Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: Updated mean 7 year follow-up

Abstract

Objectives: The acetabular labrum provides sealing function and a degree of hip joint stability. Previous early (16 month) and mid-term (mean 3.5 years) follow-up of this cohort reported better patient related outcome measures in the refixation group. To update the results of labral refixation versus focal labral excision/debridement in a cohort of patients who underwent arthroscopic correction of femoroacetabular impingement (FAI). Methods: We reported patients who underwent labral debridement/focal labral excision during a period before the development of labral repair techniques. Patients with labral tears thought to be repairable with our current arthroscopic technique were compared with patients who underwent labral refixation. In 46 hips, the labrum was focally excised/debrided (group 1); in 54 hips, the labrum was refixed (group 2). Outcomes were measured with modified-Harris-Hip-Score (mHHS), Short Form-12 (SF-12), and a visual-analog-scale (VAS) for pain preoperatively and postoperatively. Results: Mean age was 33 years in group 1 and 28 years in group 2 with mean follow-up of 7 years (range, 2-13.6 years). At mean follow-up, subjective outcomes were significantly improved (P<.01) for both groups compared with preoperative scores. The mHHS (P=.004), SF-12 (P=.016), and VAS pain scores (P<.001) were all significantly better for refixation group compared with debridement group. Although most recent outcomes for both groups fell at mean 7 years’ follow-up in comparison to 16 month and 3.5 year follow-up, the disparity between groups was greater in favor of labral refixation. Good-to-excellent results were 47.7% in debridement and 82.4% in refixation (p<.001), and failure rates were 31.8% (debridement) and 13.7% (refixation group) (p =.034). There were 4 revisions in the debridement group and none in the refixation group. Conclusion: Longer term follow-up comparing focal labral debridement/excision to refixation revealed a decrease in patient related outcome scoring and good/excellent results in both groups. Ultimately, there was a greater drop in outcome measures and good/excellent results in the debridement group and better maintenance of results in the refixation group at mean 7 years follow-up.

Functional Outcomes of Hip Arthroscopy in an Active Duty Military Population Utilizing a Criterion-Based Early Weight Bearing Progression

“…The outcomes of this study are comparable to previously reported studies with significant functional improvement as well as high return to sport/activity. [4][5][6][7]13,14,[18][19][20] This studies results suggest that accelerated weight bearing and early ROM can assist in attaining positive outcomes in terms of early improvements in rehabilitation while minimizing potential adverse effects, a concept that is supported in the literature. 18 Likewise, there were no observed failures related to early weight bearing to include catastrophic failures such as femoral neck fracture or hip instability.…”

Arthroscopic acetabuloplasty without labral detachment for focal pincer-type impingement: a minimum 2-year follow-up

“…The studies that compared labral resection with labral refixation have pointed significantly better radiological outcomes with fewer indications for THA when the labrum was preserved and fixed [26, 27, 33]. Redmond et al [13] found no differences in revision surgeries in patients treated with acetabuloplasty with and without labral detachment.…”

Hip arthroscopy for femoroacetabular impingement: use escalating beyond the evidence

“…Likewise, although labral preservation may be important for improving hip symptoms, 7 it is unclear whether this is because preservation surgery was biased to a population with isolated, rather than whole joint disease. There is some evidence to support this possibility, as factors such as degeneration, complex tears, calcification and ossification reduce the potential for labral repair and debridement is necessary 19 . Labral debridement may, therefore, be a marker of more widespread hip degeneration, which is a worse prognosis.…”

“…There is some evidence to support this possibility, as factors such as degeneration, complex tears, calcification and ossification reduce the potential for labral repair and debridement is necessary. 19 Labral debridement may, therefore, be a marker of more widespread hip degeneration, which is a worse prognosis.…”