Ashberg, Lyall

Purpose To compare the minimum 2‐year outcomes and return to sports in competitive athletes after arthroscopic iliopsoas fractional lengthening (IFL) and treatment for femoroacetabular impingement (FAI) to competitive athletes treated for FAI who did not undergo IFL. Methods Data were prospectively collected and retrospectively reviewed between November 2009 and April 2014. Included patients were high school, collegiate, or professional athletes who underwent arthroscopic IFL, treatment for FAI, and preoperative modified Harris Hip Score, Non‐Arthritic Athletic Hip Score, Hip Outcome Score–Sports Specific Subscale, and visual analog scale. Exclusion criteria were patients younger than 16 years, Tönnis grade >1, microfracture, abductor pathology, and previous hip conditions. A subgroup of athletes were matched to athletes who did not undergo IFL by age ± 5 years, sex, and body mass index ± 5. Results There were 75 athletes eligible for inclusion, 60 (80.0%) of whom had minimum 2‐year follow‐up. All patient‐reported outcome (PRO) scores demonstrated significant improvements at latest follow‐up ( P < .001). Mean satisfaction was 7.9. No patients converted to arthroplasty. Painful snapping was resolved in 55 athletes (91.7%). Nine athletes (15.0%) had nonpainful snapping at follow‐up. Thirty‐nine (65%) returned to their sport. Forty (66.7%) maintained or improved their competitive abilities. There was one case (1.6%) of temporary postoperative numbness. There were no complaints of weakness in hip flexion. Forty‐one IFL athletes were matched to 41 controls. No differences were detected in demographics, follow‐up time, intraoperative findings, procedures, mean magnitudes of improvement, or return to sports. Conclusions In competitive athletes, IFL during hip arthroscopy is safe and demonstrates favorable improvements in PROs and VAS, high satisfaction, and high rate of symptom resolution at a minimum of 2 years postoperatively. Most patients were able to return to sports and maintain or improve their competitive levels. These results were similar to a control group of athletes not requiring IFL. Level of Evidence Level III, case‐control study.

Purpose To evaluate the minimum 2‐year postoperative clinical outcomes and the rate of return to sports in athletes who underwent capsular plication for the treatment of ligamentous laxity and/or borderline dysplasia during hip arthroscopy for the treatment of femoroacetabular impingement and labral pathology. Methods Since 2008, data were prospectively collected on patients who underwent hip arthroscopy for the treatment of femoroacetabular impingement and/or labral tears. Inclusion criteria were as follows: athlete at the high school, collegiate, or professional levels preoperatively, underwent capsular plication, and preoperatively recorded patient‐reported outcome scores including modified Harris hip score (mHHS), nonarthritic athletic hip score (NAHS), hip outcome score—sports‐specific subscale (HOS‐SSS), and visual analog scale (VAS). Exclusion criteria were as follows: <16 years old, preoperative Tönnis grade >1, and previous hip conditions. Sports activity and competitive levels were collected at a minimum of 2 years postoperatively. Results Fifty‐one hips (49 patients) met the inclusion criteria, and 41 hips (39 patients) had minimum 2‐year follow‐up (80.4% follow‐up). Mean mHHS increased from 67.1 preoperatively to 83.5 ( P < .0001). Mean NAHS increased from 66.8 to 88.8 ( P < .0001). Mean HOS‐SSS improved from 46.8 to 80.1 ( P < .0001). Mean VAS decreased from 5.1 to 1.7 ( P < .0001). Thirty‐five (85.4%) hip arthroscopies allowed the patients to return to sports at follow‐up. Thirty‐four (82.9%) hip arthroscopies allowed the patients to maintain their competitive physical abilities at follow‐up. Conclusions Patient‐reported outcomes and VAS in athletes significantly improved at a minimum of 2 years after capsular plication as a part of hip arthroscopy addressing varying pathologies. In addition, most patients returned to sports at similar or higher competitive levels. These results suggest that capsular plication is a favorable treatment option in athletes with ligamentous laxity and/or borderline dysplasia. Level of Evidence Level IV, therapeutic case series.