Arthroscopic Treatment Of Labral Tears Research Articles

Labral Degeneration Predicts Inferior Mid-Term Outcomes in Hip Labral Repair: A Multicenter Comparative Analysis

To analyze and compare the mid-term outcomes of hip arthroscopy for patients with and without labral degeneration from multiple orthopaedic centers. The purpose of this research is to develop an understanding of the impacts of labral degeneration on patient outcomes following arthroscopic treatment of labral tears. A prospective multicenter hip arthroscopy registry was queried for primary surgeries from January 2014 to October 2017 with completed 2-year International Hip Outcome Tool-12 (iHOT-12) reports. Patients were placed into cohorts based on the presence or absence of labral degeneration noted intraoperatively during hip arthroscopy. Degeneration was defined as yellowing, ossification, or calcification present in at least 50% of the labrum. Differences in baseline variation between groups were assessed with a Wilcoxon rank-sum test or χ2 test. Two-year outcomes were assessed with iHOT-12. Multivariate logistic regression models were fitted while controlling for age, body mass index, sex, and preoperative iHOT-12 scores to identify significant predictors of achieving the clinically significant thresholds of minimal clinically important difference, substantial clinical benefit, and patient-acceptable symptom scale. In total, 735 patients met inclusion criteria, of whom 613 had complete outcomes information. Relative to the control group, the labral degeneration group was significantly older (mean age 44 ± 11 years vs 33 ± 12 years; P < .01). Both groups experienced statistically significant improvement in iHOT-12 scores from baseline to final follow-up (P < .001); however, patients with labral degeneration reported inferior 2-year iHOT-12 scores when compared with patients without degeneration (P < .001). In the logistic regression models, labral degeneration was a significant negative predictor of achieving iHOT-12 minimal clinically important difference (odds ratio [OR] 0.47; 95% confidence interval [95% CI] 0.28-0.79), patient acceptable symptom state (OR 0.50; 95 CI 0.32-0.77), and substantial clinical benefit (OR 0.58; 95% CI 0.37-0.89). The results of our study conclude that patients with nondegenerative labral tissue at the time of repair have superior patient-reported outcomes at mid-term follow-up. The presence of labral degeneration was a negative predictor of achieving clinically significant thresholds after controlling for patient age, body mass index, sex, and baseline iHOT-12 scores. III, retrospective comparative prognostic trial.

Arthroscopic Treatment of Labral Tears in Patients with Borderline Developmental Dysplasia of the Hip: A Retrospective Study with Mean 5.8 Years Follow-Up.

ObjectiveTo retrospectively assess the mid‐term clinical and radiological results of hip arthroscopic treatment of labral tears in patients with borderline developmental dysplasia of the hip (BDDH).MethodsFrom January 2010 and December 2019, data were retrospectively reviewed for all patients who underwent arthroscopic surgery of the hip for the treatment of intra‐articular abnormalities. Only the Patients who had borderline developmental dysplasia (BDDH) were included. All operations were performed by two senior surgeons, the arthroscopic treatment including labral repair, labral debridement, minimal acetabuloplasty, femoroplasty and capsular closure. The evaluation consisted of pain evaluation (visual analog scale [VAS]), the modified Harris hip score (MHHS), range of motion, the radiological evaluation of plain film and MRI analysis of the hip joint. The plain film evaluation included anteroposterior views of the pelvis to assess lateral center‐edge angle (LCEA) and acetabular inclination (AI), frog‐leg lateral views of the hip to assess α angle.ResultsThere were 34 patients (36 hips) ultimately enrolled in this study. The follow‐up duration of the patients were minimal 2 years (average, 69.2 months) postoperatively. The patient group included seven men and 27 women, the mean age at the time of surgery was 30.9 years. The mean BMI was 22.3 kg/m2. From the pre‐operative status to the final follow‐up visit, mean mHHS score increased from 64.5 to 92.7, mean VAS score decreased from 6.8 to 1.3. All scores exhibited statistically significant differences (P < 0.001). The mean LCEA decreased from 22.9° to 22.7°, the mean AI decreased from 7.7° to 7.6°. Which all showed no significant differences compared with the final follow‐up to the pre‐operative status (P > 0.05). However, the mean α angle was significantly decreased from 48.3° to 40.1° (P < 0.001). We encountered no significant complications such as infection, deep venous thrombosis, fluid extravasation, or permanent nerve injury. One patient (2.94%) underwent revision periacetabular osteotomies (PAO) because of subluxation of the hip joint with permanent pain after 6 months failed conservative treatment.ConclusionArthroscopic treatment of labral tears in patients with BDDH may provide safe and durable favorable results at midterm follow‐up. The best outcome could be expected in patients with labral repair and closure of the capsule with strict patient selection criteria.

Arthroscopic Treatment of Labral Tears in Patients 65 Years and Older.

The purpose of this multicenter study was to investigate the clinical outcomes after hip arthroscopy in a series of patients 65 years and older with labral tears with a minimum 2-year follow-up. Outcome data were prospectively collected and retrospectively reviewed for patients 65 years and older who underwent hip arthroscopy. Outcomes at minimum 2-year follow-up were analyzed using prospectively collected Hip Outcome Score (HOS) and modified Harris Hip Score (mHHS). A paired Student's t test was performed to determine significant differences between pre- and postoperative patient-reported outcome scores. Twenty-six patients were included, with a mean age of 67.7 years (range, 65-75 years) and mean follow-up of 50.5 months. The short-term survivorship rate was 65%, with 9 patients requiring total hip arthroplasty (THA) by latest follow-up. At minimum 2-year follow-up, mean mHHS, HOS-Activities of Daily Living, and HOS-Sports-Specific Subscale for surviving hips were 78.97 (range, 25-100), 78.56 (range, 21.7-100), and 65.93 (range, 2.78-100), respectively. The mean improvements for patients with pre- and postoperative mHHS and HOS-Sports-Specific Subscale were 28 and 36.6 (P=.0005 and P=.003, respectively). The average patient satisfaction was 7.7 on a scale of 10. There were no complications noted in this cohort. This study demonstrated that patients older than 65 years with labral pathology who have failed nonoperative measures obtain modest clinical improvement from hip arthroscopy. This clinical improvement yielded a high patient satisfaction, but due to the potential for subsequent THA in a subset of this population, surgeons should use a rigorous selection criteria and counsel patients appropriately. [Orthopedics. 2020;43(6):e579-e584.].

Arthroscopic Labral Treatment in Adolescents: Clinical Outcomes With Minimum 5-Year Follow-up

Background: The success of hip arthroscopy has led to increased application in younger populations. However, hip arthroscopy remains a challenging procedure, and its safety and efficacy in the adolescent population have been controversial. Most existing literature on outcomes in such patients contains only short-term follow-up, and a paucity of evidence is available regarding long-term outcomes in adolescents. Purpose: To report on clinical outcomes at a minimum 5-year follow-up in patients younger than 18 years who underwent arthroscopic treatment of labral tears. Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected and retrospectively reviewed on all patients younger than 18 years who underwent hip arthroscopy in a tertiary hip preservation setting at a single institution. Patients were excluded if they had previous ipsilateral hip conditions or surgery. All patients underwent either labral repair or debridement for treatment of a labral tear. Patient-reported outcome measures were recorded at 3 months and at 1, 2, or a minimum of 5 years. These included the modified Harris Hip Score (mHHS), Nonarthritic Hip Score, Hip Outcome Score–Sports Specific Subscale (HOS-SSS), visual analog scale, and patient satisfaction. Additionally, the abbreviated International Hip Outcome Tool and Short Form Health Survey were collected at latest follow-up. Results: The study included 44 hips in 32 patients that underwent arthroscopic labral repair (86.4%) or labral debridement (13.6%) between April 2008 and April 2011, with latest follow-up at a mean of 69.2 months (range, 60.0-89.9 months) postoperatively. The average age at surgery was 16.3 years (range, 14.2-17.9 years), and 39 hips from female patients. Statistically significant improvements were seen in all patient-reported outcome measures from preoperative to minimum 5-year follow-up. Improvements were noted at 1-year follow-up and maintained at minimum 5-year follow-up. At the latest follow-up, the Patient Acceptable Symptomatic State was achieved in 95.5% of patients for the mHHS and 72.7% for the HOS-SSS. Two patients subsequently underwent secondary arthroscopy on the ipsilateral hip; however, the survivorship of all hips was 100%. Conclusion: Hip arthroscopy for the treatment of labral tears in adolescents remains a technically challenging procedure that should be approached with appropriate caution. The results of the present study on a population treated in a specialized hip preservation center demonstrate that hip arthroscopy is a safe procedure with stable improvement in patient-reported outcome measures at 5 years.

Arthroscopic Treatment of Labral Tears: A Critical Analysis Review.

* With regard to anterior and inferior labral tears, arthroscopic repairs have demonstrated results similar to those of open repairs but with less soft-tissue dissection. Glenoid bone defects should be carefully examined and considered in preoperative planning. Large glenoid defects should be treated with acute repair or a bone-restoring procedure. A period of immobilization should be utilized after arthroscopic repair. Ligamentous laxity and other risk factors for failure after arthroscopic repair must be considered preoperatively.* With regard to superior labral tears, patients who are ≥36 years of age should be considered for other procedures such as a biceps tenodesis or biceps tenotomy.* With regard to posterior labral tears, tears may present with pain with or without instability symptoms. Arthroscopic repairs offer substantially less need for dissection and lead to less morbidity when compared with open repairs. Over 90% of athletes treated with posterior labral repair may return to their preoperative level of play.

Arthroscopic Treatment of Labral Tears of the Hip in Adolescents: Patterns of Clinical Presentation, Intra-articular Derangements, Radiological Associations and Minimum 2-Year Outcomes

To report on patterns of clinical presentation, intra-articular derangements, radiological associations, and minimum 2-year outcomes after hip arthroscopy (HA) in patients 18years or younger. This study was a retrospective case series on patients 18years or younger who had undergone HA for labral tears that had failed nonoperative management from April 2008 to April 2013 with a minimum 2-year follow-up. Exclusion criteria were previous hip conditions or surgery. The following were recorded: demographic, examination, radiological and intraoperative findings, intraoperative procedures performed, patient-reported outcomes (PROs), and patient satisfaction. The PROs reported included the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Sport-Specific Subscale, Hip Outcome Score-Activities of Daily Living, and Visual Analogue Score for pain. One hundred and two patients satisfied the inclusion criteria, of whom 90 (88.2%, 77 females and 13 males) had minimum 2-year follow-up. Females had increased external rotation in flexion (58.9° vs 50.0°, P= .041). Sixty-eight females had a Beighton's score of >4 compared to 6 males (P < .001). There was no distinct pattern within the group or between genders for radiological markers of acetabular coverage, depth, or version and femoral cam size. Mean femoral anteversion for females was 15.7° and for males 11.3°. Females had significantly smaller labral tears (1.73hours vs 2.34hours on the acetabular clock face, P=.028). Females were more likely to require a capsular plication and iliopsoas fractional lengthening (88.3% vs 46.2%, and 77.9% vs 38.5%, respectively). There was a significant improvement in all PRO measures in both males and females (P < .01), but females had lower preoperative and postoperative scores. Mean preoperative and postoperative PROs for males and females were as follows: modified Harris Hip Score 71.0/94.3 and 63.4/88.8, Hip Outcome Score-Activities of Daily Living 78.1/93.4 and 64.0/91.8, Hip Outcome Score-Sport-Specific Subscale 51.7/91.0 and 45.7/78.6, Non-Arthritic Hip Score 78.1/94.5 and 63.1/89.2, and visual analog score 4.77/1.85 and 6.29/2.21. The mean patient satisfaction score was 8.29 out of 10. Five patients (5.56%) required a revision procedure. HA is associated with improved outcomes and pain and high satisfaction scores at minimum 2-year follow-up in adolescent population. The pattern of labral injury is different in males and females and dictates the arthroscopic approach. Females are likely to require a capsular plication and iliopsoas release to address soft-tissue laxity and impingement. Level IV, therapeutic case series.

Arthroscopic Treatment of Labral Tears in Patients Aged 65 Years and Older: A Multi-Center Study of Prospectively Collected Outcomes

Arthroscopic Treatment of Labral Tears in Patients Aged 65 Years and Older: A Multi-Center Study of Prospectively Collected Outcomes

Microfracture in the hip: a matched-control study with average 3-year follow-up.

There is a paucity of literature regarding microfracture surgery in the hip. The purpose of this study was to compare outcomes in patients undergoing hip arthroscopy predominantly for labral tears with focal full thickness chondral damage on the acetabulum or femoral head treated with microfracture and a matched control group that did not have focal full thickness chondral damage. A prospective matched-control study was performed examining four patient-reported outcome (PRO) scores: modified Harris Hip Score (mHHS), non-arthritic hip score, Hip Outcome Score—Activities of Daily Living (HOS-ADL), and Hip Outcome Score—Sports Specific Subscale (HOS-SSS) at minimum 2 years post-operatively between 35 patients undergoing microfracture for chondral defects during hip arthroscopy and 70 patients in a control group that did not have chondral defects. The patients were matched based on gender, age within 7 years, Workman’s compensation claim, labral treatment and acetabular crossover percentage less than or greater than 20. There was no significant difference (P > 0.05) in PRO scores preoperatively between the groups. Both groups demonstrated significant improvement (P < 0.05) in all post-operative PRO scores at all time points. There was no statistically significant difference (P > 0.05) in post-operative PRO scores between the microfracture and control groups, except for HOS-ADL and the visual analog scale (VAS) score, both of which were superior in the control group (P < 0.05). Patient satisfaction was 6.9 for the microfracture group and 7.7 for the control group (P > 0.05). Arthroscopic microfracture of the hip during treatment of labral tears results in favorable outcomes that are similar to the results arthroscopic treatment of labral tears in patients without full thickness chondral damage.

Arthroscopic Treatment of Labral Tears in Patients Aged 60 Years or Older

The purpose of this study was to (1) evaluate the clinical outcomes of a series of patients aged 60 years or older who underwent hip arthroscopy for labral tears with minimum 2-year follow-up and (2) identify risk factors for conversion to total hip arthroplasty (THA). Outcome data were prospectively collected and retrospectively reviewed in patients aged 60 years or older who underwent hip arthroscopy between April 2008 and May 2012. Four patient-reported outcome (PRO) scores, pain scores, and satisfaction ratings were collected. Conversion to THA andrevision surgery rates were recorded. A subgroup analysis compared survivors with patients requiring THA. Minimum 2-year follow-up was available for 30 patients with a mean age of 63.9 years. The 2-year survivorship rate was 70%, with 9 patients undergoing conversion to THA at a mean of 1.1 years after hip arthroscopy. Two patients required additional surgery during the study period, for a reoperation rate of 37% (11 of 30 patients). The remaining cohort showed mean improvements in all PRO scores. All scores, except the sports-related PRO (P= .12), improved significantly from the preoperative baseline scores. Visual analog scale scores for pain decreased from a mean of 5.0 preoperatively to 2.7 postoperatively (P= .003). Patients who required conversion to THA had lower preoperative modified Harris Hip Scores (P= .015), lower preoperative Hip Outcome Score-Activity of Daily Living values (P= .01), higher pain scores (P= .05), greater acetabular inclination (P= .023), and more severe chondral damage (P= .033). Arthroscopic treatment of labral tears in patients aged 60 years or older should be approached with caution. Patients in this age group had an overall 2-year survivorship rate of 70% and should be counseled before surgery on the possibility of subsequent conversion to THA. Patients aged 60 years or older with poor preoperative PRO scores, high pain scores, radiographic evidence of borderline dysplasia, and severe chondral damage may be poor candidates for hip arthroscopy. Level IV, therapeutic case series.

Patient satisfaction after arthroscopic repair of acetabular labral tears.

BackgroundAcetabular labral tear is a main cause of hip pain and disability, often requiring surgical treatment. Improvements of hip arthroscopic technique have produced positive outcomes after labral repair with arthroscopy. The purpose of this study was to determine clinical outcomes and patient satisfaction after arthroscopic repair of acetabular labral tear.MethodsWe interviewed 21 patients (10 men and 11 women; mean age, 36 years [range, 22 to 57 years]) with acetabular labral tears that had been repaired arthroscopically in terms of satisfaction of the procedure. In addition, clinical outcome was assessed using visual analog scale (VAS) score, University of California, Los Angeles (UCLA) activity, Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, and Harris hip score, and radiologic outcome was assessed using serial radiography. The patients were followed for 24-50 months.ResultsThe mean Harris hip score was 73 points (range, 64 to 84 points) preoperatively and 83 points (range, 66 to 95 points) postoperatively. Fifteen hips (71%) were rated excellent and good. The mean WOMAC osteoarthritis index and VAS scores were improved at final follow-up. UCLA activity at the latest follow-up improved in 16 patients. The Tonnis grade of osteoarthritis at the latest follow-up did not change in all patients. Eighteen of the patients (86%) were satisfied with the procedure.ConclusionsHigh rate of satisfaction after arthroscopic repair of acetabular labral tears is an encouraging outcome. Arthroscopic treatment of labral tears might be a useful technique in patients with hip pathologies, such as femoroacetabular impingement with labral tears.

Arthroscopic Treatment of Labral Tears and Concurrent Avascular Necrosis of the Femoral Head in Young Adults

Avascular necrosis (AVN) of the femoral head is a progressive disease affecting young adults that results in collapse of the femoral head and subsequent degenerative joint disease. Although precollapse stages of AVN can be successfully treated with core decompression, making the diagnosis is often difficult given alternative sources of hip pain in this age group. We propose that arthroscopic-assisted core decompression of the femoral head offers an effective method of addressing AVN of the femoral head as well as coexistent hip disorders in the same operation. This article describes in detail the technique used to perform an arthroscopic-assisted core decompression of the femoral head, and a companion video demonstrating the procedure is included. Our experience suggests that arthroscopic-assisted core decompression can be used as an alternative to open core decompression, while simultaneously addressing other sources of hip pain, with successful outcomes.

Arthroscopic Treatment of Labral Tears in Acetabular Dysplasia: The Role of the Tonnis Angle and its Effect on the Outcomes (SS-40)

Labral tears are a common finding in patients with acetabular dysplasia. Currently, the role of arthroscopic treatment and the factors that might influence the outcome of labral treatment are still uncertain. The aim of this study is to assess if the size of the Tonnis angle influences the clinical outcomes in patients with acetabular dysplasia receiving arthroscopic treatment for labral tears. Retrospective study of 30 patients with acetabular dysplasia, with an associated labral tear treated with hip arthroscopy. Inclusion criteria were centre edge (CE) angle < 25, Tonnis grade 0, lateral sourcil height ≥2mm. The Tonnis angle was measured. Intraoperative findings were recorded and the type of labral treatment: resection or repair. Patients were assessed using a 100 point Modified Harris Hip Score (MHHS) pre- and post-operatively after an average of 2 years. A linear regression model was used to assess the relation of the difference in MHHS (preop-postop) and the Tonnis angle (explanatory variable). A linear regression model was also fitted within each of the treatment groups separately. 30 patients; 23 females and 7 males (mean age 37 years, range 23-51) were assessed pre-operatively and at 2 year follow up. The average CE angle was 21 degrees (range 15- 24). The average Tonnis angle was 13.8 degrees (6-25). 11 patients had a labral debridement and 19 patients a labral repair. Our study demonstrates a significant (p=0.0013) relation between the reduction in MHHS score difference (preop-postop) as the Tonnis angle increases. This study demonstrates that in patients with dysplasia who received arthroscopic treatment for labral tears, the surgical outcome (MHHS) is depending on the Tonnis angle. Patients with an increased Tonnis angle, independent of the type of treatment, have a poorer outcome and possibly, a different treatment option should be considered.

Arthroscopic treatment of labral tears in femoroacetabular impingement

Labral tears are commonly associated with femoroacetabular impingement. We reviewed 151 patients (156 hips) with femoroacetabular impingement and labral tears who had been treated arthroscopically. These were subdivided into those who had undergone a labral repair (group 1) and those who had undergone resection of the labrum (group 2). In order to ensure the groups were suitably matched for comparison of treatment effects, patients with advanced degenerative changes (Tönnis grade > 2, lateral sourcil height < 2 mm and Outerbridge grade 4 changes in the weight-bearing area of the femoral head) were excluded, leaving 96 patients (101 hips) in the study. At a mean follow-up of 2.44 years (2 to 4), the mean modified Harris hip score in the labral repair group (group 1, 69 hips) improved from 60.2 (24 to 85) pre-operatively to 93.6 (55 to 100), and in the labral resection group (group 2, 32 hips) from 62.8 (29 to 96) pre-operatively to 88.8 (35 to 100). The mean modified Harris hip score in the labral repair group was 7.3 points greater than in the resection group (p = 0.036, 95% confidence interval 0.51 to 14.09). Labral detachments were found more frequently in the labral repair group and labral flap tears in the resection group. No patient in our study group required a subsequent hip replacement during the period of follow-up. This study shows that patients without advanced degenerative changes in the hip can achieve significant improvement in their symptoms after arthroscopic treatment of femoroacetabular impingement. Where appropriate, labral repair provides a superior result to labral resection.

Arthroscopic Treatment of Labral Tears After a Previous Pemberton Osteotomy

We present 3 patients followed at our institution for developmental hip dysplasia for an average of 20 years. Each patient underwent a Pemberton pelvic osteotomy for developmental hip dysplasia and remained symptom-free during childhood. All 3, however, returned as young adults at an average 12 years from surgery with delayed onset of ipsilateral hip pain associated with a damaged labrum. The purpose of this report is to describe the late presentation of 3 symptomatic young adults with a history of childhood pelvic osteotomy. All the 3 patients were subsequently diagnosed with and successfully treated for symptomatic acetabular labral damage. All patients were informed that data concerning their case would be submitted for publication.

The Management of Labral Tears and Femoroacetabular Impingement of the Hip in the Young, Active Patient

The purpose of this systematic review was to determine (1) the quality of the literature assessing outcomes after surgical treatment of labral tears and femoroacetabular impingement (FAI), (2) patient satisfaction after open or arthroscopic intervention, and (3) differences in outcome with open or arthroscopic approaches. Computerized literature databases were searched to identify relevant articles from January 1980 to May 2008. Studies were eligible for inclusion if they had a level I, II, III, or IV study design and if the patient population had a labral tear and/or FAI as the major diagnosis. Patients with severe pre-existing osteoarthritis or acetabular dysplasia were excluded. Of the 19 articles with reported outcomes after surgery, none used a prospective study design and only 1 met the criteria for level III basis of evidence. Open surgical dislocation with labral debridement and osteoplasty is successful, with a good correlation between patient satisfaction and favorable outcome scores. The studies reviewed support that 65% to 85% of patients will be satisfied with their outcome at a mean of 40 months after surgery. A common finding in all series, however, was an increased incidence of failure among patients with substantial pre-existing osteoarthritis. Arthroscopic treatment of labral tears is also effective, with 67% to 100% of patients being satisfied with their outcomes. The quality of literature reporting outcomes of surgical intervention for labral tears and FAI is limited. Although open surgical dislocation with osteoplasty is the historical gold standard, the scientific data do not show that open techniques have outcomes superior to arthroscopic techniques. Level IV, systematic review.

Arthroscopic treatment of labratears

The acetabular labrum serves important physiological and biomechanical functions, allowing for normal hip function. Tears of the acetabular labrum occur in active, young patients. Common injuries attributed to labral tears include direct blows, falls, twisting injuries, and running. In many patients, however, the onset of symptoms is insidious, with atraumatic tearing caused by repetitive activities. These injuries, in most cases, may be diagnosed through careful history, physical examination, and magnetic resonance (MR) arthrography. A small subset of patients may respond to conservative treatment when initiated early. Arthroscopy of the hip is the gold standard both for diagnosing and treating labral tears. By using careful techniques and arthroscopic instrumentation adapted for the hip, arthroscopic treatment of labral tears may be performed with a very low rate of complications and successful treatment of symptoms in the majority of patients. However, long-term outcomes after partial labrectomy are not known.