Predictors of Achieving the Patient Acceptable Symptom State at 5 Years After Primary Hip Arthroscopy in High-Level Adult Athletes
Author(s):Owens JS, Lee MS, Jimenez AE, Harris WT, Domb BG.
DOI Link: 10.1177/03635465261436058
Background
Predictors of clinically meaningful outcomes following primary hip arthroscopy in high-level athletes remain incompletely defined, particularly at midterm follow-up. Identifying factors associated with achieving the patient acceptable symptom state (PASS) may help optimize surgical planning and outcomes.
Methods
This Level 3 case-control study analyzed prospectively collected data from 105 adult (≥18 years) high-level athletes undergoing primary hip arthroscopy for femoroacetabular impingement syndrome. Patients were stratified based on achievement of PASS for the Hip Outcome Score–Sports-Specific Subscale (HOS-SSS) at a minimum 5-year follow-up. Multivariate logistic regression identified independent predictors, and receiver operating characteristic (ROC) analysis determined threshold values.
Key Findings
80% (84/105) of athletes achieved PASS at ≥5-year follow-up.
Baseline characteristics, radiographic parameters, intraoperative findings, and procedures were similar between groups.
Postoperative alpha angle (OR 0.89; P = .021) and anterior center-edge angle (ACEA) (OR 1.20; P < .001) were independent predictors of achieving PASS.
ROC analysis demonstrated strong predictive ability (AUC = 0.814).
Thresholds associated with higher likelihood of achieving PASS:
Alpha angle <47°
ACEA >26°
Conclusion
Postoperative radiographic parameters—specifically alpha angle and ACEA—are significant predictors of achieving patient-acceptable outcomes at midterm follow-up in high-level athletes. These findings highlight the importance of precise bony correction during hip arthroscopy.
What Does This Mean for Providers?
Achieving optimal postoperative morphology is critical for maximizing functional outcomes in athletic populations. Surgeons should prioritize adequate cam resection (alpha angle <47°) and restoration of acetabular coverage (ACEA >26°) to improve the likelihood of patients reaching PASS. These data support the role of intraoperative imaging and meticulous correction to optimize long-term success in high-demand athletes.