Surgical management of labral tears during femoroacetabular impingement surgery: a systematic review

Purpose

This systematic review explored reported outcomes addressing femoroacetabular impingement (FAI), specifically those comparing labral debridement to labral repair. In addition, the quality of the evidence was evaluated for the purposes of making treatment recommendations.

Methods

Three databases (MEDLINE, EMBASE, and PubMed) were searched for comparative studies involving labral repair and debridement during FAI surgery. Two reviewers conducted a title, abstract, and full-text review of eligible studies and the references of these studies. Inclusion and exclusion criteria were applied to the searched studies, data were extracted, and a quality assessment was completed for included studies.

Results

Six eligible studies involving 490 patients were identified. The most commonly reported outcome measure was the modified Harris hip score (MHHS) (50 %). All studies reported that labral repair had greater postoperative improvements in functional scores (modified Harris hip, non-arthritic hip, hip outcome, and Merle d’Aubigne scores) compared to labral debridement. Five studies reported statistically significant improvements with labral repair. MHHS were pooled to demonstrate a clinically important difference in favor of labral repair by 7.4 points in three studies. The mean individual study quality can be considered fair. However, the overall quality of the body of evidence in this review is rated as low according to GRADE guidelines.

Conclusions

This review demonstrates a reporting of better clinical outcomes with labral repair compared to labral debridement in all studies with five of six studies reporting statistically significant improvements (of repair over debridement). However, given the lack of high quality evidence and associated limitations in study design, these results should be interpreted with caution. Consequently, definitive treatment recommendations require further investigation with well-conducted clinical trials. This systematic review enables the discussion of best evidence practice for the surgical managing of a labral tear associated with FAI.

Level of evidence

III.     

A comprehensive five-phase rehabilitation programme after hip arthroscopy for femoroacetabular impingement

Purpose

Recent advancements in the understanding of hip biomechanics have led to the development of techniques to remove bony impingement and repair and/or preserve the labrum during hip arthroscopy. Although much attention in the literature is devoted to diagnosis and treatment, there is little information about post-operative rehabilitation. Therefore, the purpose of this review is to (1) provide a five-phase rehabilitation protocol following arthroscopic treatment for FAI and (2) report clinical and functional outcomes of patients following this protocol at minimum 1-year follow-up, in order to provide the surgeon and therapist with a protocol that is supported by clinical data.

Methods

All consecutive patients undergoing hip arthroscopy and subsequent five-phase rehabilitation protocol at a single institution from 1 April 2011 to 1 April 2012 were analysed. Inclusion criteria were as follows: no prior ipsilateral hip surgery, completion of the five-phase rehabilitation protocol, minimum 1-year follow-up, and documented outcome scores. Prospective outcomes were assessed with modified Harris hip score (MHHS) and hip outcome score (HOS).

Results

Fifty-two patients (19 male and 33 female) met the inclusion criteria with a median age of 42 (range 16–59) years. Mean MHHS, HOS-ADL, and HOS-sport scores at a mean 12.5 (range 12–15) months were 80.1 ± 19.9 (0–100), 83.6 ± 19.2 (13.2–100), and 70.3 ± 27.0 (0–100), respectively.

Conclusion

This five-phase rehabilitation programme provides a framework where progression from surgery to increasing post-operative activity level can take place in a predictable manner. Patients following this rehabilitation protocol after hip arthroscopy demonstrated satisfactory clinical and functional outcomes, validating its implementation.

Level of evidence

Case series, Level IV.     

Arthroscopic debridement of the isolated Ligamentum Teres rupture

Purpose

Most tears of the Ligamentum Teres (LT) are diagnosed when treating other hip pathologies. The purpose of this study was to evaluate the outcome of arthroscopic surgery for a unique group of patients with symptomatic isolated Ligamentum Teres rupture of the hip.

Methods

The study included 29 patients who suffered from an isolated Ligamentum Teres rupture of the hip and were treated with an arthroscopic debridement from 2003 to 2008. Patients with femoroacetabular impingement or other hip pathologies except Ligamentum Teres tear were excluded. Clinical results were measured preoperatively and postoperatively with the modified Harris Hip Score (MHHS) and Non-Arthritic Hip Score (NAHS). The mean age was 25?years (SD?±?11) with a mean follow-up time of 2.5?years (SD?±?1.5).

Results

At the last follow-up, the mean MHHS improved from 70 to 86 [mean difference?=?16 (95% CI 4?C27)] and the mean NAHS improved from 64 to 86 [mean difference?=?22 (95% CI 10?C33)]. Five patients have had a second arthroscopic debridement due to symptomatic recurrent tears.

Conclusion

Arthroscopic debridement alone of the isolated Ligamentum Teres rupture has a short-term beneficial result in more than 80% of cases.     

The diagnostic value of direct CT arthrography using MDCT in the evaluation of acetabular labral tear: with arthroscopic correlation

Objective

The purpose of this study was first, to determine the sensitivity, specificity, and accuracy of MDCT arthrography (CTA) for the diagnosis of acetabular labral tear and sulcus; second, to correlate tear types using the Lage classification system on CTA compared with the arthroscopic classification; and third, to correlate CTA localization with arthroscopic localization.

Materials and methods

Direct CTA was performed using 16- or 64-slice MDCT in 126 hips (124 patients) who had chronic groin pain and positive impingement test. Images were reviewed and evaluated by two experienced musculoskeletal radiologists preoperatively. CTA findings were compared with arthroscopic findings in 58 hips (56 patients) under consensus by two orthopedic surgeons.

Results

Forty-one of the 58 hips were diagnosed as labral tears on CT arthrography. Forty-three of the 58 hips were shown to have a labral tear on arthroscopy. Sensitivity, specificity, and accuracy for detecting labral tear and sulcus by CTA were 90.7%, 86.7%, and 89.7%, and 93.8%, 97.6% and 96.6% respectively for observer 1, and 90.7% and 80.0%, 87.9% and 87.5%, 95.2%, and 93.1 % respectively for observer 2. Thirty-five out of 41 hips (85%) that were diagnosed with labral tear on CTA correlated substantially with arthroscopic Lage classification (kappa coefficient = 0.65). CTA and arthroscopic findings showed similar distribution patterns of the tears with most lesions located in antero- and postero-superior areas (p?=?0.013).

Conclusion

Direct CT arthrography using MDCT may be a useful diagnostic technique in the detection of acetabular labral tear.     

The hip fluid seal—Part I: the effect of an acetabular labral tear,repair, resection,and reconstruction on hip fluid pressurization

Purpose

The acetabular labrum is theorized to be important to normal hip function by creating intra-articular fluid pressurization through the hip fluid seal. However, the effect of a labral tear or partial labral resection, and interventions including labral repair and labral reconstruction, on the hip fluid seal remains to be defined. The purpose of this study was to characterize intra-articular fluid pressurization in six labral conditions: intact, tear, repair (looped vs. through sutures), partial resection, reconstruction with iliotibial band, and complete resection.

Methods

Eight cadaveric hips with a mean age of 47.8 years (SD 4.3, range 41–51) were included in the study. For each labral condition, the hip was compressed with a force of 2.7 times body weight (2,118 N) while intra-articular pressure was continuously measured with 1.0 × 0.3 mm pressure transducers. Peak intra-articular pressure measurements for each condition were normalized relative to the intact state. Statistical analyses were performed utilizing linear mixed-effects models with repeated measures analysis.

Results

Intra-articular fluid pressurization of the intact state varied from 78 to 422 kPa (mean 188 kPa ± SD 120). Labral tear, partial resection, and complete resection resulted in average pressurization of 75 ± 33, 53 ± 37, and 24 ± 18 %, respectively compared with the intact state. Through type labral repair resulted in significantly greater increases in pressurization from the labral tear state, compared with the looped type repair (median increase; +46 vs. ?12 %, p = 0.029). Labral reconstruction resulted in a mean pressurization of 110 ± 38 % relative to intact state, with a significant 56 ± 47 % improvement in pressurization compared with partial labral resection (p = 0.009).

Conclusions

Partial labral resection caused significant decreases in intra-articular fluid pressurization. Through type labral suture repair restored the fluid pressurization better than looped type repairs. Labral reconstruction significantly improved pressurization to levels similar to the intact state. This study demonstrated the effect of labral tears and partial resections on intra-articular fluid pressurization via the hip fluid seal, and it also demonstrated improvements in pressurization seen with through type labral repairs and labral reconstructions.     

Pre-operative intra-articular hip injection as a predictor of short-term outcome following arthroscopic management of femoroacetabular impingement

Purpose

Diagnostic hip injections are often used to confirm intra-articular pathology prior to arthroscopic treatment for femoroacetabular impingement (FAI). However, little is known whether the type of response correlates with the post-operative functional outcomes. The purpose of this study is to document the ability of a diagnostic hip injection to predict short-term functional outcomes following arthroscopic surgical management.

Methods

A prospective cohort of 52 patients diagnosed with FAI who had an intra-articular hip injection prior to arthroscopic surgery was evaluated. A pain diary was used during the 2 weeks after hip injection to document response. In addition, the modified Harris Hip Score (mHHS) was administered preoperatively and 6 months post-operatively to assess functional outcomes. The relationship between response to an intra-articular hip injection and mHHS scores 6 months after FAI surgery was evaluated.

Results

Overall, 42 of 52 (81 %) patients diagnosed with FAI achieved pain relief from the hip injection. Outcomes according to mHHS scores improved significantly at the 6-month follow-up visit (19 points, 95 % CI 15–24, p = 0.001). The therapeutic utility of the hip injection suggested that lack of pain relief predicted a lack of functional improvement following arthroscopic surgery.

Conclusion

In this study, the data suggests that a positive response from an intra-articular hip injection is not a strong predictor of short-term functional outcomes following arthroscopic management of FAI. However, a negative response from an intra-articular hip injection may predict a higher likelihood of having a negative result from surgery.

Level of evidence

Level II.     

Femoroacetabular impingement: is hyaluronic acid effective?

Purpose

Femoroacetabular impingement may predispose to the development of hip osteoarthritis. Conservative treatments are effective in the short term, but surgery is often required. Aim of this paper was to report the short-term results on hip pain and function after ultrasound-guided injections of hyaluronic acid.

Methods

In this open prospective trial, twenty patients suffering from mild femoroacetabular impingement were enrolled. Each patient received a 2-ml intra-articular ultrasound-guided injection of hyaluronic acid at baseline and after 40 days; the same dosing schedule was repeated after 6 months. The clinical evaluation was performed at baseline and after 6 and 12 months of follow-up. Pain score, Lequesne Index, Harris Hip Score and anti-inflammatory medication consumption were measured. Adverse events were also registered.

Results

Twenty-three hips (3 bilateral cases) were treated. Pain decreased from 6.7 ± 1.3 to 3.7 ± 1.8 and to 1.7 ± 1.8 after 6 and 12 months, respectively; Lequesne Index was reduced and the mean Harris Hip Score improved from 83.3 ± 6 before treatment to 88.2 ± 4.7 at 12 months. Consumption of anti-inflammatory drugs was also reduced, from 14 to 4 subjects and from 3.6 ± 2.2 to 1.3 ± 1.3 tablets/week. Local side effects after injection were observed only in 2 cases.

Conclusions

Hyaluronic acid is safe and effective in the treatment of mild femoroacetabular impingement, with significant pain reduction and function improvement.

Level of evidence

IV.     

Multiple hereditary exostoses and ischiofemoral impingement: a case–control study

Objective

To assess whether there is a significant difference in the ischiofemoral space in patients with multiple hereditary exostoses affecting the proximal femora compared to normal patients.

Introduction

Ischiofemoral impingement is an increasingly recognized cause of hip and buttock pain. This causes narrowing of the ischiofemoral space resulting in an abnormal quadratus femoris muscle.

Materials and methods

We performed a retrospective search for individuals with MHE with proximal femoral involvement on pelvic MRI over a 7-year period (2006–2013). Suitable patients were age- and sex-matched with a control group. The minimum ischiofemoral space (MIFS) was recorded in each hip, as was the presence of edema and atrophy of quadratus femoris and concomitant hip osteoarthrosis. MRI features suggestive of ischiofemoral impingement were defined as MIFS less than 10 mm or an abnormal quadratus femoris muscle.

Results

Twenty-one hips in 11 individuals with MHE were included in the study. A total of 42 hips were analyzed. The mean age was 37 years (range, 13–72 years) and 55 % were male. There was a significant difference (p?<?0.05) in the MIHS in individuals with MHE (mean, 10.7 mm, range, 0–21 mm) compared to a control group (mean, 18.1 mm, range, 10.5–26.5 mm). MRI features suggestive of ischiofemoral impingement were seen in 13/21 (62 %) hips in the MHE group and 0/21 (0 %) in the control group.

Conclusions

The reduced ischiofemoral space and associated quadratus femoris abnormalities in patients with MHE involving the proximal femora may account for hip/buttock symptoms in the absence of significant degenerative change.     

Extreme hip motion in professional ballet dancers: dynamic and morphological evaluation based on magnetic resonance imaging

Objective

To determine the prevalence of femoroacetabular impingement (FAI) of the cam or pincer type based on magnetic resonance imaging (MRI) in a group of adult female professional ballet dancers, and to quantify, in vivo, the range of motion (ROM) and congruence of the hip joint in the splits position.

Materials and methods

Institutional review board approval and informed consent from each volunteer were obtained. Thirty symptomatic or asymptomatic adult female professional ballet dancers (59 hips) and 14 asymptomatic non-dancer adult women (28 hips, control group) were included in the present study. All subjects underwent MRI in the supine position, while, for the dancers, additional images were acquired in the splits position. Labral abnormalities, cartilage lesions, and osseous abnormalities of the acetabular rim were assessed at six positions around the acetabulum. A morphological analysis, consisting of the measurement of the α angle, acetabular depth, and acetabular version, was performed. For the dancers, ROM and congruency of the hip joint in the splits position were measured.

Results

Acetabular cartilage lesions greater than 5 mm were significantly more frequent in dancer’s hips than in control hips (28.8 vs 7.1%, p?=?0.026), and were mostly present at the superior position in dancers. Distribution of labral lesions between the dancers and the control group showed substantially more pronounced labral lesions at the superior, posterosuperior, and anterosuperior positions in dancers (54 lesions in 28 dancer’s hips vs 10 lesions in 8 control hips). Herniation pits were found significantly more often (p?=?0.002) in dancer’s hips (n?=?31, 52.5%), 25 of them being located in a superior position. A cam-type morphology was found for one dancer and a retroverted hip was noted for one control. Femoroacetabular subluxations were observed in the splits position (mean: 2.05 mm).

Conclusion

The prevalence of typical FAI of the cam or pincer type was low in this selected population of professional ballet dancers. The lesions’ distribution, mostly superior, could be explained by a “pincer-like” mechanism of impingement with subluxation in relation to extreme movements performed by the dancers during their daily activities.     

Revision hip arthroscopic surgery: outcome at three years

Purpose

This study describes the medium-term results of revision hip arthroscopy.

Methods

Patients with persistent hip pain and a positive impingement sign were considered for revision surgery after the exclusion of other causes of groin pain. Seventy-four consecutive patients were prospectively assessed using the modified Harris hip score for a period of 3 years after surgery. Of the 74 patients, 11 had inadequate follow-up data; thus, a total of 63 patients were qualified for the study. The mean age at index surgery was 37 years, comprising 27 males and 36 females.

Results

Revision surgery was performed at a mean of 3 years from index surgery. Chondral lesion associated with labral re-injury was the most common finding at revision arthroscopy. In contrast to other authors, however, only 31 % of our patients underwent revision for persistent femoroacetabular impingement. The mean pre-operative mHHS for all 63 patients was 54 (SD 14.5). The mean post-operative mHHS was 53 (SD 14.9) at 6 weeks, 62 (SD 17.5) at 6 months, 63 (SD 16.5) at 1 year, 64 (SD 16.5) at 2 years and 59 (SD 16.5) at 3 years (p = n.s., 0.02, 0.045, 0.039 and n.s., respectively).

Conclusions

Revision arthroscopy results in improvement in outcome in the first 3 years after revision surgery with a success rate of 63.4 % at 1 year, falling to 55.6 % by 3 years.

Level of evidence

IV.     

Normal anatomical variants of the labrum of the hip at magnetic resonance imaging: a systematic review

Objective

To review the literature regarding normal labral variants at MRI.

Methods

A systematic search was performed in PubMed/MEDLINE and Embase. For each included study, information regarding normal labral variants and findings in asymptomatic subjects was extracted.

Results

There were 24 studies in symptomatic patients, evaluating 822 hips. The presence of a sublabral sulcus was reported by four studies in 41 hips (5 % of all evaluated hips), occurring at all anatomical locations. There were 3 cadaver studies, investigating 32 hips and reporting no normal labral variants. There were 8 studies in asymptomatic subjects, evaluating 1,096 hips. Labral tears were reported in 213 hips (19 %); no sublabral sulci were reported. Labral shape was most commonly triangular (59–89 %), whereas rounded (11–16 %), flattened (13–37 %) and teardrop (41 %) shapes were less frequently seen. Overall methodological quality of included studies was moderate, with median total quality scores of 43 % (symptomatic patients), 71 % (cadavers) and 70 % (asymptomatic subjects).

Conclusion

At MRI, a sublabral sulcus can be found at any anatomical location. Our results suggest that its prevalence is at least 5 % in symptomatic patients. The most common labral shape is triangular. Rounded, flattened and teardrop shapes are less frequent but are also encountered in asymptomatic subjects.

Key Points

? A sublabral sulcus can be detected by MRI at any anatomical site ? Its prevalence is estimated to be at least 5 % in symptomatic patients ? The most common shape of the hip labrum is triangular ? Rounded, flattened and teardrop shapes are less frequent     

The hip fluid seal—Part II: The effect of an acetabular labral tear,repair, resection,and reconstruction on hip stability to distraction

Purpose

The acetabular labrum is theorized to be important to normal hip function by providing stability to distraction forces through the suction effect of the hip fluid seal. The purpose of this study was to determine the relative contributions of the hip capsule and labrum to the distractive stability of the hip, and to characterize hip stability to distraction forces in six labral conditions: intact labrum, labral tear, labral repair (looped vs. through sutures), partial resection, labral reconstruction with iliotibial band, and complete resection.

Methods

Eight cadaveric hips with a mean age of 47.8 years (SD 4.3, range 41–51 years) were included. For each condition, the hip seal was broken by distracting the hip at a rate of 0.33 mm/s while the required force, energy, and negative intra-articular pressure were measured. For comparisons between labral conditions, measurements were normalized to the intact labral state (percent of intact).

Results

The relative contribution of the labrum to distractive stability was greatest at 1 and 2 mm of displacement, where it was significantly greater than the role of the capsule and accounted for 77 % (SD 27 %, p = 0.006) and 70 % (SD 7 %, p = 0.009) of total distractive stability, respectively. The relative contribution of the capsule to distractive stability increased with progressive displacement, providing 41 % (SD 49 %) and 52 % (SD 53 %) of distractive stability at 3 and 5 mm of distraction, respectively. The maximal distraction force required to break the hip seal in the intact labral state (capsule removed) varied from 124 to 150 N. Labral tear, partial resection, and complete resection resulted in average maximal distraction forces of 76 % (SD 34 %), 29 % (SD 26 %), and 27 % (SD 22 %), respectively, compared to the intact state. Through type labral repairs resulted in significantly greater improvements (from the labral tear state) in maximal negative pressure generated, compared to looped type repairs (median increase; +32 vs. ?9 %, p = 0.029). Labral reconstruction resulted in a mean maximal distraction force of 66 % (SD 35 %), with a significant improvement of 37 % compared to partial labral resection (p < 0.001).

Conclusion

The acetabular labrum was the primary hip stabilizer to distraction forces at small displacements (1–2 mm). Partial labral resection significantly decreased the distractive strength of the hip fluid seal. Labral reconstruction significantly improved distractive stability, compared to partial labral resection. The results of this study may provide insight into the relative importance of the capsule and labrum to distractive stability of the hip and may help to explain hip microinstability in the setting of labral disease.     

Arthroscopic treatment for acute septic arthritis of the hip joint in adults

Purpose

The purpose of our study was to evaluate the efficacy and safety of the arthroscopic management of septic arthritis of the hip joint.

Methods

From October 2009 to October 2010, nine patients with septic arthritis of the hip were treated with arthroscopic debridement and drainage and systemic antibiotics according to bacterial sensitivity or with empiric antibiotics if no bacteria was isolated from the cultures. All patients were placed in the supine position on a fracture table, and two or three arthroscopic portals were used. The medical records were retrospectively reviewed to determine the efficacy and safety of hip arthroscopy for septic arthritis.

Results

There were 4 men and 5 women, with a mean age of 49.8 years (SD 12.1). No major complication related to arthroscopy of the hip was encountered. Staphylococcus aureus was identified in 4 patients. Average follow-up was 19.4 months (SD 4.1). Septic arthritis relapsed in one patient, but the other 8 patients experienced no recurrence during the follow-up period.

Conclusions

Arthroscopic lavage and debridement is a safe and effective procedure for septic arthritis of the hip joint.

Level of evidence

IV.     

Radiographic findings of femoroacetabular impingement in capoeira players

Purpose

Capoeira is a Brazilian martial art that requires extreme movements of the hip to perform jumps and kicks. This study evaluated a group of capoeira players to assess the prevalence of femoroacetabular impingement (FAI) in athletes practicing this martial art.

Methods

Twenty-four experienced capoeira players (14 men, 10 women) underwent a diagnostic assessment, including clinical examination and standard radiographs of the pelvis and hips. The α-angle, head–neck offset, crossover sign, acetabular index, lateral centre-edge angle, and the Tönnis grade were assessed using the radiographs. Clinical relationships for any radiographic abnormalities indicating FAI were also evaluated.

Results

Four subjects (17 %) reported pain in their hips. Forty-four hips (91.7 %) had at least one radiographic sign of CAM impingement, and 22 (45.8 %) had an α-angle of more than 60°. Eighteen hips (37.5 %) had at least one sign of pincer impingement and 16 (33.3 %) a positive crossover sign. Sixteen hips (33.3 %) had mixed impingement. There was a significant positive association between having an α-angle of more than 60° and the presence of groin pain (P = 0.002). A reduced femoral head–neck offset (P < 0.001) and an increased α-angle on the anteroposterior radiograph (P = 0.008) were independently associated with a higher Tönnis grade.

Conclusion

High prevalence of radiographic CAM-type FAI among these skilled capoeira players was found. In these subjects, a negative clinical correlation for an increased α-angle was also detected. Additional caution should be exercised whenever subjects with past or present hip pain engage in capoeira.

Level of evidence

Diagnostic, Level III.     

Critical three-dimensional factors affecting outcome in osteochondral lesion of the talus

Purpose

This study aimed to investigate the relationship between clinical outcomes, patient demographics and the 3D-geometric profiles of the osteochondral lesion of the talus (OLT) following arthroscopic debridement and bone marrow stimulation.

Methods

Between 2005 and 2011, arthroscopic debridement and bone marrow stimulation were performed on 50 ankles with OLT mean age of 36.0 (19.1) years and mean follow-up time of 35.5 (20.2) months. Clinical data were assessed using validated Japanese Society of Surgery of the Foot scoring. An outcome was deemed unsatisfactory if the JSSF score was less than 80. Magnetic resonance imaging and X-rays were used to assess the 3D-geometric profiles of the OLT.

Results

The mean preoperative and postoperative scores were 73.4 (13.6) and 89.6 (11.5), respectively (p < 0.001). Unsatisfactory outcomes were identified in 12 % of patients. Linear regression analyses showed that lesion depth and patient age were significantly negatively correlated with postoperative scores (p < 0.001). High prognostic significances were attributed to defect depth and age of patient, and cut-off values of 7.8 mm and 80 years, respectively, were recommended to avoid a postoperative score less than 80. No significant correlations between poor clinical outcome and the other lesion profiles or demographic factors were identified.

Conclusion

Using 3D-geometric and demographic profiles, defect depth and age of patient are essential prognostic factors in OLT and may act as a basis for preoperative surgical decisions. A lesion depth ≥7.8 mm and age ≥80 years predict an unsatisfactory outcome following arthroscopic debridement and bone marrow stimulation.

Level of evidence

Retrospective comparative study, Level III.     

Arthroscopic inside-out repair of complete radial tears of the meniscus with a fibrin clot

Purpose

To report on the results of 12 complete radial tears of the meniscus treated using arthroscopic inside-out repair with fibrin clots, the results showed good meniscal healing and excellent clinical outcomes.

Methods

From 2007 to 2009, 12 patients with complete radial tears of the meniscus were treated by arthroscopic inside-out repair with fibrin clots. In all patients, the International Knee Documentation Committee (IKDC) subjective knee form and Lysholm score were determined pre- and post-operatively. We performed magnetic resonance imaging (MRI) and if indicated, we performed a second-look arthroscopic examination.

Results

At a mean of 30 ± 4 postoperative months, the Lysholm score and IKDC subjective knee score had improved from 65 ± 6 and 57 ± 7 to 94 ± 3 and 92 ± 3, respectively. Eleven of 12 cases showed complete healing on follow-up MRI. Six of 7 patients undergoing a second-look arthroscopic examination had healed completely.

Conclusion

This study shows successful meniscal repairs using fibrin clots in complete radial tears. This surgical procedure appears to be a good treatment method for complete radial tear of the meniscus.

Level of evidence

Case series, Level IV.     

Radiographic signs associated with femoroacetabular impingement occur with high prevalence at all ages in a hospital population

Objectives

Femoroacetabular impingement (FAI) is increasingly diagnosed clinically. Controversy exists about the significance of radiographic findings. Our goal is to determine the prevalence of radiographic FAI types and parameters in a hospital population clinically not suspected of having FAI. In addition we assessed whether pain, age and gender are associated with higher prevalences.

Methods

Three hundred ten patients were included in this retrospective study. After applying the exclusion criteria, 262 patients (522 hips) remained. Two observers scored for radiographic parameters. A generalised estimation equation, Pearson’s χ² test and logistic regression model were used.

Results

Radiographic signs of FAI were absent in only 58 hips (11.1 %). In the 40 hips (7.7 %) with cam impingement, males were more affected (P?<?0.001). In the 330 hips (63.2 %) with pincer impingement, females were more often affected (P?<?0.001). In the 82 hips (15.7 %) with signs of mixed type impingement, male hips were significantly (P?<?0.001) more often affected. Age had some effect on the prevalence of coxa vara, acetabular index and acetabular retroversion. No correlation with pain was found.

Conclusions

In this hospital population, signs occurred at a high rate. Radiographic parameters attributed to FAI are non-specific. Especially radiographic signs attributed to pincer type impingement have a high prevalence.

Key Points

? Femoroacetabular impingement is associated with an abnormal configuration of the hip joint. ? The prevalence of femoroacetabular impingement parameters was high in our study population. ? The diagnosis of femoroacetabular impingement should be made clinically.     

Hip arthroscopy with labral repair for femoroacetabular impingement: short-term outcomes

Purpose

The purpose of this study was to examine the progression of clinical outcomes 3, 6 and 12 months after hip arthroscopy with labral repair for femoroacetabular impingement (FAI).

Methods

From May 2009 to December 2011, 87 consecutive patients [55 females (median age 38, range 17–63) and 32 males (median age 38, range 15–59)] underwent hip arthroscopy and labral repair, by the same experienced surgeon. Standardised, but unstructured, post-operative rehabilitation instructions were provided. Function and pain were evaluated using modified Harris Hip Score (mHHS) and visual analogue scale (VAS) pre-operatively and post-operatively at 3, 6, and 12 months.

Results

A main effect of time was seen for mHHS and pain (VAS) at 3, 6, and 12 months (p < 0.001). Mean (SE) mHHS improved significantly from 59.9 (1.9) pre-operatively to 74.5 (1.9) after 3 months (p < 0.001), and again from 3 to 6 months from 74.5 (1.9) to 80.1 (1.9) (p = 0.004), with no additional changes from 6 to 12 months [80.1 (1.9)–78.7 (1.9), (n.s.)]. Also, the mean (SE) VAS improved significantly from pre-operative 57.9 (2.6) to 30.0 (2.6) after 3 months (p < 0.001), and from 30.0 (2.6) to 22.6 (2.6) (p = 0.017), after 6 months with no additional changes from 6 to 12 months [22.6 (2.6)–27.9 (2.6), (n.s.)].

Conclusions

Improvements in function (mHHS) and pain (VAS) were seen in patients after hip arthroscopy with labral repair for FAI at 3, 6, and 12 months. While significant improvements occurred from 3 to 6 months, no further improvements were seen from 6 to 12 months.

Level of evidence

Prospective case series, Level IV.     

MRI morphometric hip comparison analysis of anterior acetabular labral tears

Objective

Anterior (3 o’clock) acetabular labral tears (AALTs) have been reported to be associated with iliopsoas impingement (IPI). However, no study has examined the association between anatomical bony variables of the hip joint and AALTs. The purpose of this study was to evaluate the association between AALTs, femoroacetabular impingement (FAI) and other bony variables of the hip.

Material and methods

Seventy-six out of 274 hip MRI records met the inclusion criteria. Two independent blinded investigators evaluated the location of acetabular labral tears (ALTs), edema at the musculotendinous junction of the iliopsoas insertion, femoral neck anteversion angle, femoral neck shaft angle, acetabular anteversion angle, alpha angle, lateral central edge angle (LCEA), acetabular index, and acetabular depth. Comparison analyses between groups were performed.

Results

Twenty-two patients had no ALTs (controls), 19 patients had AALTs, and 35 patients had ALTs not isolated at the 3 o’clock position (25 with cam-bony deformities [FAI-cam] and 10 with pincer-bony deformities [FAI-pincer]). The alpha angle mean was significantly higher (p?<?0.001) in the FAI-cam group (62.7º, 95 % confidence interval [CI]: 56.2–69.2º) compared with the AALTs group (46.9º, 95 % CI: 40.1–53.7º). The LCEA mean was significantly higher (p?<?0.001) in FAI-pincer group (41.9º, 95 % CI: 39.3º–44.5º) compared to AALTs group (29.4º, 95 % CI: 24.2º–34.6º). There was no statistically significant difference in any of the bony variables between the controls and the AALTs group.

Conclusion

Our study demonstrated that AALTs are pathologically distinct and not associated with FAI or other bony abnormalities. This supports the previous studies, which proposed that AALTs are associated with IPI.