Does labral repair have a clinical benefit during arthroscopic treatment of femoro-acetabular impingement? Prospective multicentre study with 2-year follow-up

Abstract

Introduction: Hip arthroscopy has emerged as an effective tool for treating labral tears associated with femoro-acetabular impingement (FAI). Objective: Compare the effectiveness of debridement versus labral repair on functional outcomes at 2 years after hip arthroscopy and evaluate the influence of the repair technique. Hypothesis: There is no statistical difference in short-term functional outcomes between debridement and repair. The type of repair technique has no influence on functional outcomes. Methods: From July 2017 to June 2018, a prospective study was done at 10 participating hospitals specialised in hip preservation surgery. Patients over 18 years of age, who underwent hip arthroscopy for a labral tear due to femoro-acetabular impingement, were enrolled. Patients underwent either labral repair or debridement. The labral repairs were performed with either the loop or mattress technique and functional outcomes were evaluated using the Non-Arthritic Hip Score (NAHS). Results: One hundred and eighty-seven patients who underwent arthroscopic treatment for FAI were enrolled; 42 (22.5%) underwent labral debridement and 145 (77.5%) underwent labral repair. In the repair group, 66 (46%) were mattress sutures and 79 (54%) were loop sutures. Mean patient age was 33.3 ± 10.3 (18-63) and 38% of patients were women (n = 71). Mean follow-up was 16.2 months (10-26.4). The mean NAHS improved from 47.3 to 72.8 (p < 0.05) at final follow-up. There was no significant difference between the repair and debridement groups (p > 0.05). There was no significant difference between the mattress and loop repair subgroups (p > 0.05). Conclusions: There is no statistical difference in short-term functional outcomes between debridement and repair. The type of repair technique has no influence on functional outcomes.

Impact of bone deformities and labral and cartilage lesions on early functional results of arthroscopic treatment of femoroacetabular impingement

“…This can probably be explained by poorer visualization of the acetabulum roof if the labrum is not completely detached. The improvement in NAHS was significative in all 3 subgroups regardless of the technique used at the labrum, which is in contrast to recent work [16][17][18][19][20][21][22][23][24][25][26][27][28]. Thus, labrum preservation would not be a prognostic factor for good clinical outcomes in our series.…”

Review of impingements around the hip joint

“…However, since Ganz et al validated the importance of recovering the suction sealing mechanism, the operative treatment on the labrum has evolved from resection to restoration [9]. The current repair methods for the labrum focus on creating function seal mechanisms; thus, restoring labrum shape is paramount [10,11].…”

Midterm results after arthroscopic femoral neck osteoplasty combined with labral debridement for cam type femoroacetabular impingement in active adults

“…Labral resection/ debridement was originally performed to reduce pain and increase joint function, especially in patients with unstable and/or irreparable labral lesions, and reconstructive techniques have recently become more common [16,17]. Currently, labral repair and reconstruction retain the biomechanical role of the labrum and should allow better chance for hip preservation [3,[18][19][20][21][22]. However, debridement of the unstable peripheral portion of the labrum is technically less demanding and may be associated with a lower rate of intraarticular adhesions [16,23].…”