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

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.