Advertisement

Changes in Hip Labral Size Two Years After Arthroscopic Repair Are Correlated With Preoperative Measurements on Magnetic Resonance Imaging

Published:January 05, 2023DOI:https://doi.org/10.1016/j.arthro.2022.12.021

      Purpose

      The purposes of our study were 1) to investigate the potential change of labral size after arthroscopic repair and 2) to analyze the relationship between acetabular labral size and functional outcomes.

      Methods

      In this retrospective study, patients diagnosed with labral tear and undergoing hip arthroscopic repair in our institution between September 2016 and December 2018 were included. Magnetic resonance imaging was obtained preoperatively and postoperatively, and the labral length and labral height were measured in three anatomic sites: 11:30, 1:30, and 3:00 positions. All patients completed at least 2-year follow-up. Patients whose preoperative labral size in any position wider than 2 standard deviation away from the mean were identified as the hypertrophic labrum group and were compared with the control in radiographic variables and patient-reported outcomes (PROs), including the visual analog scale (VAS), modified Harris Hip Score (mHHS), the International Hip Outcome Tool-12 (iHOT-12) and the Hip Outcome Score-Activities of Daily Living (HOS-ADL).

      Results

      A total of 82 patients (82 hips) were included, and the mean follow-up period was 39.54 ± 8.48 months. Significant improvement in PROs was determined before and after surgeries. Twelve patients were identified with labral hypertrophy and had higher postoperative mHHS scores, higher postoperative iHOT-12 scores, and greater improvement in HOS-ADL compared with the control group. Patients with larger preoperative anterosuperior labral height exhibited more favorable clinical outcomes. Meanwhile, no significantly morphologic change in labral size was determined.

      Conclusion

      There is no significantly morphologic change in labral size of superior, anterosuperior, and anterior labrum after arthroscopic repair. Patients with hypertrophic labrum achieved more favorable clinical outcomes compared with those with normal-sized labrum.

      Level of Evidence

      Level III, retrospective comparative prognostic trial.
      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

        • Cashin M.
        • Uhthoff H.
        • O'Neill M.
        • Beaulé P.E.
        Embryology of the acetabular labral-chondral complex.
        J Bone Joint Surg Br. 2008; 90: 1019-1024
        • Seldes R.M.
        • Tan V.
        • Hunt J.
        • Katz M.
        • Winiarsky R.
        • Fitzgerald R.H.
        Anatomy, histologic features, and vascularity of the adult acetabular labrum.
        Clin Orthop Relat Res. 2001; : 232-240
        • DuBois D.F.
        • Omar I.M.
        MR imaging of the hip: normal anatomic variants and imaging pitfalls.
        Magn Reson Imaging Clin N Am. 2010; 18: 663-674
        • Bowman K.F.
        • Fox J.
        • Sekiya J.K.
        A clinically relevant review of hip biomechanics.
        Arthroscopy. 2010; 26: 1118-1129
        • 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
        • Haviv B.
        • O'Donnell J.
        Arthroscopic treatment for acetabular labral tears of the hip without bony dysmorphism.
        Am J Sports Med. 2011; 39: 79S-84S
        • McCarthy J.
        • Noble P.
        • Aluisio F.V.
        • Schuck M.
        • Wright J.
        • Lee J.A.
        Anatomy, pathologic features, and treatment of acetabular labral tears.
        Clin Orthop Relat Res. 2003; : 38-47
        • Skendzel J.G.
        • Philippon M.J.
        Management of labral tears of the hip in young patients.
        Orthop Clin North Am. 2013; 44: 477-487
        • Kaplan D.J.
        • 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
        • Walker M.
        • Maini L.
        • Kay J.
        • et al.
        The dimensions of the hip labrum can be reliably measured using magnetic resonance and computed tomography which can be used to develop a standardized definition of the hypoplastic labrum.
        Knee Surg Sports Traumatol Arthrosc. 2021; 29: 1432-1452
        • Drager J.
        • Rasio J.
        • Newhouse A.
        • Beck E.
        • Chahla J.
        • Nho S.J.
        Patients with a hypotrophic labrum achieve similar outcomes after primary labral repair compared with patients with a normal-sized labrum: A matched cohort analysis of 346 patients with femoroacetabular impingement syndrome.
        Arthroscopy. 2020; 36: 2614-2620
        • Kaplan D.J.
        • Samim M.
        • Burke C.J.
        • Baron S.L.
        • Meislin R.J.
        • Youm T.
        Decreased hip labral width measured via preoperative magnetic resonance imaging is associated with inferior outcomes for arthroscopic labral repair for femoroacetabular impingement.
        Arthroscopy. 2021; 37: 98-107
        • Haskel J.D.
        • Kaplan D.J.
        • Kirschner N.
        • et al.
        Generalized joint hypermobility is associated with decreased hip labrum width: A magnetic resonance imaging-based study.
        Arthrosc Sports Med Rehabil. 2021; 3: e765-e771
        • Ha Y.-C.
        • Lee Y.-K.
        • Koo K.-H.
        • Kwon K.-B.
        • Song S.-H.
        Prevalence and clinical significance of hypertrophic labrum in non-dysplastic hips.
        J Orthop Sci. 2017; 22: 512-516
        • Brinkman J.C.
        • Domb B.G.
        • Krych A.J.
        • et al.
        Is labral size predictive of failure with repair in hip arthroscopy?.
        Arthroscopy. 2020; 36: 2147-2157
        • Gao G.
        • Fu Q.
        • Wu R.
        • Liu R.
        • Ao Y.
        • Xu Y.
        The correlation between the labrum size and the labral tear in asymptomatic volunteers and symptomatic patients.
        J Orthop Surg Res. 2021; 16: 567
        • Nwachukwu B.U.
        • Gaudiani M.A.
        • Marsh N.A.
        • Ranawat A.S.
        Labral hypertrophy correlates with borderline hip dysplasia and microinstability in femoroacetabular impingement: a matched case-control analysis.
        Hip Int. 2019; 29: 198-203
        • Yoo J.I.
        • Ha Y.C.
        • Lee Y.K.
        • Lee G.Y.
        • Yoo M.J.
        • Koo K.H.
        Morphologic changes and outcomes after arthroscopic acetabular labral repair evaluated using postoperative computed tomography arthrography.
        Arthroscopy. 2017; 33: 337-345
        • Gao G.
        • Fu Q.
        • Wu R.
        • Liu R.
        • Cui L.
        • Xu Y.
        Ultrasound and ultrasound-guided hip injection have high accuracy in the diagnosis of femoroacetabular impingement with atypical symptoms.
        Arthroscopy. 2021; 37: 128-135
        • Jackson T.J.
        • Hammarstedt J.E.
        • Vemula S.P.
        • Domb B.G.
        Acetabular labral base repair versus circumferential suture repair: A matched-paired comparison of clinical outcomes.
        Arthroscopy. 2015; 31: 1716-1721
      1. Sun H, Huang H-J, Mamtimin M, Yang F, Duan Y-P, Zhang X, Wang J-Q. Isolated arthroscopic treatment of femoroacetabular impingement for patients with radiographic gluteus medius tear. Arthroscopy 2021:S0749-8063(0721)00897-00895.

        • Smith K.M.
        • Gerrie B.J.
        • McCulloch P.C.
        • Lintner D.M.
        • Harris J.D.
        Comparison of MRI, CT, Dunn 45° and Dunn 90° alpha angle measurements in femoroacetabular impingement.
        Hip Int. 2018; 28: 450-455
        • Tannast M.
        • Siebenrock K.A.
        • Anderson S.E.
        Femoroacetabular impingement: radiographic diagnosis—What the radiologist should know.
        Am J Roentgenol. 2007; 188: 1540-1552
        • Beck E.C.
        • Nwachukwu B.U.
        • Chapman R.
        • Gowd A.K.
        • Waterman B.R.
        • Nho S.J.
        The influence of lumbosacral spine pathology on minimum 2-year outcome after hip arthroscopy: A nested case-control analysis.
        Am J Sports Med. 2020; 48: 403-408
        • Nwachukwu B.U.
        • Beck E.C.
        • Kunze K.N.
        • Chahla J.
        • Rasio J.
        • Nho S.J.
        Defining the clinically meaningful outcomes for arthroscopic treatment of femoroacetabular impingement syndrome at minimum 5-year follow-up.
        Am J Sports Med. 2020; 48: 901-907
        • Maldonado D.R.
        • Ouyang V.
        • Lee M.S.
        • et al.
        After revision hip arthroscopy, patients having either circumferential or segmental labral reconstructions for the management of irreparable labra show clinical improvement based on proper indications.
        Arthroscopy. 2022; 38: 2459-2469
        • Nwachukwu B.U.
        • Alpaugh K.
        • McCormick F.
        • Martin S.D.
        All-arthroscopic reconstruction of the acetabular labrum by capsular augmentation.
        Arthrosc Tech. 2015; 4: e127-e131
        • Domb B.G.
        • Hartigan D.E.
        • Perets I.
        Decision making for labral treatment in the hip: Repair versus débridement versus reconstruction.
        J Am Acad Orthop Surg. 2017; 25: e53-e62
        • Philippon M.J.
        • Briggs K.K.
        • Fagrelius T.
        • Patterson D.
        Labral refixation: Current techniques and indications.
        HSS J. 2012; 8: 240-244
        • Abe I.
        • Harada Y.
        • Oinuma K.
        • et al.
        Acetabular labrum: abnormal findings at MR imaging in asymptomatic hips.
        Radiology. 2000; 216: 576-581
        • Toft F.
        • Anliker E.
        • Beck M.
        Is labral hypotrophy correlated with increased acetabular depth?.
        J Hip Preserv Surg. 2015; 2: 175-183
        • Garabekyan T.
        • Ashwell Z.
        • Chadayammuri V.
        • et al.
        Lateral acetabular coverage predicts the size of the hip labrum.
        Am J Sports Med. 2016; 44: 1582-1589
        • Gupta A.
        • Chandrasekaran S.
        • Redmond J.M.
        • et al.
        Does labral size correlate with degree of acetabular dysplasia?.
        Orthop J Sports Med. 2015; 32325967115572573
        • Parvizi J.
        • Bican O.
        • Bender B.
        • et al.
        Arthroscopy for labral tears in patients with developmental dysplasia of the hip: a cautionary note.
        J Arthroplasty. 2009; 24: 110-113
        • Woodward R.M.
        • Vesey R.M.
        • Bacon C.J.
        • White S.G.
        • Brick M.J.
        • Blankenbaker D.G.
        Microinstability of the hip: a systematic review of the imaging findings.
        Skeletal Radiol. 2020; 49: 1903-1919
        • Kamenaga T.
        • Hashimoto S.
        • Hayashi S.
        • et al.
        Larger acetabular labrum is associated with hip dysplasia, joint incongruence, and clinical symptoms.
        Arthroscopy. 2020; 36: 2446-2453
        • Perets I.
        • Chaharbakhshi E.O.
        • Mu B.
        • et al.
        Hip arthroscopy in patients ages 50 years or older: Minimum 5-year outcomes, survivorship, and risk factors for conversion to total hip replacement.
        Arthroscopy. 2018; 34: 3001-3009
        • Frank R.M.
        • Lee S.
        • Bush-Joseph C.A.
        • Salata M.J.
        • Mather R.C.
        • Nho S.J.
        Outcomes for hip arthroscopy according to sex and age: A comparative matched-group analysis.
        J Bone Joint Surg Am. 2016; 98: 797-804
        • Domb B.G.
        • Linder D.
        • Finley Z.
        • et al.
        Outcomes of hip arthroscopy in patients aged 50 years or older compared with a matched-pair control of patients aged 30 years or younger.
        Arthroscopy. 2015; 31: 231-238
        • McCormick F.
        • Nwachukwu B.U.
        • Alpaugh K.
        • Martin S.D.
        Predictors of hip arthroscopy outcomes for labral tears at minimum 2-year follow-up: The influence of age and arthritis.
        Arthroscopy. 2012; 28: 1359-1364
        • Noguchi Y.
        • Miura H.
        • Takasugi S.
        • Iwamoto Y.
        Cartilage and labrum degeneration in the dysplastic hip generally originates in the anterosuperior weight-bearing area: An arthroscopic observation.
        Arthroscopy. 1999; 15: 496-506
        • Kanezaki S.
        • Yamamoto A.
        • Nakamura S.
        • Osawa M.
        • Matsushita T.
        Magnetic resonance imaging findings compared with histological findings of the labrum in hip osteoarthritis.
        Skeletal Radiol. 2015; 44: 767-775
        • Kantarci F.
        • Ozpeynirci Y.
        • Unlu M.
        • et al.
        Cross-sectional area of the labrum: Role in the diagnosis of anterior acetabular labral tears.
        Eur Radiol. 2012; 22: 1350-1356