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V-shaped capsular plication for treating cam-type femoroacetabular impingement with hip instability in borderline
Yang Lv1, Ningjing Zeng2, Da Guo1
1Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
Insights
This study shows arthroscopic T-capsulotomy with V-shaped capsular plication effectively treats hip instability in patients with cam-type femoroacetabular impingement (FAI) and borderline developmental dysplasia of the hip (BDDH). Significant improvements in pain and function were observed post-surgery.
Area of Science:
- Orthopedic Surgery
- Hip Arthroscopy
- Hip Instability
Background:
- Femoroacetabular impingement (FAI) often coexists with borderline developmental dysplasia of the hip (BDDH), increasing instability risk.
- Capsular plication may enhance hip stability via the screw-home mechanism.
Purpose of the Study:
- To evaluate the clinical outcomes of arthroscopic T-capsulotomy with V-shaped capsular plication for cam-type FAI in BDDH-associated hip instability.
- To confirm the short-term efficacy of this combined surgical approach.
Main Methods:
- Retrospective cohort study of 15 patients with symptomatic cam-type FAI and BDDH (LCEA 20°-25°).
- All patients underwent arthroscopic labral repair, osteoplasty, and T-capsulotomy with V-shaped capsular plication.
- Clinical outcomes assessed using VAS, mHHS, HOS-ADL, and HOS-SSS pre- and post-operatively.
Main Results:
- Significant improvements in mHHS (57.3 to 86.1), VAS pain scores (5.7 to 1.1), HOS-ADL (50.1 to 89.3), and HOS-SSS (41.7 to 85.9) were observed (all P < 0.01).
- No major complications were reported in the 15 patients.
- Mean follow-up was 18.2 months (range 12-24 months).
Conclusions:
- Arthroscopic T-capsulotomy with V-shaped capsular plication is a promising technique for managing cam-type FAI with BDDH-associated instability.
- The procedure demonstrates favorable short-term clinical outcomes.
- Further research with larger cohorts and longer follow-up is recommended.
Introduction:
Purpose Patients with cam-type femoroacetabular impingement (FAI) frequently present with concomitant borderline developmental dysplasia of the hip (BDDH), a critical instability risk factor. Capsular plication may contribute to improved stability through the screw-home mechanism. This study evaluates the clinical outcomes of arthroscopic T-capsulotomy combined with V-shaped capsular plication for managing cam-type FAI in BDDH-associated instability and confirms its short-term efficacy.
Methods:
This retrospective cohort study included 15 patients diagnosed with symptomatic cam-type FAI and concomitant BDDH (LCEA: 20°-25°) between July 2019 and July 2023. All patients underwent arthroscopic labral repair, femoroacetabular osteoplasty, and T-capsulotomy with V-shaped capsular plication. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for pain, Modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score Sport-Specific Subscale (HOS-SSS) preoperatively and postoperatively. Statistical analysis employed paired t-tests for intra-group comparisons.
Results:
All 15 patients completed follow-up with a minimum duration of 12 months (mean 18.2 months, range 12-24). No major complications occurred. Significant improvements were observed in all outcome measures at final follow-up: mHHS improved from 57.33 ± 5.34 to 86.07 ± 2.67 (P < 0.01); VAS decreased from 5.73 ± 0.57 to 1.07 ± 0.57 (P < 0.001); HOS-ADL improved from 50.09 ± 5.02 to 89.31 ± 2.43; HOS-SSS improved from 41.66 ± 5.08 to 85.92 ± 4.70 (both P < 0.01).
Conclusions:
The described arthroscopic technique, adapting principles from pediatric DDH surgery, appears to be a promising approach for addressing cam-type FAI in BDDH patients with instability risk factors, demonstrating short-term clinical outcomes. But, further studies with larger cohorts and longer follow-up are warranted.
