Arthroscopy - 2026-09-17 - Journal Article
Outcomes of Capsular Plication as Part of Hip Arthroscopic Management for Surgically Identified Microinstability Are Comparable to Outcomes in Matched Controls.
Bacon CJ, Auchterlonie RP, Woodward RM, Foo GL, Lu M, Lissaman AC, Brick MJ
Topics
Key Takeaway
Hip arthroscopy with capsular plication for surgically identified microinstability achieves MCID in 70.6–84.8% of patients, with revision and arthroplasty conversion rates of 1.65%/year and 0.27%/year respectively, comparable to propensity-matched FAI controls.
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Summary
This single-surgeon retrospective case-control study compared 2-year minimum PROs and reoperation rates between hip arthroscopy patients with intraoperatively confirmed microinstability treated with capsular plication versus propensity-matched controls (matched for sex, age, lateral center-edge angle, chondral defect grade). iHOT-12, NAHS, and HOOS scores were equivalent between groups at minimum 2-year follow-up, with only the HOOS-Sports subscale showing a minor trajectory difference (P=.045). MCID, PASS, and SCB thresholds did not differ between groups for any outcome measure (all P>.1).
Key Limitation
The microinstability group underwent surgery 2.61 years later than controls and had shorter mean follow-up (2.2 vs. 2.7 years), introducing a potential survivorship and disease-duration bias that may obscure differences in longer-term outcomes.
Original Abstract
PURPOSE
To compare 2-year minimum outcomes of hip arthroscopic management with capsular plication in patients with microinstability with propensity-matched controls.
METHODS
We searched primary hip arthroscopies undertaken between August 2009 and December 2020 from a single-surgeon database, excluding those with lateral center-edge angle <18°, for those with intraoperatively confirmed microinstability: having either increased ease of distraction under anesthesia, an isolated straight anterior labral tear, inside-out chondral lesion, or lateral Seldes 2 or 3 labral tear without cam or pincer morphology. Patient-reported outcome scores were prospectively collected at 6-month, 12-month, and minimum 2-year follow-up: International Hip Outcome Tool 12-Item, Non-Arthritic Hip, and Hip Disability and Osteoarthritis Outcome Score. Scores and rates of revision/reoperation or conversion to hip arthroplasty were compared with control hips matched for gender, age, lateral center-edge angle, and degree of chondral defect.
RESULTS
Scores for 208 microinstability hips (aged 30.9 ± 10.4 years, 201 women) were comparable to 208 controls (aged 30.6 ±10.5 years, 200 women); only the Hip Disability and Osteoarthritis Outcome Score-Sports subscale showed a minor between-group difference in the trajectory of change in scores from preoperative to 2-year minimum follow-up (P = .045 for time point × group interaction), with shorter follow-up duration for microinstability group (2.2 ± 0.4 years) versus control group (2.7 ± 1.9 years; P < .001). Proportions attaining minimal clinically important difference, 0.5× preoperative standard deviation (70.6%-84.8%), patient acceptable symptom state (54.7%-59.7%), and substantial clinical benefit (48.3%-62.3%) did not differ between groups for any scores (all P > .1). Surgery occurred 2.61 years later in the microinstability group than in the control group (P < .001). Annual rates of revision/reoperative procedures and conversion to arthroplasty did not differ between groups; the combined-group rates were 1.65%/year and 0.27%/year, respectively, after 6.2 ± 2.9 years (mean ± standard deviation) of follow-up.
CONCLUSIONS
Patients with surgically identified microinstability can be successfully managed with capsular plication as part of hip arthroscopy, achieving surgical and patient-reported outcomes similar to those of other arthroscopy patients of comparable sex, age, and surgical characteristics.
LEVEL OF EVIDENCE
Level III, case-control study.