Summary
Labral base refixation, simple loop refixation, and selective partial debridement were used for labral preservation in 239 labral tears treated arthroscopiacally. All three techniques yielded favorable short-term results. Tear type and clinical context should dictate the appropriate choice of labral treatment.
Data
Introduction
Multiple biomechanics studies have suggested advantages of labral preservation in hip surgery, and superior clinical results have been shown with labral repair over labral debridement. However, the optimal surgical technique for labral preservation is unknown, and may differ in various clinical situations. Three methods for labral preservation are in frequent use in our clinic: labral base refixation, simple loop refixation, and selective partial debridement. The purpose of this study was to compare the intraoperative findings and clinical results for these three surgical approaches to labral preservation.
Methods
Data was prospectively collected on all patients that underwent arthroscopic hip surgery for labral tear in our institution between the years 2008 and 2010. The inclusion criteria for the study were the completion of pre- and post-operative hip specific evaluation forms, arthroscopic labral treatment with one of the three techniques above, and tear size between 2.5 and 4.5 hours on the clock face. The exclusion criteria were previous hip surgery, hip conditions including hip joint fractures and bony pathologies (Perthes, SCFE and AVN), and Tonnis Grade =2. Three study groups were created according to labral treatment: 1) labral base refixation; 2) simple loop refixation; and 3) selective partial debridement. Surgical outcome was assessed by modified Harris hip score (mHHS), non-arthritic hip score (NAHS), hip outcome score sport specific subscale (HOS SSS) and activities of daily living (HOS ADL), visual analog pain score (VAS), and patient satisfaction on a scale of 1 to 10.
Results
A total of 239 surgeries (230 patients) fit our inclusion/exclusion criteria; 32, 107, and 100 cases in groups 1 () , 2, and 3, respectively. A majority of surgeries were for labral tear in the context of femoro-acetabular impingement (FAI). At mean follow-up of 9.2 months, all six outcome measurement tools showed improved results after arthroscopic surgery for labral tear. Significant difference was noted in the characteristics of patients that underwent labral refixation (group 1 and 2) versus those who had selective labral debridement (group 3). Patients in groups 3 were on average older (45 versus 33 years, p<0.0001), had higher Tonnis arthritic grades (p=0.0001), did not have any isolated pincer type impingement (p<0.0001), and had higher number of combined Seldes type labral tears (p<0.0001). Those differences were not significant between group 1 and group 2. Outcome of labral refixation (group 1 and 2) was significantly better than debridement (group 3) according to HOS ADL (p=0.02), but no significant difference was found for the other scores. Outcome for group 1 was better than for group 2 only according to the HOS-SSS improvements (p=0.03).
Conclusions
All six outcome scores improved significantly at mean follow-up of 9.2 months. No difference was shown between outcomes of labral refixation vs. debridement for any score but the HOS ADL. However, there were significant differences in intraoperative pathology and patient characteristics between the groups. These results suggest that all three techniques of labral preservation yield favorable short-term results, and that tear type and clinical context should dictate the appropriate choice of labral treatment.
Article info
Identification
Copyright
© 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
