Arthroscopic Treatment of Labral Tears of the Hip in Adolescents: Patterns of Clinical Presentation, Intra-articular Derangements, Radiological Associations and Minimum 2-Year Outcomes
Purpose: To report on patterns of clinical presentation, intra-articular derangements, radiological associations, and minimum 2-year outcomes after hip arthroscopy (HA) in patients 18 years or younger.
Methods: This study was a retrospective case series on patients 18 years or younger who had undergone HA for labral tears that had failed nonoperative management from April 2008 to April 2013 with a minimum 2-year follow-up. Exclusion criteria were previous hip conditions or surgery. The following were recorded: demographic, examination, radiological and intraoperative findings, intraoperative procedures performed, patient-reported outcomes (PROs), and patient satisfaction. The PROs reported included the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Sport-Specific Subscale, Hip Outcome Score-Activities of Daily Living, and Visual Analogue Score for pain.
Results: One hundred and two patients satisfied the inclusion criteria, of whom 90 (88.2%, 77 females and 13 males) had minimum 2-year follow-up. Females had increased external rotation in flexion (58.9° vs 50.0°, P = .041). Sixty-eight females had a Beighton's score of >4 compared to 6 males (P < .001). There was no distinct pattern within the group or between genders for radiological markers of acetabular coverage, depth, or version and femoral cam size. Mean femoral anteversion for females was 15.7° and for males 11.3°. Females had significantly smaller labral tears (1.73 hours vs 2.34 hours on the acetabular clock face, P = .028). Females were more likely to require a capsular plication and iliopsoas fractional lengthening (88.3% vs 46.2%, and 77.9% vs 38.5%, respectively). There was a significant improvement in all PRO measures in both males and females (P < .01), but females had lower preoperative and postoperative scores. Mean preoperative and postoperative PROs for males and females were as follows: modified Harris Hip Score 71.0/94.3 and 63.4/88.8, Hip Outcome Score-Activities of Daily Living 78.1/93.4 and 64.0/91.8, Hip Outcome Score-Sport-Specific Subscale 51.7/91.0 and 45.7/78.6, Non-Arthritic Hip Score 78.1/94.5 and 63.1/89.2, and visual analog score 4.77/1.85 and 6.29/2.21. The mean patient satisfaction score was 8.29 out of 10. Five patients (5.56%) required a revision procedure.
Conclusions: HA is associated with improved outcomes and pain and high satisfaction scores at minimum 2-year follow-up in adolescent population. The pattern of labral injury is different in males and females and dictates the arthroscopic approach. Females are likely to require a capsular plication and iliopsoas release to address soft-tissue laxity and impingement.