Hip microinstability and its association with femoroacetabular impingement: A scoping review

Rahel Caliesch; David Beckwée; Jan Taeymans; Joseph M Schwab; Thomas Renaud; Quentin Brossard; Roger Hilfiker

doi:10.33393/aop.2024.3063

Authors

Rahel Caliesch Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Rehabilitation Research (RERE) Research Group, Vrije Universiteit Brussel, Brussels - Belgium and School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Valais, Sion - Switzerland https://orcid.org/0000-0003-0664-5793
David Beckwée Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Rehabilitation Research (RERE) Research Group, Vrije Universiteit Brussel, Brussels - Belgium https://orcid.org/0000-0001-9951-9993
Jan Taeymans Division of Physiotherapy, Department of Health Professions, University of Applied Sciences Bern, Bern - Switzerland and Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels - Belgium https://orcid.org/0000-0003-1583-4043
Joseph M Schwab Department of Orthopaedic Surgery and Traumatology, HFR Fribourg – Cantonal Hospital, University of Fribourg, Fribourg - Switzerland https://orcid.org/0000-0002-7068-5215
Thomas Renaud Institute for Physiotherapy Research, Brügg, Bern - Switzerland https://orcid.org/0000-0002-3481-9589
Quentin Brossard Medical Center Wankdorf - Department of Sport Physiotherapy, Bern - Switzerland https://orcid.org/0000-0001-8308-8922
Roger Hilfiker Physiotherapie Tschopp & Hilfiker, Glis - Switzerland https://orcid.org/0000-0001-8662-6116

DOI:

https://doi.org/10.33393/aop.2024.3063

Keywords:

femoroacetabular impingement (FAI), hip impingement, hip microinstability, scoping review

Abstract

Introduction: Hip microinstability has become a recognized cause of non-arthritic hip pain and disability in young patients. However, its pathophysiology remains unclear. We want to (1) present an overview of the evidence of hip microinstability and of its association with femoroacetabular impingement (FAI), (2) map out the type of evidence available, and (3) make recommendations for future research.

Methods: A deductive analysis and extraction method was used to extract information. In addition, diagnostic accuracy statistics were extracted or calculated.

Results: Of the 2,808 identified records, 123 were eligible for inclusion. Different definitions for microinstability exist. A standardized terminology and clear diagnostic criteria are lacking. FAI and microinstability may be associated and may aggravate each other. Conservative treatment strategies for FAI and microinstability are similar. The reported prevalence of microinstability in combination with FAI ranges from 21% to 42% in adults undergoing hip arthroscopy or magnetic resonance arthrography (MRA) of the hip.

Conclusion: Hip microinstability and FAI may be associated, occur together, or exacerbate each other. To better address this topic, a standardized terminology for microinstability is essential. Achieving consensus on physical examination and diagnosis is also necessary. Initial efforts to establish uniform diagnostic criteria have been made, but further work is needed. Specifically, randomized controlled trials are required to evaluate the effectiveness of training programmes aimed at reducing symptoms in individuals with microinstability, with or without FAI. Such studies will enable clinicians to manage microinstability with greater confidence within this context.

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Tahoun MF, Lizano-Díez X, Soler BC, Pons MT. Superior outcomes after arthroscopic treatment of femoroacetabular impingement and labral tears with closed versus open capsule. Knee Surg Sports Traumatol Arthrosc. 2023;31(10):4501-4509. https://doi.org/10.1007/s00167-022-07266-y PMID:36471028 DOI: https://doi.org/10.1007/s00167-022-07266-y

Wu JY, Li W, Xu LY, Zheng G, Chen XD, Shen C. Ligamentum teres tears and increased combined anteversion are associated with hip microinstability in patients with borderline dysplasia. Arthroscopy. 2024;40(3):745-751. https://doi.org/10.1016/j.arthro.2023.06.041. PMID: 37419221. DOI: https://doi.org/10.1016/j.arthro.2023.06.041

Nepple JJ, Fowler LM, Larson CM. Decision-making in the borderline hip. Sports Med Arthrosc Rev. 2021;29(1):15-21. https://doi.org/10.1097/JSA.0000000000000298 PMID:33395225 DOI: https://doi.org/10.1097/JSA.0000000000000298

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Wolff AB, Scanaliato JP. Editorial commentary: the importance of capsular closure following hip arthroscopy – leave no trace: an outdoorsman’s ramblings. Arthroscopy. 2022;38(11):3041-3042. https://doi.org/10.1016/j.arthro.2022.06.008 PMID:36344060 DOI: https://doi.org/10.1016/j.arthro.2022.06.008

Wu ZX, Ren WX, Ren YM, Tian MQ. Arthroscopic labral debridement versus labral repair for patients with femoroacetabular impingement: a meta-analysis. Medicine (Baltimore). 2020;99(19):e20141. https://doi.org/10.1097/MD.0000000000020141 PMID:32384496 DOI: https://doi.org/10.1097/MD.0000000000020141

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Nepple JJ, Ambastha C, Abu-Amer W, Clohisy JC. Mid-term outcomes of combined hip arthroscopy and limited open capsular plication in the non-dysplastic hip. Iowa Orthop J. 2021;41(1):133-139. PMID:34552415

Nepple JJ. Editorial commentary: at the intersection of borderline dysplasia and femoroacetabular impingement – which way should we turn? Arthroscopy. 2020;36(4):1185-1188. https://doi.org/10.1016/j.arthro.2020.01.023 PMID:32247413 DOI: https://doi.org/10.1016/j.arthro.2020.01.023

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Wong SE, Newhouse AC, Wichman DM, Bessa F, Williams J, Nho SJ. Patients with a high femoroepiphyseal roof with concomitant borderline hip dysplasia and femoroacetabular impingement syndrome do not demonstrate inferior outcomes following arthroscopic hip surgery. Arthroscopy. 2022;38(5):1509-1515. https://doi.org/10.1016/j.arthro.2021.10.012 PMID:34710573 DOI: https://doi.org/10.1016/j.arthro.2021.10.012

Kalisvaart MM, Safran MR. Hip instability treated with arthroscopic capsular plication. Knee Surg Sports Traumatol Arthrosc. 2017;25(1):24-30. https://doi.org/10.1007/s00167-016-4377-6 PMID:27885395 DOI: https://doi.org/10.1007/s00167-016-4377-6

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Curley AJ, Domb BG. Editorial commentary: evaluate for the Beighton Score and additional radiographic signs of instability prior to proceeding with hip arthroscopy in patients with combined borderline hip dysplasia and excessive femoral anteversion. Arthroscopy. 2023;39(4):978-980. https://doi.org/10.1016/j.arthro.2022.12.001 PMID:36872036 DOI: https://doi.org/10.1016/j.arthro.2022.12.001

Hohmann E. Editorial commentary: hip arthroscopy for femoroacetabular impingement in patients with borderline dysplasia does not result in inferior outcomes compared with outcomes in patients without dysplasia: do not fear. Arthroscopy. 2022;38(5):1516-1518. https://doi.org/10.1016/j.arthro.2021.12.026 PMID:35501017 DOI: https://doi.org/10.1016/j.arthro.2021.12.026

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