Skip to main content
SpringerLink
Log in

What is the utility of hip arthroscopy in patients with joint laxity? A contemporary systematic review of patient-reported and surgical outcomes

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The purpose of this study was to systematically review the literature to understand the contemporary outcomes for patients with joint laxity managed with hip arthroscopy.

Materials and methods

A search was performed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement guidelines. All literature related to joint laxity in hip arthroscopy patients was identified. Inclusion criteria consisted of patient-reported outcomes and Beighton and Horan Joint Mobility Index scoring. Study quality was assessed using the Methodological Index of Non-Randomized Studies criteria.

Results

Seven articles were identified, including 412 patients (416 hips). Patients were predominantly female (range 83–100%). Mean patient age ranged from 13–69 years. Five studies consisting of 370 hips reported a range of 75 to 100% undergoing labral repair, 0 to 13% labral debridement, 0 to 7% labral reconstruction, 43 to 100% capsular closure, 94 to 99% femoroplasty, 3 to 80% rim resection, and 9 to 50% subspine decompression for surgical management. Post-operative follow-up range was 6–99 months. The mean range of improvement in Hip Outcomes Score Activities of Daily Living, Hip Outcomes Score-Sports Subscale, modified Harris Hip Score, Visual Analog Scale, and 12 item Short Form Health Survey were 17.6–31.3, 31.3–35.1, 22.5–53.8, − 2.79–8, and 12.4–16.9 respectively.

Conclusion

Generalized ligamentous laxity patients managed with hip arthroscopy were predominantly young women. At short-term follow-up, mean patient-reported outcomes were positive, with improvement postoperatively in activities of daily living, sports, and quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The datasets generated and analyzed during the current study are available in anonymized format from the corresponding author upon reasonable request.

References

  1. Russek LN, Errico DM (2016) Prevalence, injury rate and symptom frequency in generalized joint laxity and joint hypermobility syndrome in a “healthy” college population. Clin Rheumatol 35:1029–1039. https://doi.org/10.1007/s10067-015-2951-9

    Article  PubMed  Google Scholar 

  2. Atwell K, Michael W, Dubey J et al (2021) Diagnosis and management of hypermobility spectrum disorders in primary care. J Am Board Fam Med 34:838–848. https://doi.org/10.3122/JABFM.2021.04.200374

    Article  PubMed  Google Scholar 

  3. Armstrong R, Greig DM (2018) The Beighton score as a predictor of Brighton criteria in sport and dance. Phys Ther Sport 32:145–154. https://doi.org/10.1016/J.PTSP.2018.04.016

    Article  PubMed  Google Scholar 

  4. Castori M, Morlino S, Grammatico P (2014) Towards a re-thinking of the clinical significance of generalized joint hypermobility, joint hypermobiity syndrome, and Ehlers–Danlos syndrome, hypermobility type. Am J Med Genet A 164A:588–590. https://doi.org/10.1002/AJMG.A.36437

    Article  PubMed  Google Scholar 

  5. Guier C, Shi G, Ledford C et al (2020) Primary total hip arthroplasty in patients with Ehlers–Danlos syndrome: a retrospective matched-cohort study. Arthroplast Today 6:386–389. https://doi.org/10.1016/J.ARTD.2020.05.006

    Article  PubMed  PubMed Central  Google Scholar 

  6. Tibbo ME, Wyles CC, Houdek MT, Wilke BK (2019) Outcomes of primary total knee arthroplasty in patients with Ehlers–Danlos syndromes. J Arthroplasty 34:315–318. https://doi.org/10.1016/j.arth.2018.09.079

    Article  PubMed  Google Scholar 

  7. Moore HG, Burroughs PJ, Rubin LE et al (2022) Patients with Ehlers–Danlos syndromes experience higher rates of prosthetic dislocation after total hip arthroplasty and worse implant survival at 5 years. J Am Acad Orthop Surg 30:177–183. https://doi.org/10.5435/JAAOS-D-21-00347

    Article  PubMed  Google Scholar 

  8. Domb BG, Stake CE, Lindner D et al (2013) 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 41:2591–2598. https://doi.org/10.1177/0363546513499154

    Article  PubMed  Google Scholar 

  9. Domb BG, Philippon MJ, Giordano BD (2013) Arthroscopic capsulotomy, capsular repair, and capsular plication of the hip: relation to atraumatic instability. Arthroscopy 29:162–173. https://doi.org/10.1016/j.arthro.2012.04.057

    Article  PubMed  Google Scholar 

  10. Larson CM, Stone RM (2013) Current concepts and trends for operative treatment of FAI: hip arthroscopy. Curr Rev Musculoskelet Med. https://doi.org/10.1007/s12178-013-9170-2

    Article  PubMed  PubMed Central  Google Scholar 

  11. Naal FD, Hatzung G, Müller A (2014) Validation of a self-reported Beighton score to assess hypermobility in patients with femoroacetabular impingement. Int Orthop 38:2245–2250. https://doi.org/10.1007/s00264-014-2424-9

    Article  PubMed  Google Scholar 

  12. Dumont GD (2016) Hip instability: current concepts and treatment options. Clin Sports Med 35:435–447. https://doi.org/10.1016/J.CSM.2016.02.008

    Article  PubMed  Google Scholar 

  13. Ortiz-Declet V, Mu B, Chen AW et al (2018) Should the capsule be repaired or plicated after hip arthroscopy for labral tears associated with femoroacetabular impingement or instability? A systematic review. Arthroscopy 34:303–318. https://doi.org/10.1016/J.ARTHRO.2017.06.030

    Article  PubMed  Google Scholar 

  14. Abd Razak HR, Ali N, Howe T (2014) Generalized ligamentous laxity may be a predisposing factor for musculoskeletal injuries. J Sci Med Sport 17:474–478. https://doi.org/10.1016/J.JSAMS.2013.11.001

    Article  Google Scholar 

  15. Zeng X, Zhang Y, Kwong JSW et al (2015) The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. J Evid Based Med 8:2–10. https://doi.org/10.1111/JEBM.12141

    Article  PubMed  Google Scholar 

  16. Larson CM, McGaver RS, Collette NR et al (2019) Arthroscopic surgery for femoroacetabular impingement in skeletally immature athletes: radiographic and clinical analysis. Arthroscopy 35:1819–1825. https://doi.org/10.1016/j.arthro.2019.01.029

    Article  PubMed  Google Scholar 

  17. Kemp JL, Collins NJ, Roos EM, Crossley KM (2013) Psychometric properties of patient-reported outcome measures for hip arthroscopic surgery. Am J Sports Med 41:2065–2073. https://doi.org/10.1177/0363546513494173

    Article  PubMed  Google Scholar 

  18. Chahal J, Van Thiel GS, Mather RC et al (2015) The patient acceptable symptomatic state for the modified Harris hip score and hip outcome score among patients undergoing surgical treatment for femoroacetabular impingement. Am J Sports Med 43:1844–1849. https://doi.org/10.1177/0363546515587739

    Article  PubMed  Google Scholar 

  19. Cote MP, Lubowitz JH, Rossi MJ, Brand JC (2018) Reviews pooling heterogeneous, low-evidence, high-bias data result in incorrect conclusions: but heterogeneity is an opportunity to explore. Arthroscopy 34:3126–3128. https://doi.org/10.1016/j.arthro.2018.10.005

    Article  PubMed  Google Scholar 

  20. Hammarstedt J, Redmond J, Gupta A, Domb B (2015) Arthroscopic ligamentum teres reconstruction of the hip in Ehlers–Danlos syndrome: a case study. Hip Int 25:286–291

    Article  PubMed  Google Scholar 

  21. Larson C, Stone R, Grossi E et al (2015) Ehlers–Danlos syndrome: arthroscopic management for extreme soft-tissue hip instability. Arthroscopy 31:2287–2294. https://doi.org/10.1016/j.arthro.2015.06.005

    Article  PubMed  Google Scholar 

  22. Ukwuani G, Waterman B, Nwachukwu B et al (2019) Return to dance and predictors of outcome after hip arthroscopy for femoroacetabular impingement syndrome. Arthroscopy 35:1101-1108.e3. https://doi.org/10.1016/j.arthro.2018.10.121

    Article  PubMed  Google Scholar 

  23. Saadat AA, Lall AC, Battaglia MR et al (2019) Prevalence of generalized ligamentous laxity in patients undergoing hip arthroscopy: a prospective study of patients’ clinical presentation, physical examination, intraoperative findings, and surgical procedures. Am J Sports Med 47:885–893. https://doi.org/10.1177/0363546518825246

    Article  PubMed  Google Scholar 

  24. Stone AV, Mehta N, Beck EC et al (2019) Comparable patient-reported outcomes in females with or without joint hypermobility after hip arthroscopy and capsular plication for femoroacetabular impingement syndrome. J Hip Preserv Surg 6:33–40. https://doi.org/10.1093/jhps/hnz004

    Article  PubMed  PubMed Central  Google Scholar 

  25. Pontiff M, Ithurburn MP, Ellis T, et al (2016) Function and quality of life in women with and without generalized joint laxity undergoing hip arthroscopy for. 11:378–387

  26. Maldonado DR, Chen JW, Yelton MJ et al (2020) Achieving successful outcomes of hip arthroscopy in the setting of generalized ligamentous laxity with labral preservation and appropriate capsular management: a propensity matched controlled study. Am J Sports Med 48:1625–1635. https://doi.org/10.1177/0363546520914604

    Article  PubMed  Google Scholar 

  27. Demmler JC, Atkinson MD, Reinhold EJ et al (2019) Diagnosed prevalence of Ehlers–Danlos syndrome and hypermobility spectrum disorder in Wales, UK: a national electronic cohort study and case-control comparison. BMJ Open. https://doi.org/10.1136/bmjopen-2019-031365

    Article  PubMed  PubMed Central  Google Scholar 

  28. Maruyama S, Sekine C, Shagawa M et al (2022) Menstrual cycle changes joint laxity in females-differences between eumenorrhea and oligomenorrhea. J Clin Med. https://doi.org/10.3390/JCM11113222

    Article  PubMed  PubMed Central  Google Scholar 

  29. Cherni Y, Desseauve D, Decatoire A et al (2019) Evaluation of ligament laxity during pregnancy. J Gynecol Obstet Hum Reprod 48:351–357. https://doi.org/10.1016/J.JOGOH.2019.02.009

    Article  PubMed  Google Scholar 

  30. Muldoon M, Gosey G, Healey R, Santore R (2016) Hypermobility: a key factor in hip dysplasia. A prospective evaluation of 266 patients. J Hip Preserv Surg 1:2

    Google Scholar 

  31. Katz JN, Arant KR, Loeser RF (2021) Diagnosis and treatment of hip and knee osteoarthritis: a review. JAMA 325:568–578. https://doi.org/10.1001/JAMA.2020.22171

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Kalisvaart MM, Safran MR (2015) Microinstability of the hip–it does exist: etiology, diagnosis and treatment. J Hip Preserv Surg 2:123–135. https://doi.org/10.1093/jhps/hnv017

    Article  PubMed  PubMed Central  Google Scholar 

  33. O’Donnell JM, Arora M (2018) A novel and simple classification for ligamentum teres pathology based on joint hypermobility. J Hip Preserv Surg 5:113–118. https://doi.org/10.1093/jhps/hnx039

    Article  PubMed  Google Scholar 

  34. Devitt BM, Smith BN, Stapf R et al (2017) Generalized joint hypermobility is predictive of hip capsular thickness. Orthop J Sports Med 5:1–7. https://doi.org/10.1177/2325967117701882

    Article  Google Scholar 

  35. Duthon VB, Charbonnier C, Kolo FC et al (2013) Correlation of clinical and magnetic resonance imaging findings in hips of elite female ballet dancers. Arthroscopy 29:411–419. https://doi.org/10.1016/J.ARTHRO.2012.10.012

    Article  PubMed  Google Scholar 

  36. Mitchell RJ, Gerrie BJ, McCulloch PC et al (2016) Radiographic evidence of hip microinstability in elite ballet. Arthroscopy 32:1038-1044.e1. https://doi.org/10.1016/j.arthro.2015.12.049

    Article  PubMed  Google Scholar 

  37. Naal FD, Müller A, Varghese VD et al (2017) Outcome of hip impingement surgery: does generalized joint hypermobility matter? Am J Sports Med 45:1309–1314. https://doi.org/10.1177/0363546516688636

    Article  PubMed  Google Scholar 

  38. Brennan K, Spencer-Smith C, Villar R (2013) The influence of ligamentous laxity on the outcome of hip arthroscopy for femoroacetabular impingement. Arthroscopy 29:e213. https://doi.org/10.1016/j.arthro.2013.09.065

    Article  Google Scholar 

  39. Philippon MJ, Skendze JG, Herzog M et al (2013) Hip arthroscopy for FAI: predictors of patient satisfaction and conversion to total hip arthroplasty 5 to 7 years following arthroscopy. Orthop J Sports Med 1:2013. https://doi.org/10.1177/2325967113S00006

    Article  Google Scholar 

  40. Duplantier NL, McCulloch PC, Nho SJ et al (2016) Hip dislocation or subluxation after hip arthroscopy: a systematic review. Arthroscopy 32:1428–1434. https://doi.org/10.1016/j.arthro.2016.01.056

    Article  PubMed  Google Scholar 

  41. Sundemo D, Jacobsson MS, Karlsson J et al (2022) Generalized joint hypermobility does not influence 1-year patient satisfaction or functional outcome after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/S00167-022-07008-0

    Article  PubMed  PubMed Central  Google Scholar 

  42. Harris JD, Slikker W, Gupta AK et al (2013) Routine complete capsular closure during hip arthroscopy. Arthrosc Tech 2:e89–e94. https://doi.org/10.1016/j.eats.2012.11.007

    Article  PubMed  PubMed Central  Google Scholar 

  43. Frank RM, Lee S, Bush-Joseph CA et al (2014) Improved outcomes after hip arthroscopic surgery in patients undergoing t-capsulotomy with complete repair versus partial repair for femoroacetabular impingement: a comparative matched-pair analysis. Am J Sports Med 42:2634–2642. https://doi.org/10.1177/0363546514548017

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

None

Funding

No funding was received for our analysis.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mailcode A40, Cleveland, OH, 44195, USA

    Michael A. Gaudiani, Linsen T. Samuel, Robert J. Burkhart, Alexander J. Acuña, James T. Rosneck & Atul F. Kamath

Authors
  1. Michael A. Gaudiani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Linsen T. Samuel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert J. Burkhart
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexander J. Acuña
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. James T. Rosneck
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Atul F. Kamath
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MAG, LTS, RJB, and AJA were involved in the study concept and design. JTR and AJA were involved in the acquisition of data and analysis of the data. MAG, LTS, RJB, AJA, and AFK were involved in the drafting of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Atul F. Kamath.

Ethics declarations

Conflict of interest

A.F.K. reports the following disclosures: research support (Signature Orthopedics), paid presenter or speaker (DePuy Synthes and Zimmer Biomet), paid consultant (DePuy Synthes and Zimmer Biomet), stock or stock options (Zimmer Biomet, Johnson & Johnson, and Procter & Gamble), IP royalties (Innomed), and board or committee member (AAOS, AAHKS, and Anterior Hip Foundation M.A.G, L.T.S, R.J.B, A.J.A, and J.T.R have nothing to disclose.

Ethical approval

Our analysis included de-indefitied information from a publicly available dataset and therefore, IRB approval was not required.

Informed consent

Our analysis included de-indefitied information from a publicly available dataset and therefore, patient consent was not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gaudiani, M.A., Samuel, L.T., Burkhart, R.J. et al. What is the utility of hip arthroscopy in patients with joint laxity? A contemporary systematic review of patient-reported and surgical outcomes. Arch Orthop Trauma Surg 143, 5133–5142 (2023). https://doi.org/10.1007/s00402-022-04737-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-022-04737-2

Keywords

Search

Navigation