Advertisement

Decreased Hip Labral Width Measured via Preoperative Magnetic Resonance Imaging Is Associated With Inferior Outcomes for Arthroscopic Labral Repair for Femoroacetabular Impingement

      Purpose

      To determine the association between labral width as measured on preoperative magnetic resonance imaging (MRI) and hip-specific validated patient self-reported outcomes at a minimum of 2 years’ follow-up.

      Methods

      We performed an institutional review board–approved retrospective review of prospectively gathered hip arthroscopy patients from 2010 to 2017. The inclusion criteria were defined as patients aged 18 to 65 years with radiographic evidence of femoroacetabular impingement who underwent a primary labral repair and had a minimum of 2 years’ clinical follow-up. The exclusion criteria were defined as inadequate preoperative imaging, prior hip surgery, Tönnis grade 1 or higher, or lateral center-edge angle lower than 25°. An a priori power analysis was performed. MRI measurements of labral width were conducted by 2 blinded, musculoskeletal fellowship–trained radiologists at standardized “clock-face” locations using a previously validated technique. Outcomes were assessed using the Harris Hip Score (HHS), modified Harris Hip Score (mHHS), and Non-arthritic Hip Score (NAHS). For the mHHS, scores of 8 and 74 were used to define the minimal clinically important difference and patient acceptable symptomatic state, respectively. Patients were divided into groups by a labral width less than 1 SD below the mean (hypoplastic) or widths above 1 SD below the mean. Statistical analysis was performed using linear and polynomial regression; the Mann-Whitney U, χ2, and Fisher exact tests; and intraclass correlation coefficient testing.

      Results

      A total of 103 patients (107 hips) met the inclusion criteria (mean age, 39.4 ± 17 years; body mass index, 25.0 ± 4; 51% right sided; 68% female patients; mean follow-up, 76.5 ± 19.1 months [range, 30.0-113.0 months]). Mean labral width at the 11:30 clock-face position (indirect rectus), 3-o’clock position (psoas U), and 1:30 clock-face position (point halfway between the 2 aforementioned positions) was 7.1 ± 2.2 mm, 7.0 ± 2.0 mm, and 5.5 ± 1.9 mm, respectively. Intraclass correlation coefficient agreements were good to excellent between readers at all positions (0.83-0.91, P < .001). The preoperative HHS, mHHS, and NAHS were not statistically significantly different (P > .05) between the 2 groups. Sex, laterality, and body mass index were not predictive of outcomes (P > .05). The postoperative HHS, mHHS, and NAHS were found to be significantly lower in the hypoplastic group at each location tested (P < .01), including the mHHS at the 11:30 clock-face position (69 vs 87), 3-o’clock position (70 vs 87), and 1:30 clock-face position (71 vs 87). The proportion of patients with hypoplastic labra who reached the minimal clinically important difference was significantly lower (P < .001) at the 11:30 clock-face position (50% vs 91%), 3-o’clock position (56% vs 90%), and 1:30 clock-face position (58% vs 91%) in comparison to the non-hypoplastic labrum group. The proportion of patients with hypoplastic labra above the patient acceptable symptomatic state was significantly lower (P < .001) at the 11:30 clock-face position (44% vs 83%), 3-o’clock position (37.5% vs 84%), and 1:30 clock-face position (42% vs 85%) in comparison to the non-hypoplastic labrum group. Linear regression modeling was not significant at any position (P > .05). Polynomial regression was significant at the 11:30 clock-face position (R2 = 0.23, P < .001), 3-o’clock position (R2 = 0.17, P < .001), and 1:30 clock-face position (R2 = 0.26, P < .004).

      Conclusions

      Hip labral width less than 1 SD below the mean measured via preoperative MRI was associated with significantly worse functional outcomes after arthroscopic labral repair and treatment of femoroacetabular impingement. The negative relation between labral width and outcomes may be nonlinear.

      Level of Evidence

      Level IV, case series with subgroup analysis.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ferguson S.J.
        • Bryant J.T.
        • Ganz R.
        • Ito K.
        The acetabular labrum seal: A poroelastic finite element model.
        Clin Biomech (Bristol, Avon). 2000; 15: 463-468
        • Seldes R.M.
        • Tan V.
        • Hunt J.
        • Katz M.
        • Winiarsky R.
        • Fitzgerald Jr., R.H.
        Anatomy, histologic features, and vascularity of the adult acetabular labrum.
        Clin Orthop Relat Res. 2001; : 232-240
        • Ferguson S.J.
        • Bryant J.T.
        • Ganz R.
        • Ito K.
        An in vitro investigation of the acetabular labral seal in hip joint mechanics.
        J Biomech. 2003; 36: 171-178
        • Myers S.R.
        • Eijer H.
        • Ganz R.
        Anterior femoroacetabular impingement after periacetabular osteotomy.
        Clin Orthop Relat Res. 1999; 363: 93-99
        • Bharam S.
        Labral tears, extra-articular injuries, and hip arthroscopy in the athlete.
        Clin Sports Med. 2006; 25: 279-292, ix
        • Maldonado D.R.
        • Lall A.C.
        • Walker-Santiago R.
        • et al.
        Hip labral reconstruction: Consensus study on indications, graft type and technique among high-volume surgeons.
        J Hip Preserv Surg. 2019; 6: 41-49
        • Herickhoff P.K.
        • Safran M.R.
        Surgical decision making for acetabular labral tears: An international perspective.
        Orthop J Sports Med. 2018; 6 (2325967118797324)
        • Domb B.G.
        • Hartigan D.E.
        • Perets I.
        Decision making for labral treatment in the hip: Repair versus debridement versus reconstruction.
        J Am Acad Orthop Surg. 2017; 25: e53-e62
        • Philippon M.J.
        • Peixoto L.
        • Goljan P.
        Acetabular labral tears: Debridement, repair, reconstruction.
        Oper Tech Sports Med. 2012; 20: 281-286
        • Philippon M.J.
        • Bolia I.K.
        • Locks R.
        • Briggs K.K.
        Labral preservation: Outcomes following labrum augmentation versus labrum reconstruction.
        Arthroscopy. 2018; 34: 2604-2611
        • Kaplan D.J.
        • Baron S.
        • Samim M.
        • Burke C.J.
        • Meislin R.J.
        • Youm T.
        Validity of magnetic resonance imaging measurement of hip labral width compared with intraoperative assessment.
        Arthroscopy. 2020; 36: 751-758
        • Philippon M.J.
        • Nepple J.J.
        • Campbell K.J.
        • et al.
        The hip fluid seal—Part I: The effect of an acetabular labral tear, repair, resection, and reconstruction on hip fluid pressurization.
        Knee Surg Sports Traumatol Arthrosc. 2014; 22: 722-729
        • McCrum C.L.
        Editorial Commentary: Predicting the size of the labrum: We have the technology, should we put it to use?.
        Arthroscopy. 2020; 36: 759-760
        • Bsat S.
        • Frei H.
        • Beaule P.E.
        The acetabular labrum: A review of its function.
        Bone Joint J. 2016; 98-B: 730-735
        • Beltran L.S.
        • Rosenberg Z.S.
        • Mayo J.D.
        • et al.
        Imaging evaluation of developmental hip dysplasia in the young adult.
        AJR Am J Roentgenol. 2013; 200: 1077-1088
        • Philippon M.J.
        • Michalski M.P.
        • Campbell K.J.
        • et al.
        An anatomical study of the acetabulum with clinical applications to hip arthroscopy.
        J Bone Joint Surg Am. 2014; 96: 1673-1682
        • Shenoy K.
        • Dai A.Z.
        • Mahure S.A.
        • Kaplan D.J.
        • Capogna B.
        • Youm T.
        Arthroscopic repair of hip labrum with suture anchors.
        Arthrosc Tech. 2017; 6: e2143-e2149
        • Kaplan K.M.
        • Shah M.R.
        • Youm T.
        Femoroacetabular impingement—Diagnosis and treatment.
        Bull NYU Hosp Jt Dis. 2010; 68: 70-75
        • Ramisetty N.
        • Kwon Y.
        • Mohtadi N.
        Patient-reported outcome measures for hip preservation surgery—A systematic review of the literature.
        J Hip Preserv Surg. 2015; 2: 15-27
        • Thorborg K.
        • Roos E.M.
        • Bartels E.M.
        • Petersen J.
        • Holmich P.
        Validity, reliability and responsiveness of patient-reported outcome questionnaires when assessing hip and groin disability: A systematic review.
        Br J Sports Med. 2010; 44: 1186-1196
        • Christensen C.P.
        • Althausen P.L.
        • Mittleman M.A.
        • Lee J.A.
        • McCarthy J.C.
        The Nonarthritic Hip Score: Reliable and validated.
        Clin Orthop Relat Res. 2003; : 75-83
        • Kemp J.L.
        • Collins N.J.
        • Roos E.M.
        • Crossley K.M.
        Psychometric properties of patient-reported outcome measures for hip arthroscopic surgery.
        Am J Sports Med. 2013; 41: 2065-2073
        • Chahal J.
        • Van Thiel G.S.
        • Mather III, R.C.
        • et al.
        The patient acceptable symptomatic state for the modified Harris Hip Score and Hip Outcome Score among patients undergoing surgical treatment for femoroacetabular impingement.
        Am J Sports Med. 2015; 43: 1844-1849
        • Flores S.E.
        • Sheridan J.R.
        • Borak K.R.
        • Zhang A.L.
        When do patients improve after hip arthroscopy for femoroacetabular impingement? A prospective cohort analysis.
        Am J Sports Med. 2018; 46: 3111-3118
        • Cicchetti D.V.
        Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instrument in psychology.
        Psychol Assess. 1994; 6: 284-290
        • Espinosa N.
        • Rothenfluh D.A.
        • Beck M.
        • Ganz R.
        • Leunig M.
        Treatment of femoro-acetabular impingement: Preliminary results of labral refixation.
        J Bone Joint Surg Am. 2006; 88: 925-935
        • Menge T.J.
        • Briggs K.K.
        • Dornan G.J.
        • McNamara S.C.
        • Philippon M.J.
        Survivorship and outcomes 10 years following hip arthroscopy for femoroacetabular impingement: Labral debridement compared with labral repair.
        J Bone Joint Surg Am. 2017; 99: 997-1004
        • Philippon M.J.
        • Briggs K.K.
        • Hay C.J.
        • Kuppersmith D.A.
        • Dewing C.B.
        • Huang M.J.
        Arthroscopic labral reconstruction in the hip using iliotibial band autograft: Technique and early outcomes.
        Arthroscopy. 2010; 26: 750-756
        • Maldonado D.R.
        • Kyin C.
        • Rosinsky P.J.
        • et al.
        Circumferential acetabular labral reconstruction for irreparable labral tears in the primary setting: Minimum two-year outcomes with a nested matched-pair control [published online February 26, 2020]. Arthroscopy.
        • Harris J.D.
        Hip labral repair: Options and outcomes.
        Curr Rev Musculoskelet Med. 2016; 9: 361-367
        • Troelsen A.
        • Jacobsen S.
        • Bolvig L.
        • Gelineck J.
        • Romer L.
        • Soballe K.
        Ultrasound versus magnetic resonance arthrography in acetabular labral tear diagnostics: A prospective comparison in 20 dysplastic hips.
        Acta Radiol. 2007; 48: 1004-1010
        • Magee T.
        Comparison of 3.0-T MR vs 3.0-T MR arthrography of the hip for detection of acetabular labral tears and chondral defects in the same patient population.
        Br J Radiol. 2015; 88: 20140817
        • Fry R.
        • Domb B.
        Labral base refixation in the hip: Rationale and technique for an anatomic approach to labral repair.
        Arthroscopy. 2010; 26 (suppl): S81-S89
        • Al Mana L.
        • Coughlin R.P.
        • Desai V.
        • Simunovic N.
        • Duong A.
        • Ayeni O.R.
        The hip labrum reconstruction: Indications and outcomes—An updated systematic review.
        Curr Rev Musculoskelet Med. 2019; 12: 156-165
        • Clohisy J.C.
        • Baca G.
        • Beaule P.E.
        • et al.
        Descriptive epidemiology of femoroacetabular impingement: A North American cohort of patients undergoing surgery.
        Am J Sports Med. 2013; 41: 1348-1356
        • Shin J.J.
        • de Sa D.L.
        • Burnham J.M.
        • Mauro C.S.
        Refractory pain following hip arthroscopy: Evaluation and management.
        J Hip Preserv Surg. 2018; 5: 3-14
        • Ross J.R.
        • Larson C.M.
        • Adeoye O.
        • Kelly B.T.
        • Bedi A.
        Residual deformity is the most common reason for revision hip arthroscopy: A three-dimensional CT study.
        Clin Orthop Relat Res. 2015; 473: 1388-1395