Skip to main content

Advertisement

SpringerLink
Log in

The anterior hip capsule is thinner in dysplastic hips: a study comparing different young adult hip patients

  • HIP
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To investigate the thickness and intra-substance change of anterior capsule of the hip joint, and compare the difference of the capsular features in patients with different statuses of hip stability.

Methods

A retrospective study was performed to review a hip preservation database. Using the lateral center edge angle(LCEA), patients with borderline dysplasia of the hip (BDH) of 20° ≤ LCEA ≤ 25°, femoracetabular impingement(FAI) with LCEA > 30° and dysplasia of the hip (DH) of LCEA < 20° were enrolled and stratified into different treatment groups. The patients’ imaging was reviewed by two experienced musculoskeletal radiologists who were blinded to clinical outcomes. Thickness and intra-substance change of the anterior hip capsule was measured on the sagittal oblique sequences of MRI. A surgeon measured the thickness of the anterior hip capsule during arthroscopy. The capsular thickness and intra-substance change were compared among different groups.

Results

Thirty patients (17 women and 13 men) enrolled in each group (FAI, BDH, and DH) matched by sex and ages were evaluated. There were no significant differences in terms of age, sex, BMI, Alpha angle, and Tönnis grade among all three groups. The mean thickness of the anterior capsule in the DH group was 3.2 ± 0.5 mm, which was significantly thinner than that in the BDH and FAI groups (4.5 ± 0.8 mm and 4.7 ± 0.6 mm), and there was no significant difference in capsular thickness between the BDH and FAI groups. The Median of anterior capsule thickness via arthroscopic measuring was 6 mm and 7 mm in the BDH and FAI groups respectively, which has no statistical difference. The intra-substance change of the anterior capsule shows a significant difference among the three groups, and a higher incidence of delamination of the capsule was found in DH groups (p < 0.001).

Conclusions

Patients with hip dysplasia have a significantly reduced capsular thickness on MRI and delaminated anterior joint capsule, which could be a sequence of instability. The clinical relevance of this study is that capsular thickness and intra-substance changes of the anterior capsule vary which could alter capsular management strategies.

Level of evidence

Level III of evidence, DIAGNOSTIC STUDIES, No consistently applied reference standard.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Barton C, Salineros MJ, Rakhra KS, Beaulé PE (2011) Validity of the alpha angle measurement on plain radiographs in the evaluation of cam-type femoroacetabular impingement. Clin Orthop Relat Res 469(2):464–469

    Article  Google Scholar 

  2. Beals TR, Soares RW, Briggs KK, Day HK, Philippon MJ (2022) Ten-Year Outcomes After Hip Arthroscopy in Patients With Femoroacetabular Impingement and Borderline Dysplasia. Am J Sports Med 50(3):739–745

    Article  Google Scholar 

  3. Beck EC, Nwachukwu BU, Chahla J et al (2019) Patients with borderline hip dysplasia achieve clinically significant outcome after arthroscopic femoroacetabular impingement surgery: a case-control study with minimum 2-year Follow-up. Am J Sports Med 47(11):2636–2645

    Article  Google Scholar 

  4. Bolia IK, Briggs KK, Locks R, Chahla J, Utsunomiya H, Philippon MJ (2018) Prevalence of high-grade cartilage defects in patients with borderline dysplasia with femoroacetabular impingement: a comparative cohort study. Arthroscopy 34(8):2347–2352

    Article  Google Scholar 

  5. Chandrasekaran S, Darwish N, Martin TJ, Suarez-Ahedo C, Lodhia P, Domb BG (2017) Arthroscopic capsular plication and labral seal restoration in borderline hip dysplasia: 2-year clinical outcomes in 55 cases. Arthroscopy 33(7):1332–1340

    Article  Google Scholar 

  6. D’Ambrosi R, Hantes ME, Mariani I, Di Francia VP, Della Rocca F (2021) Successful return to sport in patients with symptomatic borderline dysplasia following hip arthroscopy and T-shaped capsular plication. Knee Surg Sports Traumatol Arthrosc 29(5):1370–1377

    Article  Google Scholar 

  7. Dantas P, Gonçalves S, Mascarenhas V, Camporese A, Marin-Peña O (2021) Hip arthroscopy with initial access to the peripheral compartment provides significant improvement in FAI patients. Knee Surg Sports Traumatol Arthrosc 29(5):1453–1460

    Article  Google Scholar 

  8. Devitt BM, Smith BN, Stapf R, Tacey M, O’Donnell JM (2017) Generalized joint hypermobility is predictive of hip capsular thickness. Orthop J Sports Med 5(4):2325967117701882

    Google Scholar 

  9. Domb BG, Chaharbakhshi EO, Perets I, Yuen LC, Walsh JP, Ashberg L (2018) Hip arthroscopic surgery with labral preservation and capsular plication in patients with borderline hip dysplasia: minimum 5-year patient-reported outcomes. Am J Sports Med 46(2):305–313

    Article  Google Scholar 

  10. Domb BG, Philippon MJ, Giordano BD (2013) Arthroscopic capsulotomy, capsular repair, and capsular plication of the hip: relation to atraumatic instability. Arthroscopy 29(1):162–173

    Article  Google Scholar 

  11. Domb BG, Stake CE, Lindner D, El-Bitar Y, Jackson TJ (2013) Arthroscopic capsular plication and labral preservation in borderline hip dysplasia: two-year clinical outcomes of a surgical approach to a challenging problem. Am J Sports Med 41(11):2591–2598

    Article  Google Scholar 

  12. Estberger A, Pålsson A, Kostogiannis I, Ageberg E (2021) Less hip range of motion is associated with a greater alpha angle in people with longstanding hip and groin pain. Knee Surg Sports Traumatol Arthrosc 29(12):4091–4099

    Article  Google Scholar 

  13. Fox AJ, Wanivenhaus F, Burge AJ, Warren RF, Rodeo SA (2015) The human meniscus: a review of anatomy, function, injury, and advances in treatment. Clin Anat (New York, N.Y.) 28(2):269–287

  14. Hatakeyama A, Utsunomiya H, Nishikino S et al (2018) Predictors of poor clinical outcome after arthroscopic labral preservation, capsular plication, and cam osteoplasty in the setting of borderline hip dysplasia. Am J Sports Med 46(1):135–143

    Article  Google Scholar 

  15. Joo YD, Sobti AS, Oh KJ (2014) Measurement of capsular thickness in magnetic resonance arthrography in idiopathic adhesive capsulitis of hip. Hip Pelvis 26(3):178–184

    Article  Google Scholar 

  16. Kay J, Memon M, Rubin S, Simunovic N et al (2020) The dimensions of the hip capsule can be measured using magnetic resonance imaging and may have a role in arthroscopic planning. Knee Surg Sports Traumatol Arthrosc 28(4):1246–1261

    Article  Google Scholar 

  17. Kho J, Azzopardi C, Davies AM, James SL, Botchu R (2020) MRI assessment of anatomy and pathology of the iliofemoral ligament. Clin Radiol 75(12):960.e17-960.e22

    Article  CAS  Google Scholar 

  18. Larson CM, Moreau-Gaudry A, Kelly BT et al (2015) Are normal hips being labeled as pathologic? A CT-based method for defining normal acetabular coverage. Clin Orthop Relat Res 473(4):1247–1254

    Article  Google Scholar 

  19. Magerkurth O, Jacobson JA, Morag Y, Caoili E, Fessell D, Sekiya JK (2013) Capsular laxity of the hip: findings at magnetic resonance arthrography. Arthroscopy 29(10):1615–1622

    Article  Google Scholar 

  20. Maldonado DR, Chen SL, Walker-Santiago R et al (2020) An intact ligamentum teres predicts a superior prognosis in patients with borderline dysplasia: a matched-pair controlled study with minimum 5-year outcomes after hip arthroscopic surgery. Am J Sports Med 48(3):673–681

    Article  Google Scholar 

  21. Martin HD, Savage A, Braly BA, Palmer IJ, Beall DP, Kelly B (2008) The function of the hip capsular ligaments: a quantitative report. Arthroscopy 24(2):188–195

    Article  Google Scholar 

  22. Matsuda DK (2017) Editorial Commentary: Hip capsule: to repair or not? Arthroscopy 33(1):116–117

    Article  Google Scholar 

  23. Matsuda DK, Gupta N, Khatod M et al (2017) Poorer arthroscopic outcomes of mild dysplasia with cam femoroacetabular impingement versus mixed femoroacetabular impingement in absence of capsular repair. Am J Orthop (Belle Mead NJ) 46(1):E47–E53

    Google Scholar 

  24. McClincy MP, Wylie JD, Yen YM, Novais EN (2019) Mild or borderline hip dysplasia: are we characterizing hips with a lateral center-edge angle between 18° and 25° appropriately? Am J Sports Med 47(1):112–122

    Article  Google Scholar 

  25. Myers CA, Register BC, Lertwanich P et al (2011) Role of the acetabular labrum and the iliofemoral ligament in hip stability: an in vitro biplane fluoroscopy study. Am J Sports Med 39(Suppl):85S-91S

    Article  Google Scholar 

  26. Nepple JJ, Smith MV (2015) Biomechanics of the hip capsule and capsule management strategies in hip arthroscopy. Sports Med Arthrosc Rev 23(4):164–168

    Article  Google Scholar 

  27. Ng K, Jeffers J, Beaulé PE (2019) Hip joint capsular anatomy, mechanics, and surgical management. J Bone Joint Surg Am 101(23):2141–2151

    Article  Google Scholar 

  28. Nho SJ, Beck EC, Kunze KN, Okoroha K, Suppauksorn S (2019) Contemporary management of the hip capsule during arthroscopic hip preservation surgery. Curr Rev Musculoskelet Med 12(3):260–270

    Article  Google Scholar 

  29. Nwachukwu BU, Gaudiani MA, Marsh NA, Ranawat AS (2019) Labral hypertrophy correlates with borderline hip dysplasia and microinstability in femoroacetabular impingement: a matched case-control analysis. Hip Int 29(2):198–203

    Article  Google Scholar 

  30. Philippon MJ, Michalski MP, Campbell KJ et al (2015) A quantitative analysis of hip capsular thickness. Knee Surg Sports Traumatol Arthrosc 23(9):2548–2553

    Article  Google Scholar 

  31. Rakhra KS, Bonura AA, Nairn R, Schweitzer ME, Kolanko NM, Beaule PE (2016) Is the hip capsule thicker in diseased hips? Bone Joint Res 5(11):586–593

    Article  CAS  Google Scholar 

  32. Robben SG, Lequin MH, Diepstraten AF, den Hollander JC, Entius CA, Meradji M (1999) Anterior joint capsule of the normal hip and in children with transient synovitis: US study with anatomic and histologic correlation. Radiology 210(2):499–507

    Article  CAS  Google Scholar 

  33. Saito M, Khokher ZH, Kuroda Y, Khanduja V (2021) The role of iliocapsularis in hip pathology: a scoping review. J Hip Preserv Surg 8(2):145–155

    Article  Google Scholar 

  34. Schmitz MR, Murtha AS, Clohisy JC; ANCHOR Study Group (2020) Developmental dysplasia of the hip in adolescents and young adults. J Am Acad Orthop Surg 28(3):91–101

    Article  Google Scholar 

  35. Strickland CD, Kraeutler MJ, Brick MJ et al (2018) MRI evaluation of repaired versus unrepaired interportal capsulotomy in simultaneous bilateral hip arthroscopy: a double-blind, randomized controlled trial. J Bone Joint Surg Am 100(2):91–98

    Article  Google Scholar 

  36. Tamaki Y, Goto T, Wada K, Hamada D, Tsuruo Y, Sairyo K (2020) Anatomic evaluation of the insertional footprints of the iliofemoral and ischiofemoral ligaments: a cadaveric study. BMC Musculoskelet Disord 21(1):828

    Article  Google Scholar 

  37. Tsutsumi M, Nimura A, Akita K (2020) New insight into the iliofemoral ligament based on the anatomical study of the hip joint capsule. J Anat 236(5):946–953

    Article  CAS  Google Scholar 

  38. van Arkel RJ, Amis AA, Cobb JP, Jeffers JR (2015) The capsular ligaments provide more hip rotational restraint than the acetabular labrum and the ligamentum teres: an experimental study. Bone Joint J 97-B(4): 484–491

  39. van Arkel RJ, Jeffers JR, Amis AA (2017) Editorial Commentary: Anatomical vandalism of the hip? Hip capsular repair seems a sound adjunct to hip arthroscopic surgery. Arthroscopy 33(2):314–316

    Article  Google Scholar 

  40. Wiberg G (1953) Shelf operation in congenital dysplasia of the acetabulum and in subluxation and dislocation of the hip. J Bone Joint Surg Am 35-A(1):65–80

  41. Wyatt M, Weidner J, Pfluger D, Beck M (2017) The Femoro-Epiphyseal Acetabular Roof (FEAR) Index: a new measurement associated with instability in borderline hip dysplasia? Clin Orthop Relat Res 475(3):861–869

    Article  Google Scholar 

  42. Yin QF, Wang L, Liang T, Zhao H, Wang XS (2021) Longitudinal capsulotomy in hip arthroscopy: a safe and feasible procedure for cam-type femoracetabular impingement. Orthop Surg 13(6):1793–1801

    Article  Google Scholar 

  43. Zhang K, de Sa D, Yu H, Choudur HN, Simunovic N, Ayeni OR (2018) Hip capsular thickness correlates with range of motion limitations in femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc 26(10):3178–3187

    Article  Google Scholar 

  44. Zhou J, Melugin HP, Hale RF et al (2021) Sex differences in the prevalence of radiographic findings of structural hip deformities in patients with symptomatic femoroacetabular impingement. J Hip Preserv Surg 8(3):233–239

    Article  Google Scholar 

Download references

Funding

No sources of funding to declare.

Author information

Authors and Affiliations

  1. Department of Radiology, The Second Hospital of Shandong University, Jinan, China

    Hui Bai

  2. Department of Orthopedics, The Second Hospital of Shandong University, #247 Beiyuan Street, Jinan, 250033, China

    Ying-Qiang Fu & Qing-Feng Yin

  3. Cheeloo College of Medicine, Shandong University, Jinan, China

    Ying-Qiang Fu

  4. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada

    Olufemi R. Ayeni

Authors
  1. Hui Bai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ying-Qiang Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Olufemi R. Ayeni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Qing-Feng Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HB performed the data collection and analysis, created figures and tables, and aided in drafting the manuscript. YQF contributed to data collection and statistical analysis, and aided in drafting the manuscript. ORA participated in designing of this study, and helped to draft and revise the manuscript. QFY conceived of this study and involved in the design and coordination, offered access to clinical data, and draft the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Qing-Feng Yin.

Ethics declarations

Conflict of interest

ORA is a Speaker Bureau for Conmed and Smith and Nephew. Other authors declare that they have no competing interests.

Ethical approval

This retrospective study was approved by the institutional research ethics committee of the second hospital of Shandong university (No. KYLL-2021 kJ-P0441).

Informed consent

Retrospective study with anonymous data, and the requirement for informed consent was waived.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (JPEG 3430 kb)

Supplementary file2 (JPG 811 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bai, H., Fu, YQ., Ayeni, O.R. et al. The anterior hip capsule is thinner in dysplastic hips: a study comparing different young adult hip patients. Knee Surg Sports Traumatol Arthrosc 31, 70–78 (2023). https://doi.org/10.1007/s00167-022-07022-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-022-07022-2

Keywords

Search

Navigation