Arthroscopic Labral Debridement Research Articles

Long-term Results of Arthroscopic Labral Debridement: Predictors of Outcomes

Limited data exist regarding the long-term results of labral debridement and the effect of coexisting pathology on outcomes. Our hypothesis was that untreated coexisting hip pathologies such as femoroacetabular impingement and arthritis significantly affect the outcomes of arthroscopic labral debridement. Between 1996 and 2003, fifty consecutive patients who underwent hip arthroscopy and labral debridement with a mean follow-up of 8.4 years were included in our study. Patients' preoperative Harris Hip Scores and coexisting pathologies such as femoroacetabular impingement, dysplasia, or arthritis were recorded as variables. Postoperative Harris Hip Score and satisfaction at final follow-up were recorded as outcomes. Good or excellent results were achieved in 62% of cases (58% in patients with untreated femoroacetabular impingement and 19% in patients with arthritis). Failures included 2 cases that were converted to total hip replacement (4.5 and 5.2 years after index procedure) due to advancement of arthritis and 1 case of repeat arthroscopy for cam decompression. Patients with no coexisting pathology had significantly higher satisfaction and Harris Hip Scores. Almost all of the patients with low postoperative Harris Hip Scores had arthritic changes. Arthritis had a significant correlation with low postoperative Harris Hip Scores and satisfaction. Coexisting pathology, especially arthritis and untreated femoroacetabular impingement, can result in inferior outcomes. Arthroscopic labral debridement of symptomatic tears in selected patients with no coexisting pathology can result in favorable long-term results. Arthritis is the strongest independent predictor of poor outcomes.

Periacetabular Osteotomy After Failed Hip Arthroscopy for Labral Tears in Patients with Acetabular Dysplasia

Chronic mechanical overload of the acetabular rim may lead to acetabular labral disease in patients with hip dysplasia. Although arthroscopic debridement of the labrum may provide symptomatic relief, the underlying mechanical abnormality remains. There is little information regarding how the results of periacetabular osteotomy are affected by a prior primary treatment for labral disease in the presence of acetabular dysplasia. In a retrospective matched-cohort study, seventeen patients who had arthroscopic labral debridement prior to periacetabular osteotomy (the arthroscopy group) were compared with a control group of thirty-four patients who did not undergo arthroscopic labral debridement prior to periacetabular osteotomy (the non-arthroscopy group). Two control patients were randomly matched to each experimental patient from a pool of controls. Functional outcomes were assessed with use of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Failure of periacetabular osteotomy was defined as conversion to a total hip replacement. Changes in the preoperative and postoperative WOMAC scores of arthroscopy and non-arthroscopy patients were comparable, and the differences between the two treatment groups were not significant. We were unable to show a significant difference between the seventeen arthroscopy and thirty-four non-arthroscopy patients with regard to the risk of having to undergo a total hip replacement. When arthroscopic labral debridement fails to improve symptoms in patients with labral disease secondary to acetabular dysplasia, periacetabular osteotomy may still be considered as a joint-preserving procedure that can achieve good functional results.

Arthroscopic Debridement Versus Refixation of the Acetabular Labrum Associated With Femoroacetabular Impingement: Minimum 2-Year Follow-up (SS-35)

Introduction The purpose of this study was to update a prior report comparing outcomes of arthroscopic labral debridement to labral refixation. Methods We previously reported outcomes for labral debridement compared to labral repair at minimum 12 months follow-up. We reviewed patients who underwent labral debridement during a period prior to the development of labral repair techniques. Patients with labral tears felt to be repairable with our current arthroscopic technique were compared to patients who underwent labral refixation. To better match the two groups, only patients with labral pathology due to pincer or combined-type femoroacetabular impingement (FAI) were included. In the first 39 hips, the labrum was debrided (Group 1); in the next 40 hips, the labrum was refixed (Group 2). Outcomes were measured with modified Harris Hip Score (HHS), Short Form 12 (SF-12), and a visual analog pain scale (VAS) preoperatively and postoperatively. Preoperative and postoperative radiographs were obtained to evaluate bony resection and osteoarthritis. Results The mean age was 33 years in Group 1 and 28 years in Group 2 with a mean follow up of 34 months (range, 24-60 months). Preoperative mean subjective outcomes scores were not significantly different between groups. At a mean of 34 months follow-up, subjective outcomes were significantly improved (p<0.01) for both groups compared to preoperative scores. Harris Hip Scores were significantly better for the refixation group (93.5) compared to the debridement group (84.4) at most recent follow-up (p<0.01). At a mean of 34 months follow-up, good-to-excellent results were noted in 66.7% of the debridement group compared to 90.0% of the refixation group (p=0.014). Conclusion Arthroscopic management of labral pathology and its associated pincer impingement results in significant improvement. With further follow-up (minimum 2 years), the labral refixation group continued to demonstrate better HHS outcomes, as well as a greater percentage of good-to-excellent results when compared with the labral debridement group. The purpose of this study was to update a prior report comparing outcomes of arthroscopic labral debridement to labral refixation. We previously reported outcomes for labral debridement compared to labral repair at minimum 12 months follow-up. We reviewed patients who underwent labral debridement during a period prior to the development of labral repair techniques. Patients with labral tears felt to be repairable with our current arthroscopic technique were compared to patients who underwent labral refixation. To better match the two groups, only patients with labral pathology due to pincer or combined-type femoroacetabular impingement (FAI) were included. In the first 39 hips, the labrum was debrided (Group 1); in the next 40 hips, the labrum was refixed (Group 2). Outcomes were measured with modified Harris Hip Score (HHS), Short Form 12 (SF-12), and a visual analog pain scale (VAS) preoperatively and postoperatively. Preoperative and postoperative radiographs were obtained to evaluate bony resection and osteoarthritis. The mean age was 33 years in Group 1 and 28 years in Group 2 with a mean follow up of 34 months (range, 24-60 months). Preoperative mean subjective outcomes scores were not significantly different between groups. At a mean of 34 months follow-up, subjective outcomes were significantly improved (p<0.01) for both groups compared to preoperative scores. Harris Hip Scores were significantly better for the refixation group (93.5) compared to the debridement group (84.4) at most recent follow-up (p<0.01). At a mean of 34 months follow-up, good-to-excellent results were noted in 66.7% of the debridement group compared to 90.0% of the refixation group (p=0.014). Arthroscopic management of labral pathology and its associated pincer impingement results in significant improvement. With further follow-up (minimum 2 years), the labral refixation group continued to demonstrate better HHS outcomes, as well as a greater percentage of good-to-excellent results when compared with the labral debridement group.

Factors Affecting Recovery After Arthroscopic Labral Debridement of the Hip

The purpose of this study was to develop and validate a model predicting whether patients would have shorter-than-typical or longer-than-typical recoveries after hip arthroscopy for labral tears. We retrospectively reviewed 268 cases of hip arthroscopy implemented between 2000 and 2007 by 2 orthopaedic surgeons at our institution. The development cohort consisted of patients with magnetic resonance angiography-identified labral tears and a history and physical examination consistent with either labral pathology or loose bodies. Univariate analysis targeted preoperative patient characteristics correlated with the risk of longer-than-typical recoveries. Multivariate logistic regression was applied to generate an algorithm predicting risk of longer-than-typical recovery based on baseline characteristics. The algorithm was tested in the validation sample of 52 patients who were treated in 2007 and was found to be valid. Five predictors for longer-than-typical recovery were identified: Workers' Compensation status, female gender, use of pain medications, presence of a limp, and presence of a lateral labral tear. The multivariate algorithm was developed and successfully validated. This study identifies many new predictors of recovery, and it also corroborates those that have already been identified. The 5 predictors for longer-than-typical recovery identified by our validated multivariate algorithm were Workers' Compensation status, female gender, use of pain medications, presence of a limp, and presence of a lateral labral tear. Level IV, therapeutic case series.

Arthroscopic Debridement Versus Refixation of the Acetabular Labrum Associated With Femoroacetabular Impingement

The purpose of this study was to compare the outcomes of arthroscopic labral debridement with those of labral refixation. We reviewed patients who underwent labral debridement during a period before the development of labral repair techniques. Patients with labral tears deemed repairable with our current arthroscopic technique were compared with patients who underwent labral refixation with a minimum 1 of year of follow-up. To better match the 2 groups, only patients with labral pathology caused by pincer-type or combined pincer- and cam-type femoroacetabular impingement were included. In the first 36 hips the labrum was debrided (group 1); in the next 39 hips the labrum underwent refixation (group 2). Outcomes were measured preoperatively and postoperatively with the modified Harris Hip Score (HHS), Short Form 12, and visual analog scale for pain. Preoperative and postoperative radiographs were obtained to evaluate bony resection (alpha angle) and osteoarthritis (Tönnis grade). The mean age was 31 years in group 1, with a mean follow-up of 21.4 months, and 27 years in group 2, with a mean follow-up of 16.5 months. Preoperative subjective outcomes scores were not significantly different between groups. At the 1-year follow-up visit, subjective outcomes were significantly improved (P < .01) in both groups. HHSs were significantly better for the refixation group (94.3) compared with the debridement group (88.9) at 1 year (P = .029). At most recent follow-up, good to excellent results were noted in 66.7% of hips in the debridement group compared with 89.7% of hips in the refixation group (P < .01). Although other variables could have influenced these outcomes, these preliminary results indicate that labral refixation resulted in better HHS outcomes and a greater percentage of good to excellent results compared with the results of labral debridement in an earlier cohort. Level III, retrospective comparative study.

Treatment of failed arthroscopic acetabular labral debridement by femoral chondro-osteoplasty

Femoroacetabular impingement is recognised as being a cause of labral tears and chondral damage. We report a series of five patients who presented with persistent pain in the hip after arthroscopy for isolated labral debridement. All five had a bony abnormality consistent with cam-type femoroacetabular impingement. They had a further operation to correct the abnormality by chondro-osteoplasty of the femoral head-neck junction. At a mean follow-up of 16.3 months (12 to 24) all had symptomatic improvement.

Prognostic Value of Magnetic Resonance Arthrography for Czerny Stage II and III Acetabular Labral Tears

To assess the intraobserver reliability and prognostic value of magnetic resonance arthrography (MRA) on the basis of postoperative outcome measures following arthroscopic acetabular labral debridement (partial limbectomy). Between January 1999 and November 2000, 24 patients (13 females, 11 males) with an average age of 37.1 years (range, 21 to 56 years) underwent hip arthroscopy for the treatment of presumed acetabular labral tears. All patients underwent preoperative MRA and/or magnetic resonance imaging (MRI); images were evaluated by a single musculoskeletal radiologist on 2 independent occasions. Hip arthroscopy was performed on all patients. Outcomes were assessed by means of the Modified Harris Hip Score (MHHS) and the Short Form-36 (SF-36) questionnaires, which were completed by patients an average of 24.1 months (range, 12 to 55 months) postoperatively. The accuracy of the initial read, as well as the prognostic value of the Czerny MRA classification system for stage II (intrasubstance tears) and stage III (complete avulsions) acetabular labral tears, was assessed. Twenty-two of 23 tears (96%) were detected on the initial read. On the basis of intraoperative findings, 1 false-positive MRA, 1 false-negative MRA, and 1 incident of MRA overstaging were reported. On repeat interpretation, 23 of 23 (100%) tears were identified, and intraobserver reliability for recording the presence of a tear was excellent (kappa coefficient = 0.96). No difference was noted in outcomes between patients with or without arthroscopic evidence of chondromalacia (all P > .29), or between patients older or younger than 30 years (all P > .34). Likewise, no difference in outcome was seen between 15 patients with Czerny stage II tears revealed on MRA versus 9 patients with Czerny stage III tears (all P > .79). MRA is sensitive and accurate for the detection of acetabular labral tears, with excellent intraobserver reliability. Arthroscopic partial limbectomy is successful in two thirds of patients. Patients with Czerny stage II and III tears do not appear to have significantly different outcomes following arthroscopic labral debridement. Level IV, prognostic case series.

Correlation of Short Form-36 and Disability Status with Outcomes of Arthroscopic Acetabular Labral Debridement

Background Arthroscopic debridement is the standard of care for the treatment of acetabular labral tears. The Short Form-36 has not been used to measure hip arthroscopy outcomes, and the impact of disability status on hip arthroscopy outcomes has not been reported. Hypothesis Short Form-36 subscale scores will demonstrate good correlation with the modified Harris hip score, but patients undergoing disability evaluation will have significantly worse outcome scores. Study Design Case series; Level of evidence, 4. Methods The records of active-duty soldiers who underwent hip arthroscopy at the authors’ institution were retrospectively reviewed. Forty consecutive patients who underwent hip arthroscopy for the primary indication of labral tear formed the basis of the study group. Patients completed the modified Harris hip score, the Short Form-36 general health survey, and a subjective overall satisfaction questionnaire. Results Thirty-three patients, with a mean age of 34.6 years, were available for follow-up at a mean of 25.7 months postoperatively. Fourteen (43%) patients were undergoing medical evaluation boards (military equivalent of workers’ compensation or disability claim). Pearson correlation coefficients for comparing the Short Form-36 Bodily Pain, Physical Function, and Physical Component subscale scores to the modified Harris hip score were 0.73, 0.71, and 0.85, respectively (P <. 001). The mean modified Harris hip score was significantly lower in patients on disability status than in those who were not (92.4 vs 61.1; P <. 0001). The Short Form-36 subscale scores were significantly lower in disability patients (P <. 02). Patient-reported satisfaction rates (70% overall) were 50% for those undergoing disability evaluations and 84% for those who were not (P <. 04). There was no significant difference in outcomes based on patient age, surgically proven chondromalacia, or gender for military evaluation board status. Conclusion The Short Form-36 demonstrated good correlation with the modified Harris hip score for measuring outcomes after arthroscopic partial limbectomy. Arthroscopic debridement yielded a high percentage of good results when patients undergoing disability evaluations were excluded. Disability status may be a negative predictor of success after hip arthroscopy.

Arthroscopic debridement of glenoid labral tears in athletes

This is a retrospective study of 46 patients who underwent arthroscopic glenoid labral debridement from June 1988 to June 1990. All patients complained of pain in the involved shoulder and all were active in sports involving overhead use of the shoulder, including 30 baseball players (16 professional, 14 collegiate/high school). The average age was 22 years (range 16 to 45) and the average follow-up was 2.7 years (range 18 to 50 months). At operation, 35 patients had posterior glenoid lesions, 9 had anterior-superior lesions, and 2 had anterior-inferior lesions. The posterior lesions were further divided into those that involved a horizontal flap tear (n = 19), and those that involved fraying (n = 16). Overall, at an average of 31 months follow-up, 54% (25 of 46) of patients had good to excellent results. Professional baseball players had a statistically significant enhanced outcome with 75% (12 of 16) good-excellent compared with the remaining nonprofessional group, with 43% (13 of 30) good-excellent results. Outcome did not correlate with shoulder laxity, labral lesion location, mechanism of injury, or the presence of a rotator cuff lesion. Conclusions: Arthroscopic debridement of glenoid labral lesions does not yield consistent long-term results. Aggressive, supervised physical therapy in highly motivated individuals may be the most important factors in influencing outcome in patients having arthroscopic labral debridement in the absence of overt shoulder instability.

Arthroscopic treatment of glenoid labral tears.

We reviewed 52 consecutive patients who had undergone arthroscopic labral debridement. The average age was 29 and there were 35 men and 17 women. At operation, 27 patients had superior labrum anterior and posterior (SLAP) lesions, 20 patients had anteroinferior labral lesions, and 5 patients had posterior labral lesions. Despite the fact that, preoperatively, none of these patients had a history of dislocations or clinically evident instability, 70% of the patients with superior labral lesions, and all of those with anteroinferior and posterior lesions had instability on examination under anesthesia. The average followup was 36 months. At 1 year after arthroscopy, 78% of the patients with superior lesions had excellent relief compared with 30% of the patients in the anteroinferior group. At 2 years followup, these results decreased to 63% and 25%, respectively, and only 45% of the patients with superior labral lesions and 25% of those with anteroinferior lesions had returned to their previous athletic performance level. Four patients required a reoperation: 2 for instability and 2 for impingement. We conclude that occult instability is frequently present in patients with glenoid labral tears. The overall results are not encouraging, but this procedure may have an indication for short-term goals in competitive athletes or those who are willing to accept some compromise in function.

Arthroscopic labral debridement. A three-year follow-up study.

This is a retrospective review of 40 patients who underwent arthroscopic labral debridement of the shoulder. All patients were active participants in sports involving use of the shoulder. All patients presented with shoulder pain. Only 40% were found to have distinct glenohumeral instability on examination. At surgery, all patients had labral injury. Ten patients had anterosuperior labral tears, 20 had anteroinferior labral tears or detachments, and 10 had posteroinferior labral tears or detachments. Outcome was assessed at a minimum of 2 years (average, 43 months) postoperatively. Overall, only 7% of the patients had significant symptomatic relief at followup. However, 72% noted relief of symptoms during the 1st year after surgery, but there was deterioration over time. Arthroscopic labral debridement is not an effective long-term solution for symptomatic relief in the overhead athlete.