, B.G.D. receives consulting fees from Arthrex, Medacta, and Stryker; receives research support from ATI Physical Therapy; receives research and education support from Arthrex, Medacta, and Stryker; receives educational support from Arthrex, Breg, Medwest Associates, St. Alexius Medical Center, and Ossur; receives royalties from Amplitude, Arthrex, DJO Global, Medacta, Stryker, and Orthomerica; receives speaking fees from Arthrex; receives travel and lodging support from Arthrex, Medacta, Stryker, and Prime Surgical; receives food and beverage payments from Arthrex, DJO Global, Medacta, Stryker, Zimmer Biomet, DePuy Synthes Sales, Medtronic, and Trice Medical; receives honoraria from Medacta; receives nonconsulting fees from Stryker; and has a medical directorship with St. Alexius Medical Center, outside the submitted work. Moreover, B.G.D. has patents issued and receives royalties for the following: method and instrumentation for acetabular labrum reconstruction (8920497), licensed by Arthrex; adjustable multi-component hip orthosis (8708941), licensed by Orthomerica and DJO Global; and knotless suture anchors and methods of suture repair (9737292), licensed by Arthrex. Finally, B.G.D. is a board member of the American Hip Institute Research Foundation, AANA Learning Center Committee, Journal of Hip Preservation Surgery, and Arthroscopy and has had ownership interests in the American Hip Institute, Hinsdale Orthopedic Associates, Hinsdale Orthopedic Imaging, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

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