Influence of Acetabular Labral Tear Length on Postoperative Clinical Outcomes and Patient Satisfaction following Hip Arthroscopy for Femoroacetabular Impingement Syndrome with Capsular Plication

Abstract

Objectives: To determine the effect of labral tear length on post-operative outcomes following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Methods: Patients undergoing primary hip arthroscopy for FAIS from January 2012 to January 2016 were identified in a prospectively collected database. All patients completed the hip outcome score (HOS)-activities of daily living (ADL), HOS-sports subscale (HOS-SS), modified Harris hip score (mHHS), international hip outcome tool-12 (IHOT-12), and visual analog scales (VAS) for pain and satisfaction. Patients were stratified by labral tear length into small (<2.5 cm) or large (>2.5 cm) labral tear based on the ROC curve analysis. Patient demographics and outcomes were analyzed using parametric and multivariate linear regression analyses to identify predictors of labral tear length. Binary logistic regression analysis was performed to determine whether labral tear length predicted the likelihood of achieving the Minimal Clinically Important Difference (MCID). Results: A total of 747 eligible patients were included in the analysis. Mean age and BMI were 33.5±12.3 years and 25.4±8.6 kg/m2 22, respectively. Mean length of labral tears was 2.7±0.7 cm with 99% occurring in the anterosuperior position. Men had a higher proportion of large tears (>2.5 cm) when compared to women (75% vs 44%; p<0.001). All PROs showed improvement at a minimum of 2-years postoperatively (p<0.05 for all). Independent T-test demonstrated significant differences in two-year outcomes between patients with tears less than and greater than 2.5 cm: HOS-ADL (87.3±16.3 vs. 84.3±18.3, p=0.033), HOS-SS (76.6±23.5 vs. 70.5±27.7, p=0.005), mHHS (82.5±18.0 vs. 78.5±18.2, p=0.009), and satisfaction (83.5±23.4 vs. 77.8±34.9, p=0.026). Multivariate regression analysis demonstrated that labral tear length is an independent predictor of VAS satisfaction, HOS-ADL, -SS, and mHHS. Binary logistic regression analysis demonstrated that patients with small labral tears (<2.5 cm) had a higher likelihood of achieving MCID HOS-SS (OR: 1.61; p-value<0.02) and PASS mHHS (OR:1.56; p-value 0.038) than those with larger tears (more than 2.5 cm). Conclusion: Labral tear length is associated with numerous preoperative factors. These factors were found to be predictive of injury pathology and outcomes following hip arthroscopy for FAIS. Furthermore, patients with smaller tears (< 2.5 cm) had better outcomes and a higher likelihood of achieving a minimal clinically important difference at 2 years follow-up. [Table: see text]