Abstract
In order to access and resect the acetabular rim, arthroscopic acetabuloplasty was described with labral detachment. When the chondrolabral junction remains intact, acetabuloplasty and labral refixation can be performed maintaining an unharmed labrum. We aimed to evaluate the outcome of a group of patients treated with arthroscopic acetabuloplasty without labral detachment. During the study period, we retrospectively analysed 44 patients with pincer-type o combined impingement and an intact chondroblabral junction, with an average follow-up of 32 months (range: 27–38). We excluded patients with isolated CAM-type impingement and previous hip pathology. Radiographs were analysed to define impingement and classify grade of osteoarthritis. Clinical evaluation consisted of pre-operative and post-operative modified Harris hip score (mHHS) and WOMAC as well as post-operative visual analogue scale (VAS) of pain and satisfaction. Reoperations were considered surgical failures for purposes of survival analysis. Mean mHHS changed from 51.06 (SD 4.81) pre-operatively to 84.97 (SD 12.79) post-operatively. Pre-operative WOMAC was 29.18 (SD 8) and post-operative, 13.10 (SD 11). Post-operative VAS was 7.5 and 2.27 for satisfaction and pain, respectively. When comparing patients with Tönnis 0 to those with Tönnis 1, the former showed better results regarding post-operative mHHS (89.9 s versus 77.85, P = 0.03), pain VAS (1.5 versus 6.3, P = 0.03) and satisfaction VAS (8.2 versus 6.3, P = 0.01). Survival was 100% at 24 months and 76% at 40 months (95% CI: 35–98%). Arthroscopic acetabuloplasty without labral detachment achieved good clinical outcomes. Slight degenerative changes on radiographs correlated with poorer clinical outcomes.
Highlights
Hip labral pathology has been acknowledged as a common cause of persistent hip pain and dysfunction [1]
We aimed to evaluate the outcome of a group of patients with pincer-type femoroacetabular impingement (FAI) treated with arthroscopic acetabuloplasty without labral detachment
MATERIALS AND METHODS We retrospectively analysed a consecutive series of patients with diagnosis of a labral rupture secondary to pincer-type o combined impingement treated with a hip arthroscopy between January 2012 and June 2015
Summary
Hip labral pathology has been acknowledged as a common cause of persistent hip pain and dysfunction [1]. Two patterns of FAI have been described; CAM-type FAI as a result of loss of the femoral head sphericity or the head-neck junction offset and pincer-type impingement when there is focal or global acetabular overcoverage [4, 5]. Likewise, both patterns can coexist originating a combined impingement. Global overcoverage arises in cases of coxa profunda or protrusio acetabuli, producing extensive labral damage; whereas focal rim overcoverage appears when a linear overhang exists at the antero-superior edge of the acetabulum [5, 7], with a normal relationship between the anterior and posterior walls distally. Arthroscopic treatment of focal pincer consists of resecting the surplussed rim at the antero-superior acetabular area, previously described as zones 2 and 3 by Ilizaliturri et al [8]
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