An Intact Ligamentum Teres Predicts a Superior Prognosis in Patients With Borderline Dysplasia: A Matched-Pair Controlled Study With Minimum 5-Year Outcomes After Hip Arthroscopic Surgery

Abstract

Background: Hip arthroscopic surgery in patients with borderline dysplasia continues to be controversial. In addition, it has been suggested that ligamentum teres (LT) tears may lead to inferior short-term patient-reported outcomes (PROs) when compared with a match-controlled group. Purposes: (1) To report minimum 5-year PROs in patients with borderline dysplasia and LT tears who underwent hip arthroscopic surgery and (2) to compare these PROs to those of a matched-pair control group of patients with borderline dysplastic hips without LT tears. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected for patients who underwent hip arthroscopic surgery between September 2008 and August 2013. Patients were included if they had a preoperative diagnosis of borderline dysplasia (lateral center-edge angle [LCEA], 18°-25°) and had preoperative and minimum 5-year postoperative modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and visual analog scale (VAS) for pain scores. Exclusion criteria were osteoarthritis of Tönnis grade >1, previous hip conditions, any previous ipsilateral hip surgery, or workers’ compensation status. There were 2 borderline dysplastic groups created. An LT tear group was matched 1:1 to a control group (no LT tear) with similar age, sex, body mass index (BMI), and laterality via propensity score matching. Significance was set at P < .05. Results: A total of 24 patients with an LT tear (24 hips) were matched to 24 patients without an LT tear (24 hips). There was no significant difference in age, sex, BMI, or laterality between groups. The mean age was 36.2 ± 17.2 and 34.9 ± 15.9 years for the control and LT tear groups, respectively ( P = .783). There were 17 (70.8%) and 16 (66.7%) female patients in the control and LT tear groups, respectively, and the mean preoperative LCEA was 23.3° and 22.2° in the control and LT tear groups, respectively. No differences were observed between groups in baseline PROs, intraoperative findings, or surgical procedures. LT debridement was performed in 17 (70.8%) patients in the LT tear group compared with 0 (0.0%) in the control group. Also, 5-year postoperative PROs were comparable in both groups, with the control group exhibiting superior Veterans RAND 12-Item Health Survey (VR-12) mental ( P = .041) and Short Form–12 (SF-12) mental ( P = .042) scores. Finally, hips with an intact LT were significantly more likely ( P = .022) to achieve the patient acceptable symptomatic state (PASS) for the mHHS (100.0% and 75.0%, respectively). No significant differences were present between the groups for the minimal clinically important difference (MCID) of the mHHS ( P = .140), MCID of the Hip Outcome Score–Sport-Specific Subscale (HOS-SSS) ( P = .550), or PASS of the HOS-SSS ( P = .390). Conclusion: After hip arthroscopic surgery, patients with borderline dysplasia and LT tears demonstrated favorable PROs at a minimum 5-year follow-up. Outcomes were similar to a matched-pair control group without LT tears, with the group with intact LTs showing higher VR-12 mental and SF-12 mental scores. Furthermore, patients with borderline dysplasia and intact LTs were significantly more likely to achieve the PASS for the mHHS.

Revision Hip Arthroscopy in the Borderline Dysplastic Population: Reporting Outcomes With Minimum 2-Year Follow-up, With a Subanalysis Against a Propensity-Matched Nondysplastic Control Group

“…Furthermore, the definition of borderline dysplasia varies across the literature, and the cutoff values used in the present study, albeit previously reported, may be perceived as arbitrary. 6,31 Arthroscopic management of patients with acetabular borderline dysplasia has evolved toward capsular plication and labral reconstruction/augmentation (when labral repair is not amenable), instead of capsulotomy without repair and selective labral debridement. 13,28 Therefore, while the borderline dysplasia and control groups contain patients who underwent labral selective debridement, patients with the same surgical findings in the current day would be treated with a labral restoration alternative.…”

“…Patients were excluded if they had a Tönnis grade >1 or previous hip conditions (Legg-Calve-Perthes disease, avascular necrosis, or slipped capital femoral epiphysis). Two groups were created: the study group with borderline dysplasia defined as a lateral center-edge angle (LCEA) between 18° and 25° (Figure 1) 31 and a control group with normal coverage (LCEA, 26°-40°). This study was approved by an institutional review board.…”

“…54 However, hip arthroscopy has been demonstrated to be a safe surgical alternative for managing intra-articular abnormalities in the setting of borderline acetabular dysplasia at short- and midterm follow-up. 11,16,26,31 Alternatively, periacetabular osteotomy (PAO) has shown promise for short-term outcomes as well. 22,38 When arthroscopic management is used for this population, variables such as acetabular inclination, Tönnis grade for osteoarthritis, generalized ligamentous laxity, excessive femoral anteversion, and ligamentum teres tears have been established as potential risk factors for failure or conversion to total hip arthroplasty (THA).…”

Editorial Commentary: “Loose Lips Sink Ships”–But What About “Loose Hips”?

“…Recent literature has suggested that LT tears may portend an inferior outcome. This past March, Maldonado et al 12 reported on 5-year outcomes of a matched-pair study comparing patients with and without LT tears in association with borderline dysplasia. Although the patient reported outcomes were generally favorable for both groups, the group undergoing LT debridement for tears had inferior patient acceptable symptomatic states for the modified Harris Hip Score (75% vs 100% of the control group).…”

“…Although the patient reported outcomes were generally favorable for both groups, the group undergoing LT debridement for tears had inferior patient acceptable symptomatic states for the modified Harris Hip Score (75% vs 100% of the control group). 12 Limited reports of LT reconstruction have offered a new treatment option that has had generally favorable outcomes. 13,14 Hip arthroscopy in patients with EDS has also been reported.…”