Endoscopic Shelf Acetabuloplasty Concomitant With Labral Repair, Cam Osteoplasty, and Capsular Plication to Treat Acetabular Dysplasia in Artistic Athletes: A Case Series

Abstract

Background: Knowledge of clinical outcomes and return to artistic activities after endoscopic shelf acetabuloplasty (ESA) for acetabular dysplasia in artistic athletes is lacking. Hypothesis: Hip arthroscopic surgery including ESA will enable artistic athletes to return to their activities with a high success rate, significantly improved acetabular coverage, and preserved joint cartilage. Study Design: Case series; Level of evidence, 4. Methods: We reviewed 28 hips in 23 female artistic athletes (14 ballet, 9 rhythmic gymnastics, 4 dance, and 1 baton twirling) who underwent arthroscopic labral preservation, capsular plication, and ESA. Their mean age was 25.8 ± 10.2 years. Preoperatively, all patients had generalized joint laxity (Beighton score, 7.1 ± 1.8). We evaluated preoperative and postoperative radiographs and outcome scores including the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), International Hip Outcome Tool 12 (iHOT-12), Vail Hip Score (VHS), and Hip Outcome Score–Sports (HOS— Sports). Statistical analysis was performed using paired t tests and Bonferroni correction. Results: The mean follow-up was 32.5 ± 12.5 months. The mean lateral center-edge angle significantly increased from preoperatively (15.7° ± 5.3°) to postoperatively (39.8° ± 8.2°; P < .001) and at the final follow-up (33.7° ± 8.6°; P < .001). The vertical-center-anterior angle significantly improved from preoperatively (16.2° ± 8.8°) to final follow-up (33.6° ± 8.0°; P < .001). All hips maintained a Tönnis grade of 0 or 1 at the final follow-up. Overall, 20 patients (87%) were able to return to their preinjury level. All outcome scores improved from preoperatively to postoperatively: mHHS, from 68.5 ± 18.1 to 88.3 ± 18.5; NAHS, from 50.8 ± 17.7 to 69.0 ± 11.4; iHOT-12, from 36.9 ± 19.3 to 75.2 ± 19.8; VHS, from 53.8 ± 13.7 to 79.4 ± 19.4; and HOS--Sports, from 59.9 ± 17.0 to 79.6 ± 21.3 ( P < .001 for all). In total, 3 patients could not return to artistic activities as the result of postoperative deep gluteal syndrome. Conclusion: ESA concomitant with labral repair, cam osteoplasty, and capsular plication to treat dysplastic hips in patients with joint laxity enabled artistic athletes to return to their activities with a high success rate.

Excellent Clinical Outcomes and Return to Dance of 6 Active, Professional Ballet Dancers Aged Younger Than 40 Years at Total Hip Arthroplasty Through Direct Anterior Approach With a Custom Stem: A Case Report

“…Furthermore, 2 studies have reported outcomes after other types of hip surgery for symptomatic hip dysplasia in dancers. Uchida et al 17 performed arthroscopic labral preservation, capsular plication, and endoscopic shelf acetabuloplasty for dancers with symptomatic hip dysplasia and reported satisfactory postoperative clinical scores at 2 to 6 years with 87% of patients able to return to their preinjury dance level. Novais et al 18 performed periacetabular osteotomy (PAO) for dancers with symptomatic hip dysplasia and reported satisfactory postoperative clinical scores at a median follow-up of 2.7 years (interquartile range, 1.7-5.9 years), but only 63% of dancers were able to return to dance, which is a considerably lower rate than that reported in this series (100%).…”

Shelf acetabuloplasty may inhibit range of motion: A computer simulation analysis

“…On the other hand, recent developments in endoscopic surgical techniques have made it possible to perform endoscopic shelf acetabuloplasty, especially in cases of high activity patients, such as artistic athletes. 19 In this active population, hip ROM is important, particularly when the athlete wants to return to sports with a performance similar to, or higher than that of preoperative performance 20 ; thus, maintaining maximum ROM is essential for these patients. In this regard, our results…”

“…In fact, there has been previous study reporting that more than 50% of hips show no change in joint space width as 20 years, 18 that might be too long‐term period to follow functional outcomes in detail. On the other hand, recent developments in endoscopic surgical techniques have made it possible to perform endoscopic shelf acetabuloplasty, especially in cases of high activity patients, such as artistic athletes 19 . In this active population, hip ROM is important, particularly when the athlete wants to return to sports with a performance similar to, or higher than that of preoperative performance 20 ; thus, maintaining maximum ROM is essential for these patients.…”

Hip arthroscopic management for treating a rhythmic gymnast with a large bone cyst at the femoral head in the setting of hip dysplasia—a case report

“…Uchida et al . [ 14 ] reported that endoscopic shelf acetabuloplasty concomitant with labral repair, cam osteoplasty and capsular plication can yield good clinical outcomes, with a high rate of return to sports for artistic dancers in the setting of acetabular dysplasia. This case report lends support to this evidence.…”