Minimum 2-Year Outcomes of Arthroscopic Management of Symptomatic Hip Labrum Tears in Patients With Global Acetabular Overcoverage

Chandrasekaran, Sivashankar; Darwish, Nader; Close, Mary R.; Suárez-Ahedo, Carlos; Lodhia, Parth; Domb, Benjamin G.

doi:10.1016/j.arthro.2017.01.039

Cited by 18 publications

(25 citation statements)

References 21 publications

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“…This threshold was determined according to previous literature examining patients with global acetabular overcoverage. 13 Patients were included if they had an LCEA >40° and a minimum 5-year follow-up for the modified Harris Hip Score (mHHS), 1 the Nonarthritic Hip Score (NAHS), 16 and the Hip Outcome Score–Sports-Specific Subscale (HOS-SSS). 46 Patients were excluded if they had a previous ipsilateral hip operation or condition (eg, avascular necrosis, slipped capital femoral epiphysis, fractures, and Legg-Calve-Perthes disease), active workers’ compensation claims, or a preoperative Tönnis grade >1 or if they did not have minimum 5-year outcomes.…”

Section: Methodsmentioning

confidence: 99%

Hip Arthroscopic Surgery in the Context of Femoroacetabular Impingement Syndrome, Labral Tear, and Acetabular Overcoverage: Minimum 5-Year Outcomes With a Subanalysis Against Patients Without Overcoverage

et al. 2020

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Background: Improvement in patient-reported outcomes (PROs) has been reported in the short term after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and labral tear in the setting of acetabular overcoverage. Yet, there is a paucity of information in the literature on midterm PROs. Purpose: To (1) report minimum 5-year PROs in patients who underwent primary hip arthroscopy for FAIS and acetabular labral tears in the context of acetabular overcoverage and (2) compare outcomes with those of a propensity-matched control group without acetabular overcoverage. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively analyzed on all patients who underwent hip arthroscopy for FAIS and labral tears between February 2008 and November 2013. Inclusion criteria were lateral center-edge angle >40° and minimum 5-year follow-up for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and the Hip Outcome Score–Sports-Specific Subscale (HOS-SSS). Exclusion criteria were previous ipsilateral hip surgery or conditions, active workers’ compensation claims, or lack of minimum 5-year outcomes. A 1:1 propensity-matched comparison was made between the study group and a control group without acetabular overcoverage (lateral center-edge angle, 25°-40°) based on age at surgery, sex, body mass index, Tönnis grade, laterality, and follow-up time. The minimal clinically important difference (MCID) was calculated for the mHHS, HOS-SSS, and NAHS. Secondary surgical procedures were recorded. Results: A total of 54 patients satisfied the inclusion criteria for the study group, of whom 45 (83.3%; 45 hips) had a minimum 5-year follow-up and were matched without differences in age at surgery, sex, body mass index, or follow-up time. The study and control groups demonstrated significant and comparable improvements for the mHHS (mean ± SD Δ, 24.06 ± 24.19 vs 26.33 ± 17.27; P = .625), NAHS (Δ, 31.22 ± 25.31 vs 27.15 ± 17.61; P = .399), and HOS-SSS (Δ, 33.16 ± 34.73 vs 34.75 ± 26.15; P = .557). The rates for achieving the MCID were similar for the study and control groups for the mHHS (76.7% vs 84.2%; P = .399), HOS-SSS (79.1% vs 75.8%; P = .731), and NAHS (81.4% vs 84.2%; P = .738). Need for revision surgery was similar ( P = .748). A lower conversion rate to total hip arthroplasty was reported for the study than for the control group (2.2% vs 15.6%; P = .026). Conclusion: In the context of FAIS, labral tears, and acetabular overcoverage, patients who underwent hip arthroscopy reported significant improvement in several PROs at minimum 5-year follow-up. Moreover, outcomes were comparable with those of a propensity-matched control group without acetabular overcoverage. Furthermore, the rate of achieving the MCID for the mHHS, HOS-SSS, and NAHS was similar between these groups.

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Section: Methodsmentioning

confidence: 99%

Hip Arthroscopic Surgery in the Context of Femoroacetabular Impingement Syndrome, Labral Tear, and Acetabular Overcoverage: Minimum 5-Year Outcomes With a Subanalysis Against Patients Without Overcoverage

et al. 2020

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“…Hip arthroscopy with global acetabular overcoverage improved patientreported outcomes and pain, but at the 2-year followup, secondary procedures were reported in 17% of patients, possibly owing to adhesions. 9 In another report, after revision labral reconstruction, 14% of patients required total hip arthroplasty and 7% had recurrent scarring. 10 Otherwise, labral reconstruction resulted in outcomes similar to those in patients not needing revision.…”

Section: Some Thoughtsmentioning

confidence: 95%

Editorial Commentary: Acetabular Labral Repair—Is A Knotless Anchor Better?

Barber

Evanson

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Knotless anchors have an important role in arthroscopic acetabular labral repair. Different anchors show 2 primary failure modes: suture breakage and suture pullout from the anchor ("eyelet failure"). Knotless anchors show minimal displacement at physiological loads and should perform well for arthroscopic labral repair. Surgeons should consider the suture-passing device size and use a device that creates as small of a labral hole as possible. See related article on page 70 K notless suture anchors are commonly used in hip arthroscopy and offer some advantages over anchors that require knot tying. These advantages include their ease of use and quicker insertion time compared with tied knots. Although not clearly documented in the current literature, there are anecdotal reports of adhesions between a retained knot and the adjacent capsule or psoas tendon observed during revision hip arthroscopy. This has led some surgeons to suggest that a knotless suture anchor may decrease the creation of such adhesions.

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“…Cartilage damage occurs as a circumferential narrow band at the peripheral rim and follows the superficial to deep pattern of chondromalacia. [18][19][20] In hips with severe acetabular overcoverage, contrecoup lesions of the posteroinferior femoroacetabular cartilage can be observed. These lesions result from a posterior levering of the femoral head against the too prominent acetabular rim.…”

Section: Impingementmentioning

confidence: 99%

“…14). 13,20,58 Femoral retrotorsion may contribute to the anterior impingement conflict and can lead to hypotrophic degenerative tearing of the labrum (►Fig. 15).…”

Section: Normal Labrummentioning

confidence: 99%

See 1 more Smart Citation

Intra-articular Lesions: Imaging and Surgical Correlation

Schmaranzer

Todorski

Lerch

et al. 2017

Semin Musculoskelet Radiol

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The past 2 decades have seen a substantial increase in hip joint preserving procedures, primarily secondary to not only hip dysplasia, but the recognition and description of femoroacetabular impingement (FAI), and its association with chondral lesions, as a potentially pre-arthritic condition. Morphological magnetic resonance imaging (MRI) plays an essential role in the preoperative assessment of osseous deformities and in particular of the resulting joint degeneration. An accurate descriptive report of chondrolabral lesions is warranted describing the tear pattern, size, localization, and extension of the lesions. This is important because different damage patterns and localization of the lesions may determine the surgical approach. The current imaging standard is direct magnetic resonance arthrography (MRA) with a small field of view, with acquisition of radial images in addition to the classic coronal, sagittal, and axial-oblique images. Early cartilage damage detected on direct MRA obtained with or without traction can predict long-term failure after FAI surgery.

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Minimum 2-Year Outcomes of Arthroscopic Management of Symptomatic Hip Labrum Tears in Patients With Global Acetabular Overcoverage

Cited by 18 publications

References 21 publications

Hip Arthroscopic Surgery in the Context of Femoroacetabular Impingement Syndrome, Labral Tear, and Acetabular Overcoverage: Minimum 5-Year Outcomes With a Subanalysis Against Patients Without Overcoverage

Hip Arthroscopic Surgery in the Context of Femoroacetabular Impingement Syndrome, Labral Tear, and Acetabular Overcoverage: Minimum 5-Year Outcomes With a Subanalysis Against Patients Without Overcoverage

Editorial Commentary: Acetabular Labral Repair—Is A Knotless Anchor Better?

Intra-articular Lesions: Imaging and Surgical Correlation

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