Arthroscopic Acetabular Labral Repair Versus Labral Debridement: Long-term Survivorship and Functional Outcomes
Key findings
- This retrospective study compared two different arthroscopic treatments for acetabular labral tears—repair vs. debridement—using an adjusted analysis to evaluate the long-term risk of conversion to total hip arthroplasty
- Data were reviewed on 204 patients of a single surgeon: 105 who underwent labral debridement and 99 who underwent labral repair
- In multivariable analysis, patients who underwent labral repair had a significantly lower risk of conversion to total hip arthroplasty compared with patients who underwent labral debridement (HR, 0.24; 95% CI, 0.07–0.74; P=0.014)
- Factors that significantly increased the risk of conversion to total hip arthroplasty were age at the time of arthroscopy (HR, 1.06 per year; P=0.002) and Tӧnnis grade (HR, 2.39; P=0.026)
- Technical advances in recent years have expanded the number of patients who can undergo labral repair
Hip arthroscopic surgeons now emphasize repair, rather than debridement, when treating acetabular labral tears. However, biomechanical studies conflict when comparing the effects of these surgical options on cartilage preservation.
Subscribe to the latest updates from Orthopaedics Advances in Motion
Michael P. Kucharik, MD, a former research fellow with the Sports Medicine Service in the Department of Orthopaedics at Massachusetts General Hospital, Scott D. Martin, MD, director of the Joint Preservation Service at the Hospital, and colleagues from the Sports Medicine Service demonstrated a clear difference between the two labral treatments in a retrospective cohort study. In The Orthopaedic Journal of Sports Medicine, they show that patients who undergo labral repair are significantly less likely to require total hip arthroplasty (THA) than those who undergo labral debridement.
Methods
The study included 204 patients with an acetabular labral tear who underwent arthroscopy by Dr. Martin between April 2007 and October 2014, and had at least five years of clinical follow-up:
- Labral debridement was performed if the labral tear was degenerative, hypoplastic, or isolated to a single plane involving <50% of the labrum—105 patients (51.5%)
- Labral repair was performed if there was adequate healthy labral tissue for suture fixation or if the tear was complex with extension into the chondrolabral junction—99 patients (48.5%)
Conversion to THA
28 patients (14%) underwent THA within 10 years after hip arthroscopy:
- Labral debridement group—23 patients (22%) at a mean of 3.7 years
- Labral repair group—5 patients (5%) at a mean of 3.7 years
In a multivariable analysis, the researchers adjusted for all variables that were significantly different between treatment groups at baseline and those presumed to predict conversion to THA. Labral repair was associated with a significantly lower risk of conversion to THA than debridement (HR, 0.24; 95% CI, 0.07–0.74; P=0.014).
Factors significantly associated with a greater risk of conversion to THA were older age at the time of arthroscopy (HR, 1.06 per year; P=0.002) and Tönnis grade* (HR, 2.39; P=0.026).
Other factors studied, but not significantly associated with risk of THA, were concomitant treatment with abrasion chondroplasty or acetabuloplasty, body mass index, Outerbridge grade, and femoroacetabular impingement evident on radiographs before arthroscopy.
Guidance for Orthopedic Surgeons
Arthroscopic hip surgeons should counsel patients with cartilage wear regarding the increased risk of conversion to THA.
Still, Dr. Martin has expanded his repair indications in recent years given the advances in arthroscopic labral reconstruction techniques. There is evidence that some complex tears and/or hypoplastic labrums can be repaired with local capsular autografts or with allografts/autografts from tensor fascia lata, semi-tendinosus, rectus femoris, gracilis, iliotibial band or dermal tissue.
*The Tönnis grade osteoarthritis classification, as originally described in 1972 by Busse et al., consists of three progressive degrees, or grades, of degenerative changes to the hip.
view original journal article Subscription may be required
Learn more about the Sports Medicine Service
Refer a patient to the Sports Medicine Service