American Hip Institute Research Foundation, Des Plaines, Illinois, USA.
School of Medicine, Vanderbilt University, Nashville, Tennessee, USA.
Am J Sports Med. 2020 Jun;48(7):1625-1635. doi: 10.1177/0363546520914604. Epub 2020 May 6.
Association among generalized ligamentous laxity (GLL), hip microinstability, and patient-reported outcomes (PROs) after hip arthroscopy has yet to be completely established.
(1) To report minimum 2-year PROs in patients with GLL who underwent hip arthroscopy in the setting of symptomatic labral tears and femoroacetabular impingement syndrome and (2) to compare clinical results with a matched-pair control group without GLL.
Cohort study; Level of evidence, 3.
Data from a prospectively collected database were retrospectively reviewed between August 2014 and December 2016. Patients were considered eligible if they received primary arthroscopic treatment for symptomatic labral tears and femoroacetabular impingement. Inclusion criteria included preoperative and minimum 2-year follow-up scores for the following PROs: modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), and visual analog scale for pain (VAS). From the sample population, 2 groups were created: the GLL group (Beighton score ≥4) and the control group (Beighton score <4). Patients were matched in a 1:2 ratio via propensity score matching according to age, sex, body mass index, Tönnis grade, and preoperative lateral center-edge angle. Patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) for mHHS, Hip Outcome Score-Sports Specific Scale (HOS-SSS), and International Hip Outcome Tool-12 (iHOT-12) were calculated.
A total of 57 patients with GLL were matched to 88 control patients. Age, sex, body mass index, and follow-up times were not different between groups ( > .05). Preoperative radiographic measurements demonstrated no difference between groups. Intraoperative findings and procedures between groups were similar except for capsular treatment, with the GLL group receiving a greater percentage of capsular plications ( = .04). At minimum 2-year follow-up, both groups showed significant improvement in PROs and VAS ( < .001). Furthermore, the postoperative PROs at minimum 2-year follow-up and the magnitude of improvement (delta value) were similar between groups for mHHS, NAHS, HOS-SSS, and VAS ( > .05). Moreover, groups reached comparable rates of MCID and PASS for mHHS, HOS-SSS, and iHOT-12.
Patients with GLL after hip arthroscopy for symptomatic femoroacetabular impingement and labral tears may expect favorable outcomes with appropriate labral and capsular management at minimum 2-year follow-up. When compared with a pair-matched control group without GLL, results were comparable for mHHS, NAHS, HOS-SSS, and VAS and reached PASS and/or MCID for mHHS, HOS-SSS, and iHOT-12.
全身韧带松弛（GLL）、髋关节微不稳与髋关节镜术后患者报告的结局（PROs）之间的关联尚未完全确定。
（1）报告 GLL 患者接受髋关节镜治疗髋关节盂唇撕裂和股骨髋臼撞击综合征的最低 2 年 PROs；（2）与无 GLL 的配对对照组进行比较。
队列研究；证据水平，3 级。
对 2014 年 8 月至 2016 年 12 月期间前瞻性收集的数据库中的数据进行回顾性分析。如果患者接受了髋关节镜治疗髋关节盂唇撕裂和股骨髋臼撞击综合征，且术前和最低 2 年的以下 PROs 评分可评估，则认为其符合纳入标准：改良 Harris 髋关节评分（mHHS）、非关节炎髋关节评分（NAHS）和疼痛视觉模拟评分（VAS）。从样本人群中创建了 2 个组：GLL 组（Beighton 评分≥4）和对照组（Beighton 评分<4）。通过倾向评分匹配以 1:2 的比例对患者进行匹配，匹配因素包括年龄、性别、体重指数、Tönnis 分级和术前外侧中心边缘角。计算 mHHS、髋关节结局评分-运动特异性评分（HOS-SSS）和国际髋关节结局工具-12（iHOT-12）的患者可接受的症状状态（PASS）和最小临床重要差异（MCID）。
共有 57 例 GLL 患者与 88 例对照组患者相匹配。两组间的年龄、性别、体重指数和随访时间无差异（>.05）。术前影像学测量值在组间无差异。两组间的术中发现和手术过程相似，除了囊处理外，GLL 组接受囊缝合的比例更高（=.04）。在最低 2 年随访时，两组的 PROs 和 VAS 均显著改善（<.001）。此外，mHHS、NAHS、HOS-SSS 和 VAS 的最低 2 年随访时的术后 PROs 和改善幅度（差值）在组间相似（>.05）。此外，两组在 mHHS、HOS-SSS 和 iHOT-12 方面达到了 MCID 和 PASS 的可比比率。
髋关节镜治疗髋关节盂唇撕裂和股骨髋臼撞击综合征后，GLL 患者在最低 2 年随访时可预期获得良好的结局，同时对盂唇和囊进行适当的处理。与无 GLL 的配对对照组相比，mHHS、NAHS、HOS-SSS 和 VAS 的结果具有可比性，mHHS、HOS-SSS 和 iHOT-12 达到了 PASS 和/或 MCID。
