Midterm Follow-Up and Assessment of Cartilage Thickness by Arthro-Magnetic Resonance Imaging After Arthroscopic Cam Resection, Labral Repair, and Rim Trimming Without Labral Detachment

Forster-Horváth, Csaba; Unterreithmeier, Ulrich; Fries, Simon; Ganal, Simon; Gütler, Jens; Vogel, Nicole; Herzog, R.

doi:10.1016/j.arthro.2020.10.012

Cited by 14 publications

(9 citation statements)

References 43 publications

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“…Overall, the study by Forster-Horvath et al 7 provides relevant data at midterm on what can be expected after treating combined FAI with rim trimming over the top, keeping the integrity of the suction seal. Because removal of the labrum results in lower intra-articular hip contact area and loss of suction seal, 12 we think that maintaining the chondrolabral union will help improve stability, load distribution, regulation of the synovial fluid, proprioception, and maintenance of intra-articular negative pressure.…”

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confidence: 96%

“…However, this practice was adopted by many hip preservation surgeons even in the presence of combined FAI with evidence of little damage or no harm to the chondrolabral junction. 6 The work by Forster-Horvath, Unterreithmeier, Fries, Ganal, Gütler, Vogel, and Herzog, "Midterm Follow-Up and Assessment of Cartilage Thickness by Arthro-Magnetic Resonance Imaging after Arthroscopic Cam Resection, Labral Repair, and Rim Trimming Without Labral Detachment," 7 analyzed the midterm clinical and radiological outcomes of arthroscopic treatment of FAI with femoral osteoplasty, labral repair, and rim trimming without labral detachment. The authors further analyzed cartilage thickness with magnetic resonance arthrography (MRA) using coronal proton density images.…”

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confidence: 99%

“…The authors further analyzed cartilage thickness with magnetic resonance arthrography (MRA) using coronal proton density images. To look critically at the work by Forster-Hovarth et al, 7 the assessment of cartilage integrity at 3 weightbearing subregions needs to be clearly elucidated. First, the authors used different magnetic flux densities within preoperative and postoperative evaluation (3 versus 1.5 T).…”

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confidence: 99%

“…9,10 One of the aims of hip joint preservation surgery, above eradication of pain and reduction of cartilage wear, is improvement of function. Forster-Horvath et al 7 used the nonarthritic hip score (NAHS) and the short form-36 (SF-36) to assess function, using the minimally clinically important difference (MCID) as a Buenos Aires, Argentina (P.A.S.) The authors report the following potential conflicts of interest or sources of funding: C.P.-G. reports grants, AOSSM/Sanofi, NIH, OREF, Zimmer.…”

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confidence: 99%

“…Although Forster-Horvath et al 7 reached interesting conclusions, the cohort was small (78 hips) and lacked a control group of patients treated with the traditional labral refixation technique. Besides this, the statistical analyses were based mostly on linear correlations (Pearson test) instead of multivariate or linear regression analyses.…”

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confidence: 99%

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Editorial Commentary: Reach Over the Top and Preserve the Hip Labrum

Slullitel¹,

Pascual‐Garrido²

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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There is increasing interest in fine tuning of hip arthroscopy to improve the long-term outcomes of femoroacetabular impingement (FAI) surgery. Recently, some advocated for rim trimming and labral refixation without taking down the labrum, using a so-called over-the-top technique. Although some studies have already reported on the outcomes of this procedure, very few have focused on how maintaining an unharmed chondrolabral junction may decrease cartilage wear over time. Preserving labral attachment should be the standard of care in the treatment of FAI, to keep the suction seal working normally.

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Section: See Related Article On Page 541mentioning

confidence: 96%

Section: See Related Article On Page 541mentioning

confidence: 99%

Section: See Related Article On Page 541mentioning

confidence: 99%

Section: See Related Article On Page 541mentioning

confidence: 99%

Section: See Related Article On Page 541mentioning

confidence: 99%

See 3 more Smart Citations

Editorial Commentary: Reach Over the Top and Preserve the Hip Labrum

Slullitel¹,

Pascual‐Garrido²

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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There is no definite consensus on the adequate radiographic correction in arthroscopic osteochondroplasty for femoroacetabular impingement: a systematic review and meta-analysis

Cohen

Khan

Kay

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of this study is to evaluate and define what is considered an adequate radiographic correction in arthroscopic osteochondroplasty for FAI and to secondarily assess how radiographic outcomes relate to patient reported outcomes and complications. MethodsThe databases EMBASE, PubMed, and MEDLINE were searched for relevant literature from database inception until January 2021. Studies were screened by two reviewers independently and in duplicate for studies reporting on post‐operative radiographic outcomes in arthroscopic osteochondroplasty for FAI. Data on radiographic outcomes as well as data reporting functional outcomes and complications were recorded. A meta‐analysis was used to combine the mean pre‐ and post‐operative radiographic outcomes using a random effects model. A risk of bias assessment was performed for all included studies using the MINORS score. ResultsThe most commonly reported radiographic outcome was the alpha angle with a pooled mean post‐operative angle of 44° (95% CI 41°–46°), and mean pre‐ to post‐surgical difference of − 19° (− 22 to − 16, I2 = 96%), followed by the LCEA with a pooled mean post‐operative angle of 30° (95% CI 29–31) and mean difference after surgery of − 4° (− 6 to − 1, I2 = 97%,). Eleven studies reported on the correlation between radiographic and clinical outcomes with no consistent consensus correlation found amongst the included studies. Similarly, six studies correlated radiographic outcomes with conversion to THA with no consistent consensus correlation found amongst the included studies. ConclusionBased on this review, the main conclusion is that there is no consensus definition on the optimal radiographic correction for FAI and there was no consistent correlation between radiographic correction and functional outcomes. However, based on the uniform improvement in functional outcomes, this review suggests a post‐operative alpha angle target of 44° with a correction target of 19° and LCEA target of 30° with a correction target of 3°. Level of evidenceIV.

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