Prognostic value of chondral defects on the outcome after arthroscopic treatment of acetabular labral tears

Abstract

Pathology of the acetabular labrum plays an increasing role in the treatment of hip pain. Hip arthroscopy has proven its clinical value as a useful procedure for successful treatment of labral tears. Until today, only a few studies have investigated the influence of articular cartilage defects on the clinical outcome of partial arthroscopic labrum resection in a larger patient population. We prospectively evaluated patients with an intraoperatively proven labral lesion/tear without any radiological and arthroscopical sign of a concomitant bony femoroacetabular impingement or hip dysplasia for a minimum postoperative follow-up of 2 years. Cartilage defects were classified according to Outerbridge and divided into two subgroups: Outerbridge < or = 1 and Outerbridge > or = 2, respectively. To evaluate combined results, various established scoring systems (visual analogue scale, modified Harris Hip Score, Larson Hip Score) were used. Out of 54 originally enrolled patients, 50 individuals (29 female, 21 male) with a median age of 33 years (range 15-49) were available for follow-up after a mean of 34 (range 24-48) months. At follow-up, the total study population experienced significant improvement in pain and in the combined evaluation scales (Larson Hip Score/MHHS). When patients were categorized into two subgroups, either with intraoperatively present or absent articular cartilage defects, our data indicated that subjects with no degenerative changes of the articular cartilage surface significantly improved in the applied clinically scoring systems. In contrast, in patients with an articular cartilage lesion during hip arthroscopy score values had a tendency to be unimproved or even deteriorated at follow-up. Regression analysis revealed a significant negative correlation between postoperative outcome and the grading of the coexistent articular cartilage defect. On the basis of our investigation, we conclude that partial arthroscopic resection of a torn labrum without attending bone deformity (dysplasia or femoroacetabular impingement) can reveal good and satisfied results. Depending on the extent of a coexisting articular cartilage defect subjective clinical results are compromised.

What Factors Influence Long-term Survivorship After Hip Arthroscopy?

“…Although the previous long-term study identified only a trend between lower mHHS and preoperative diagnoses of osteoarthritis or avascular necrosis [4], our data show higher acetabular and femoral Outerbridge grades of III and IV predict eventual need for a THA. Also, previously published short-and midterm studies have indicated the presence and severity of arthritis or chondral degradation were predictors of worse questionnaire scores, mHHS, modified Farjo and Glick classifications, and Larson hip scores (Table 7) [4,10,21,31,32]. Because the treatment for articular lesions in the hip, namely judicious removal or microfracture surgery, is similar to that in the knee, this finding is not surprising given similar conclusions [8].…”

Timing in hip arthroscopy: does surgical timing change clinical results?

“…We demonstrate better clinical outcome when labral tears, impingement lesions or chondral surface damage are treated arthroscopically within six months of symptom onset. This finding may perhaps be related to the knowledge that chondral injury can progress, as this is commonly described as cause of surgical failure [14]. Our results certainly emphasise the importance of early and accurate diagnosis of intraarticular hip pathology.…”

Five-year results of arthroscopic techniques for the treatment of acetabular chondral lesions in femoroacetabular impingement

“…Although FAI is often compounded by acetabular cartilage damage and labral lesions, rapid return to health is of personal and economic importance, particularly in such patient groups [5][6][7]. Choice of treatment option to repair cartilage defects in the hip depends on the size and severity of the injury.…”