Espinosa, J Bone Joint Surg Am 2006 - Treatment of Femoro-Acetabular Impingement: Preliminary Results of Labral Refixation

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Treatment of Femoro-Acetabular Impingement: Preliminary Results of Labral Refixation

Espinosa, Leunig, et al.·J Bone Joint Surg Am·2006·500 citations

Background

Recent advances in the understanding of the anatomy and function of the acetabular labrum suggest that it is important for normal joint function. We found no available data regarding whether labral refixation after treatment of femoro-acetabular impingement affects the clinical and radiographic results.

Methods

We retrospectively reviewed the clinical and radiographic results of 52 patients (60 hips) with femoro-acetabular impingement who underwent arthrotomy and surgical dislocation of the hip to allow trimming of the acetabular rim and femoral osteochondroplasty.
In the first 25 hips, the torn labrum was resected (Group 1); in the next 35 hips, the intact portion of the labrum was reattached to the acetabular rim (Group 2).
At one and 2 years postoperatively, the Merle d'Aubigné clinical score and the Tönnis arthrosis classification system were used to compare the 2 groups.

Results

At one year postoperatively, both groups showed a significant improvement in their clinical scores (mainly pain reduction) compared with their preoperative values (p = 0.0003 for Group 1 and p < 0.0001 for Group 2).
At two years postoperatively, 28% of the hips in Group 1 (labral resection) had an excellent result, 48% had a good result, 20% had a moderate result, and 4% had a poor result.
In contrast, in Group 2 (labral reattachment), 80% of the hips had an excellent result, 14% had a good result, and 6% had a moderate result.
Comparison of the clinical scores between the two groups revealed significantly better outcomes for Group 2 at one year (p = 0.0001) and at two years (p = 0.01).
Radiographic signs of osteoarthritis were significantly more prevalent in Group 1 than in Group 2 at one year (p = 0.02) and at two years (p = 0.009).

Conclusions

Patients treated with labral refixation recovered earlier and had superior clinical and radiographic results when compared with patients who had undergone resection of a torn labrum. Although the results must be considered preliminary, we now recommend refixation of the intact portion of the labrum after trimming of the acetabular rim during surgical treatment of femoro-acetabular impingement.

Copyright remains with the authors and publisher.

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Treatment of Femoro-Acetabular Impingement: Preliminary Results of Labral Refixation

Espinosa, Leunig, et al.·J Bone Joint Surg Am·2006·500 citations

Background

Recent advances in the understanding of the anatomy and function of the acetabular labrum suggest that it is important for normal joint function. We found no available data regarding whether labral refixation after treatment of femoro-acetabular impingement affects the clinical and radiographic results.

Methods

We retrospectively reviewed the clinical and radiographic results of 52 patients (60 hips) with femoro-acetabular impingement who underwent arthrotomy and surgical dislocation of the hip to allow trimming of the acetabular rim and femoral osteochondroplasty.
In the first 25 hips, the torn labrum was resected (Group 1); in the next 35 hips, the intact portion of the labrum was reattached to the acetabular rim (Group 2).
At one and 2 years postoperatively, the Merle d'Aubigné clinical score and the Tönnis arthrosis classification system were used to compare the 2 groups.

Results

At one year postoperatively, both groups showed a significant improvement in their clinical scores (mainly pain reduction) compared with their preoperative values (p = 0.0003 for Group 1 and p < 0.0001 for Group 2).
At two years postoperatively, 28% of the hips in Group 1 (labral resection) had an excellent result, 48% had a good result, 20% had a moderate result, and 4% had a poor result.
In contrast, in Group 2 (labral reattachment), 80% of the hips had an excellent result, 14% had a good result, and 6% had a moderate result.
Comparison of the clinical scores between the two groups revealed significantly better outcomes for Group 2 at one year (p = 0.0001) and at two years (p = 0.01).
Radiographic signs of osteoarthritis were significantly more prevalent in Group 1 than in Group 2 at one year (p = 0.02) and at two years (p = 0.009).

Conclusions

Patients treated with labral refixation recovered earlier and had superior clinical and radiographic results when compared with patients who had undergone resection of a torn labrum. Although the results must be considered preliminary, we now recommend refixation of the intact portion of the labrum after trimming of the acetabular rim during surgical treatment of femoro-acetabular impingement.

Copyright remains with the authors and publisher.

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