Factors Associated With Return to Sport at Minimum 10-Year Follow-up in Athletes With Borderline Hip Dysplasia Undergoing Hip Arthroscopy With Capsular Plication.
Orthopaedic journal of sports medicine · 2026
BHD athletes did as well as non-dysplastic controls 10 years after hip arthroscopy with capsular plication, but there's no non-plication comparator to prove the plication mattered.
The paper
Retrospective cohort study, n=50 patients (53 hips) with borderline hip dysplasia versus 53 propensity-matched controls with normal acetabular coverage, undergoing primary hip arthroscopy with labral treatment and capsular plication, minimum 10-year follow-up.
What they found
At minimum 10-year follow-up, 87.0% of BHD patients (40/46 who attempted) and 85.4% of controls (41/48) returned to sport, with 82.1% and 83.3% of returners still playing at 10 years respectively; PRO improvements were similar between groups. Only 16% of the BHD group discontinued sport over 10 years, and this was attributed to lifestyle change or loss of interest rather than hip symptoms.
Study design
Level 3 retrospective comparative cohort study, single center, propensity-matched 1:1 on age, sex, BMI, follow-up time, Tönnis grade and preoperative competition level; n=50 BHD hips vs 53 controls, athletic population undergoing hip arthroscopy with capsular plication.
Methodology
This is retrospective chart review with all the usual biases: selection bias in who was offered surgery, no blinding of outcome assessors or patients, and reliance on patient-reported RTS status at 10 years which is subject to recall and self-report bias. Propensity matching on five variables helps balance the comparison but cannot account for unmeasured confounders (surgeon technique evolution over the 2008-2014 enrollment window, activity level drift, or why some patients were classed BHD vs normal). Single high-volume surgeon/center series (Domb group) also limits generalisability, and there is no reporting of loss to follow-up rate or how the 'attempted RTS' denominator was defined, which a clinician would need to interrogate before trusting the percentages.
The appraisal
The headline finding, that BHD patients do just as well as anatomically normal controls after arthroscopy with capsular plication, is a reassuring equivalence-type result, but this is an uncontrolled-for-surgery comparison between two operated groups, not a surgery-versus-nonoperative or surgery-versus-no-BHD comparison, so it cannot tell you whether capsular plication is necessary or whether BHD patients would have done just as well without it. The RTS and continuation rates are clinically meaningful numbers if accurate, but with no confidence intervals reported in the abstract and a modest sample, the precision of these percentages is uncertain.
The gap
No comparator arm without capsular plication or without surgery at all, so the paper cannot isolate what capsular plication itself contributes to these outcomes in BHD hips; a randomized or at least surgical-technique-controlled comparison would be needed before treating plication as the reason for this favorable trajectory.
Landmark context
This adds a rare 10-year athletic RTS endpoint to an already-existing body of short/midterm outcome literature on BHD arthroscopy with capsular plication. Worth being precise about mechanism: capsular plication addresses the compensatory capsulolabral laxity that develops around an under-covered acetabulum, it does not correct the bony deficiency itself, that would need a periacetabular osteotomy. So this paper is evidence that soft-tissue-only management holds up long-term in carefully selected BHD athletes, not that plication normalises the underlying dysplasia.
What to do Monday
For the physio or S&C coach managing this athlete post-op, the useful message is prognostic: a well-selected BHD hip treated with labral work and plication tracks the same long-term RTS and continuation curve as a non-dysplastic operated hip, so you can counsel accordingly rather than assuming a ceiling. It doesn't change your rehab criteria, clearance should still be driven by hip abductor/extensor strength symmetry and sport-specific hop or cutting tests, not by the BHD label itself. It also reframes late dropout: if this athlete stops playing at year 5 to 10, the data says lifestyle and interest are more likely culprits than a failing hip, so don't over-medicalise a training enthusiasm dip without objective signs first.
In practice
Applies to athletic patients with LCEA 18-25 degrees who've had labral repair plus capsular plication and are somewhere between early return and long-term monitoring. In clinic, this data lets you give an honestly optimistic prognosis, RTS and continuation rates matching non-dysplastic operated peers, but clearance decisions should still hinge on objective hip strength symmetry (Single Leg Hip Thrust, Cable Hip Abduction/Adduction) and a power or limb-symmetry hop test before returning to cutting or pivoting sport, since plicated capsules still need conservative early end-range loading regardless of the good long-term ceiling. On the S&C floor, once cleared, programme these athletes the same as any post-arthroscopy hip; there's no basis here for permanent load restriction on the BHD label alone, and a drop-off in training engagement years later is more likely life-stage than hip failure, so investigate objectively before assuming the joint. Caveat: this is one center's technique and case selection, treat it as supportive context for the conversation, not a guarantee if your surgical partner's plication approach or rehab protocol differs.
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