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.     

Increased range of motion but otherwise similar clinical outcome of arthroscopy over open osteoplasty for femoroacetabular impingement at midterm follow-up: A systematic review

BackgroundA systematic review was conducted comparing patient reported outcomes measures (PROMs), functional scores, and the rate of complications between arthroscopic and open treatment for femoroacetabular impingement (FAI) at mid-term follow-up.Material and methodsThis systematic review was performed according to the PRISMA guidelines. The literature search was performed in October 2020. All clinical trials treating FAI using open osteoplasty or arthroscopic surgery were considered for inclusion. Only articles reporting >12 months follow-up were included.ResultsData from 97 articles (9981 procedures) were collected. At a mean 19.2 months follow-up there was no difference between the two cohorts. At a mean follow-up of 38 months, the external rotation was increased in the arthroscopic group (P < 0.0001). The modified Harris Hip Score scored greater in favour of the open osteoplasty group (P = 0.04), as did the Hip Outcome Score - Activities of Daily Living subscale (P = 0.01). At a mean 45.1 months the arthroscopic group presented greater external rotation (P < 0.0001) and SF-12 Mental (P = 0.04). The modified Harris Hip Score was greater in favour of the open osteoplasty group (P = 0.03), as was the HOS-ADL (P = 0.01). Regarding complications, the arthroscopic group experienced lower rates of subsequent revisions (P < 0.0001).ConclusionBased on the significant reduction of revisions-rate and significant increase in range of motion, arthroscopy treatment for the management of FAI may be recommended.     

Arthroscopic treatment for symptomatic bilateral cam-type femoroacetabular impingement

Arthroscopic femoral osteochondroplasty improves clinical outcome in patients with unilateral cam-type femoroacetabular impingement. The goal of this study was to evaluate the clinical outcome and pathological similarities in patients who have had bilateral arthroscopic femoral osteochondroplasy for cam-type femoroacetabular impingement. The study group included 82 patients who had sequential bilateral hip arthroscopies for symptomatic cam-type femoroacetabular impingement with a minimum of 12 months follow-up. All patients had bilateral restricted hips at presentation. We differentiated between patients who had bilateral painful hips and those with unilateral pain at presentation. Scores and surgical findings were compared between the 2 study groups and between bilateral surgeries in each group. Pre- and postoperative Modified Harris Hip Scores and Non-Arthritic Hip Scores were undertaken prospectively by an independent observer. Mean patient age at the first surgery was 29 years (range, 14-63 years). The average time difference between arthroscopies was 5 months (range, 0.3-30 months). Postoperative scores improved significantly in both study groups in the first and second (contralateral) surgeries. Intra-articular pathologies between sides were linearly correlated for both groups. The time interval between surgeries had a linear correlation to age, reverse correlation to chondral damage, and reverse correlation to postoperative scores at the first surgery. Our results suggest that symptomatic patients with cam-type femoroacetabular impingement have similar accompanied pathologies on both sides and can benefit from sequential arthroscopic osteochondroplasty.     

Behandlung des FAI durch einen minimal-invasiven ventralen Zugang mit arthroskopischer Unterstützung

Femoroacetabular impingement (FAI) may be considered as an important cause of hip pain among young patients. A new surgical technique using a mini open anterior Hueter approach with arthroscopic assistance was developed in our department in 1999. The goal of our study was to evaluate the midterm clinical results and the quality of life after cam resection, rim trimming, and labrum refixation using this technique. The first 100 hips operated on using this technique were evaluated with the Nonarthritic Hip Score (NAHS) at a mean follow-up of 54 months. The mean age of the patients was 33.4 years, with 50 men and 47 women. At the last follow-up, the mean NAHS score increased significantly from 54.5±12 by 29.6 points to 84.3±16 (p<0.001). The clinical result was very good in 40 cases, good in 38 cases, fair in 8 cases, and poor in 14 patients. Eleven hips developed osteoarthrosis and finally had a total hip replacement. One patient had a femoral neck fracture at 3 weeks postoperatively. The best results were obtained in patients under 40 years of age (53 patients) and with a Tönnis osteoarthrosis grade of 0, 90% of whom had a very good or good result at a mean follow-up of 55 months. Refixation of the labrum was not significantly correlated with a higher NAHS (87±11 versus 82±19, p=0.13) at the last follow-up. Resection of cam FAI of the femoral head-neck junction using a mini anterior Hueter approach with arthroscopic assistance is a safe and effective technique in treating young adults with femoroacetabular impingement. This technique offers direct visualization of the anterior femoral head-neck junction and is less invasive than the surgical dislocation approach.     

Acetabular Labral Tears in Patients with Sports Injury

Background

We wanted to investigate acetabular labral tears and their correlation with femoroacetabular impingement in patients with sports injury.

Methods

Among 111 patients who were diagnosed with the acetabular labral tears after arthroscopic treatment from January 2004 to December 2007, we selected 41 patients with sports injury. There were 12 cases of Taekwondo injury, 5 of golf injury, 4 of soccer injury, 3 of gymnastics injury, 2 of Hapkido injury, 2 of aerobics injury, 2 of rock-climbing injury, 2 of fitness training injury and 9 of other sports injuries. We checked the subtypes of acetabular labral tears and the accompanying femoroacetabular impingement. For the cases with accompanying femoroacetabular impingement, we investigated the subtypes according to the types of sports, gender and age. At last follow-up, we checked the Harris Hip Score (HHS), the Hip Outcome Score (HOS) sports scale and the percentage of patients who returned to their sports activity.

Results

The average age of symptomatic onset was 26 years (range, 12 to 65 years). The ratio of males to females was 29 : 12. An average duration of the hip pain was 17 months (range, 1 to 60 months). The degenerative type of acetabular labral tears was the most prevalent with 32 cases (78%), and there were 9 cases (22%) of the partial tear type. Thirty cases (73%) were accompanied by femoroacetabular impingement. The average age of the 23 cases (56%) of the cam-type was 23 years (range, 12 to 48 years), and it was more likely to occur in men (87%) and for people practicing martial arts such as Taekwondo or Hapkido. An average age of the 5 cases (12%) of the pincer-type was 26 (range, 16 to 43 years), it usually occurred in women (60%) and for non-martial arts such as golf and gymnastics. There were 2 cases of the mixed type (cam + pincer-type). At 27 months follow-up, the HHS was 61 to 92 points, the HOS sports scale increased 43 to 75%, and the rate of returning to sports was 71%.

Conclusions

In spite of the early expression of symptoms and the short duration of the acetabular labral tears, the high rate of degenerative acetabular labral tears in sports patients is likely associated with repetitive injury after the expression of symptoms. Femoroacetabular impingement in sports patients is seemed to be a cause of the early occurrence of acetabular labral tears. Because the possibility of acetabular labral tears is high in femoroacetabular impingement, sports patients may need to undergo early screening for the diagnosis and care of femoroacetabular impingement.     

Arthroscopically assisted anterior decompression for femoroacetabular impingement: technique and early clinical results

Introduction  In patients with symptomatic femoroacetabular impingement resection osteochondroplasty of the femoral head–neck junction may improve hip pain and range of motion. We evaluated the short-term treatment results of an arthroscopically assisted mini-open anterior approach to compare it with the results after surgical dislocation for FAI. Methods  The clinical and radiographic results of 33 patients were reviewed retrospectively 15 months after the surgery. Harris hip scores and plain radiographs were obtained preoperatively and at follow-up. Patient satisfaction with the treatment result was quantified with a Visual Analogous scale (VAS) ranging from 0 (very dissatisfied) to 10 (very satisfied). Results  The mean Harris hip score improved from 64 points preoperatively to 85 points at the time of follow-up (P < 0.001). Mean patient satisfaction on the VAS was seven points (range: 2–10 points). In two of our first patients we observed a transient femoral nerve palsy (completely resolved at follow-up) and 15 patients reported numbness in the area of the lateral cutaneous femoral nerve. Conclusions  Treatment of anterior femoroacetabular impingement through an arthroscopically assisted mini-open anterior approach can reduce pain and improve function in a short-term observation period. Femoral osteochondroplasty as well as surgical treatment of acetabular cartilage and labrum lesions are possible, but the access is limited to the anterior and anterolateral part of the hip joint.     

Iliopsoas Impingement: A Newly Identified Cause of Labral Pathology in the Hip

Labral tears typically occur anterosuperiorly in association with femoroacetabular impingement or dysplasia. Less commonly, labral pathology may occur in an atypical direct anterior location adjacent to the iliopsoas tendon in the absence of bony abnormalities. We hypothesize that this pattern of injury is related to compression or traction on the anterior capsulo-labral complex by the iliopsoas tendon where it crosses the acetabular rim. In a retrospective review of prospectively collected data, we identified 25 patients that underwent isolated, primary, unilateral iliopsoas release and presented for at least 1 year follow-up (mean 21 months). Pre-operative demographics, clinical presentation, intra-operative findings, and outcome questionnaires were analyzed. The injury was treated with a tenotomy of the iliopsoas tendon at the level of the joint line and either labral debridement or repair. Mean post-operative outcome scores were 87.17, 92.46, and 78.8 for the modified Harris Hip Score, activities of daily living Hip Outcome Score, and sports-related score, respectively. The atypical labral injury identified in this study appears to represent a distinct pathological entity, psoas impingement, with an etiology which has not been previously described.