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This may be in part because of heterogeneity in the definitions for BHD with respect to measurements such as the lateral center\u2010edge angle, T\u00f6nnis angle, and anterior wall index. Recent research analyzing predictors of poor outcomes after HA alone for patients with BHD has shown that the predominant predictors of poor outcomes after HA included T\u00f6nnis angle of 15\u00b0 or greater, age at surgery greater than 40 to 42 years, female sex, preoperative clinical arthritis, grade 3 or 4 articular cartilage changes to the femoral head or acetabulum, anterior wall index lower than 0.35, and labral debridement. In addition, we have investigated other predictors of failure of HA in the treatment of BHD and coined the term \u201cthe terrible triad of hip instability.\u201d This triad of risk factors includes (1) lateral center\u2010edge angle lower than 25\u00b0, (2) presence of joint hypermobility (Beighton score &gt; 4), and (3) presence of a hypertrophic labrum (labral width &gt; 8 mm on magnetic resonance imaging).<\/jats:p>","DOI":"10.1016\/j.arthro.2024.11.072","type":"journal-article","created":{"date-parts":[[2024,11,22]],"date-time":"2024-11-22T21:41:51Z","timestamp":1732311711000},"page":"2646-2647","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["<i>Editorial Commentary:<\/i>\n                    Forty, Female, 15\u00b0 (T\u00f6nnis Angle), and the Terrible Triad of Hip Instability Are Among the Predominant Predictors of Poor Outcomes After Hip Arthroscopy in Patients With Borderline Dysplasia"],"prefix":"10.1002","volume":"41","author":[{"given":"Alexander R.","family":"Markes","sequence":"first","affiliation":[{"name":"University of California San Francisco"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan L.","family":"Zhang","sequence":"additional","affiliation":[{"name":"University of California San Francisco"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,11,22]]},"reference":[{"key":"e_1_2_2_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465231184395"},{"key":"e_1_2_2_3_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.22.00491"},{"key":"e_1_2_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546520969878"},{"key":"e_1_2_2_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967124S00172"},{"key":"e_1_2_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/23259671211007401"},{"key":"e_1_2_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.asmr.2024.100971"},{"key":"e_1_2_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2024.10.021"}],"container-title":["Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0749806324009769?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0749806324009769?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2024.11.072","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1016\/j.arthro.2024.11.072","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2024.11.072","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T09:21:36Z","timestamp":1773566496000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/10.1016\/j.arthro.2024.11.072"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,22]]},"references-count":7,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1016\/j.arthro.2024.11.072"],"URL":"https:\/\/doi.org\/10.1016\/j.arthro.2024.11.072","archive":["Portico"],"relation":{},"ISSN":["0749-8063","1526-3231"],"issn-type":[{"value":"0749-8063","type":"print"},{"value":"1526-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,22]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Editorial Commentary: Forty, Female, 15\u00b0 (T\u00f6nnis Angle), and the Terrible Triad of Hip Instability Are Among the Predominant Predictors of Poor Outcomes After Hip Arthroscopy in Patients With Borderline Dysplasia","name":"articletitle","label":"Article Title"},{"value":"Arthroscopy: The Journal of Arthroscopic & Related Surgery","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.arthro.2024.11.072","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"https:\/\/doi.org\/10.1016\/j.arthro.2024.10.021","name":"associatedlink","label":"CrossRef DOI link to the associated document"},{"value":"simple-article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2024 by the Arthroscopy Association of North America","name":"copyright","label":"Copyright"}]}}