Outcomes After Arthroscopic Repair in Patients With Tears of Hypertrophic Versus Morphologically Normal Acetabular Labra

Abstract

Background: Recently, a hypertrophic labrum has been reported in the absence of hip dysplasia, which can possibly contribute to an acetabular labral tear. Purpose: To compare the clinical outcomes and complications, including the incidence of iatrogenic acetabular labrum and cartilage injury, in patients with tears of hypertrophic versus morphologically normal acetabular labra over a minimum follow-up period of 2 years and to assess the morphologic changes at follow-up computed tomography arthrography in the 2 groups. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2010 and December 2016, 20 patients (22 hips) with a hypertrophic labrum underwent arthroscopic hip surgery. A total of 22 patients (22 hips) without a hypertrophic labrum were assigned to the control group based on matching criteria, including age, sex, body mass index, labral tear, and labral repair. Clinical outcomes were assessed with the visual analog scale score, UCLA activity scale score (University of California, Los Angeles), and modified Harris Hip Score. Radiologic outcomes were assessed through serial radiography. Patients were followed for at least 2 years. Results: The mean age at surgery was 42 years. The most common cause of arthroscopic surgery in the study group was an isolated acetabular labral tear without any bony structural abnormalities (68.2%, 15 of 22 hips). All improvements in both groups were statistically significant at the last postoperative follow-up ( P < .001). Although the radiologic and clinical outcomes were not significantly different between the groups, the complication rates, including iatrogenic labral perforations and cartilage injury, were significantly higher in patients with hypertrophic acetabular labral tears (9 vs 3, P = .042). The patient-reported satisfaction scores at the last postoperative follow-up were 8.4 and 7.9 in the study and control groups, respectively ( P = .351). Conclusion: The high rates of patient-reported satisfaction and the clinical outcomes after arthroscopic repair in both groups are encouraging. Arthroscopic treatment in patients with hypertrophic acetabular labral tears should be carefully performed to prevent iatrogenic injury during the surgery, and isolated hypertrophic labral tears can have good results after repair.

The narrow subspine space and relatively large labrum are radiographic features of subspine impingement: a case-control study

“…We measured the width of the labrum at 11:30, 1:30, and 3:00 in MRI scans. Three standardized locations of the anterior to superior labrum were used for the measurements, as described by several studies [ 24 , 25 ]. The length of the labrum was measured at the 11:30 clock-face position on a coronal proton density (PD) sequence, in which we used the posterior border of the indirect head of the rectus femoris tendon as the landmark; at the 3-o’clock position on an axial oblique PD sequence at the psoas U, where the iliopsoas tendon passes anterior to the labrum; and at the 1:30 clock-face position, a half-point between the 11:30 and 3:00 positions on a sagittal fat-suppressed PD image.…”

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].…”

Editorial Commentary: Hip Labral Width Does Not Matter: Now Sit Down and Eat Your Porridge!

“…Larson relatively definitively has shown that labral repair is better than debridement, 2 so labral debridement in general has appropriately become less used. Some have considered hypertrophic labra to be more prone to failure since it can be associated with hip dysplasia, but in the studies by Brinkman et al 1 and by Lim et al, 3 large labra can still be primarily repaired with good results, assuming that there is not actual bony undercoverage. Primary hip labral reconstruction, as has been recently advocated by White et al, 4 has been shown to yield good outcomes as well.…”