Hip Arthroscopy Yields Favorable Outcome, Return-to-Sport Rate, and 5-Year Survivorship in Athletic Population With Generalized Ligamentous Laxity in the Treatment of Femoroacetabular Impingement and Labral Tears
Author(s):Quesada-Jimenez R, Shah PP, Strok MJ, Becker N, Kahana-Rojkind AH, Domb BG.
DOI Link: 10.1002/arj.70078
Background
Generalized ligamentous laxity (GLL) has been considered a potential risk factor for inferior outcomes after hip arthroscopy due to concerns regarding instability and soft-tissue integrity. Long-term comparative outcomes in athletic populations remain limited.
Methods
This retrospective comparative study evaluated athletic patients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome and labral tears. Patients with GLL (Beighton ≥4) were matched 1:1 to a control group without laxity (Beighton <3). Minimum 5-year patient-reported outcomes (mHHS, NAHS, HOS-SSS, iHOT-12, VAS), return-to-sport (RTS), MCID achievement, revision surgery, and survivorship were analyzed.
Key Findings
Both groups demonstrated significant improvement across all PROs (P < .01).
No significant differences were observed between GLL and control groups in postoperative PRO scores, MCID achievement, RTS rates, or survivorship.
In the GLL cohort:
- RTS rate was 83% at any postoperative time point
- 6% of those returning to sport were still active at 5 years
- Significant improvements were seen in mHHS (66.1→86.7), NAHS (67.6→87.0), iHOT-12 (40.1→78.2), HOS-SSS (45.0→79.7), and VAS (4.9→2.1)
Conclusion
Athletes with generalized ligamentous laxity achieve comparable long-term outcomes, survivorship, and return-to-sport rates following hip arthroscopy when compared to patients without laxity.
What Does This Mean for Providers?
GLL should not be considered a contraindication to hip arthroscopy in athletic patients with FAI and labral pathology. With appropriate surgical technique and patient selection, outcomes, survivorship, and RTS rates are comparable to non-lax patients. These findings support similar expectations and counseling across both cohorts, even in the presence of increased baseline instability risk.