Save the Torn Labrum in Hips With Borderline Acetabular Coverage

Kalore, Niraj V.; Jiranek, William A.

doi:10.1007/s11999-012-2499-9

Cited by 82 publications

(92 citation statements)

References 32 publications

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“…A couple of studies have been published looking specifically at the results of surgical treatment of borderline dysplastic hips, with one study showing higher rates of failure in the borderline hips than in those with adequate acetabular cover [10], and the other study showing comparable outcomes [15]. Currently stability of the hip is assessed with the LCEA.…”

Section: Discussionmentioning

confidence: 99%

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The Femoro-Epiphyseal Acetabular Roof (FEAR) Index: A New Measurement Associated With Instability in Borderline Hip Dysplasia?

Wyatt

Weidner

Pflüger

et al. 2017

Clinical Orthopaedics &Amp; Related Research

144

161

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Background The definition of osseous instability in radiographic borderline dysplastic hips is difficult. A reliable radiographic tool that aids decision-makingspecifically, a tool that might be associated with instability-therefore would be very helpful for this group of patients. Questions/purposes (1) To compare a new radiographic measurement, which we call the Femoro-Epiphyseal Acetabular Roof (FEAR) index, with the lateral centeredge angle (LCEA) and acetabular index (AI), with respect to intra-and interobserver reliability; (2) to correlate AI, neck-shaft angle, LCEA, iliocapsularis volume, femoral antetorsion, and FEAR index with the surgical treatment received in stable and unstable borderline dysplastic hips; and (3) to assess whether the FEAR index is associated clinical instability in borderline dysplastic hips. Methods We defined and validated the FEAR index in 10 standardized radiographs of asymptomatic controls using two blinded independent observers. Interrater and intrarater coefficients were calculated, supplemented by Bland-Altman plots. We compared its reliability with LCEA and AI. We performed a case-control study using standardized radiographs of 39 surgically treated symptomatic borderline radiographically dysplastic hips and 20 age-matched controls with asymptomatic hips (a 2:1 ratio), the latter were patients attending our institution for trauma unrelated to their hips but who had standardized pelvic radiographs between January 1, 2016 and March 1, 2016. Patient demographics were assessed using univariate Wilcoxon two-sample tests. There was no difference in mean age (overall: 31.5 ± 11.8 years [95% CI, 27.7-35.4 years]; stable borderline group: mean, 32.1± 13.3 years [95% CI, 25.5-38.7 years]; unstable borderline group: mean, 31.1 ± 10.7 years [95% CI, 26.2-35.9 years]; p = 0.96) among study groups. Treatment received was either a periacetabular osteotomy (if the hip was unstable) or, for patients with femoroacetabular impingement, either an open or arthroscopic femoroacetabular impingement procedure. The association of received treatment categories with the variables AI, neck-shaft angle, LCEA, iliocapsularis volume, femoral antetorsion, and FEAR index were evaluated first using Wilcoxon two-sample tests (two-sided) followed by stepwise multiple logistic regression analysis to identify the potential associated variables in a combined setting. Sensitivity, specificity, and receiver operator curves were calculated. The primary endpoint was the association between the FEAR index and instability, which we defined as migration of the femoral head either already visible on conventional radiographs or recentering of the Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Results The FEAR index showed excellent intra-and interobserver reliability, ...

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Section: Discussionmentioning

confidence: 99%

“…The ability of the FEAR index to identify instability was less encouraging and this may reflect other factors such as ligamentous laxity being pertinent in the decision-making process. Interestingly, hypermobility has been noted to be more prevalent in symptomatic patients with FAI [10,14].…”

Section: Discussionmentioning

confidence: 99%

The Femoro-Epiphyseal Acetabular Roof (FEAR) Index: A New Measurement Associated With Instability in Borderline Hip Dysplasia?

Wyatt

Weidner

Pflüger

et al. 2017

Clinical Orthopaedics &Amp; Related Research

144

161

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“…A surgeon also has the option of repair, reconstruction, or resection when the labrum is detached for rim resection. Several clinical studies suggest that patients with repairs fare better than those with excision [20,22,31,[35][36][37]51], but another study found that the labrum is repaired in only one-fourth of arthroscopic…”

Section: Background Rationale and Study Findingsmentioning

confidence: 99%

“…Animal and clinical studies suggest that repairs can heal [6,48] and that patients with repairs enjoy better function when compared with those with excision [21,22,31,36,51]. In cases in which the labrum cannot be repaired as a result of complete ossification, prior resection, radial discontinuity, or poor tissue quality, techniques for labral reconstruction using an iliotibial band, ligamentum teres, or allograft tissue have been described by experienced surgeons treating younger patients with large labral defects [20,26,52,55].…”

Section: Introductionmentioning

confidence: 99%

No Regeneration of the Human Acetabular Labrum After Excision to Bone

Miozzari

Celia

Clark

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Treatment options for a symptomatic, torn, irreparable, or completely ossified acetabular labrum are limited to either excision and/or reconstruction with grafts. In a previous animal model, regeneration of the acetabular labrum after excision to the bony rim has been shown. In humans, less is known about the potential of regeneration of the labrum. Recent studies seem to confirm labral regrowth, but it is still unclear if wide excision might be a surgical option in cases where repair is not possible.Questions/purposes The purposes of this study were (1) to determine the extent of acetabular labrum regeneration after excision to the bony rim; and (2) to determine whether this procedure results in higher hip scores. Methods We reviewed all patients treated with surgical dislocation for symptomatic femoroacetabular impingement by a single surgeon at one institution between 2003 and 2008, of whom 14 underwent wide labral excision (of at least 60°) down to bone; we used this approach when there was an absence of reparable tissue. Of these 14, nine were available for voluntary reexamination. The mean age at surgery was 38 ± 9 SD years and the mean followup was 4 ± 1 SD years. All patients consented to a physical examination and an MRI arthrogram, which was evaluated for evidence of new tissue formation by four observers. A modified Harris hip score and the UCLA were recorded.

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“…There is increased recognition of coexisting impingement and dysplasia, underscoring the importance of accurate preoperative assessment of morphology and hip pathomechanics. The challenging patient with so-called borderline acetabular dysplasia (lateral center-edge angle of 20°-25°) is increasingly recognized, as is the importance of preserving the labrum in these patients [7]. Studies of periacetabular osteotomy and rotational osteotomy from Europe, North America, and Japan consistently show relief of pain and restoration of function, provided strict patient selection criteria are met [15].…”

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confidence: 99%