Midterm Outcomes of Iliopsoas Fractional Lengthening for Internal Snapping as a Part of Hip Arthroscopy for Femoroacetabular Impingement and Labral Tear: A Matched Control Study
Purpose: To compare the patient-reported outcomes scores (PROs) of patients with femoroacetabular impingement (FAI), labral tears, and complete ligamentum teres (LT) tears to a matched-pair control group with intact LTs, as well as to report the relative risk of total hip arthroplasty (THA) conversion.
Methods: Data between February 2008 and April 2015 were retrospectively reviewed. Patients undergoing hip arthroscopy included those who had complete LT tear, labral tears, FAI, and minimum 2-year follow-up with modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), International Hip Outcome Tool-12 (iHOT-12), and visual analog scale (VAS). Patients were excluded for Tönnis osteoarthritis grade >1, previous hip conditions or surgeries, and Worker's Compensation claims. Patients with full LT tears were matched in a 1:3 ratio with patients without LT tears based on age at surgery ± 5 years, sex, body mass index ± 5, capsular treatment, and acetabular Outerbridge grade. Revision surgeries and conversions to THA were documented. Relative risk for conversion to THA was determined (P = .05).
Results: Eighteen patients (18 hips) had minimum 2-year follow-up and were eligible for matching; as described, each study group patient was matched to 3 control patients, resulting in a size of 18 to 54 patients. PROs showed significant improvement in the complete LT tear group with the exception of the HOS-SSS measure. In the intact LT control group, all PROs significantly improved, with no exception. Based on relative risk, patients with complete LT tears were 3 times more likely to require THA than a matched control group.
Conclusions: After hip arthroscopy, patients with FAI and complete LT tears reported significant improvement in PROs. Among hips that did not require THA, functional scores were comparable to a matched control group. However, patients with complete LT tears were 3 times more likely to require an eventual THA than the matched control group. We conclude that patients with complete LT tears should be considered an at-risk population, and that indications and treatment may be refined to incorporate the clinical significance of complete LT tears.
Level of evidence: Level III, comparative trial, case-control.