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Li ZI, Shankar DS, Vasavada KD, Akpinar B, Lin LJ, Samim MM, Burke CJ, Youm T. Decreased Hip Labral Width Measured on Preoperative Magnetic Resonance Imaging Is Associated With Greater Revision Rate After Primary Arthroscopic Labral Repair for Femoroacetabular Impingement Syndrome at 5-Year Follow-Up. Arthroscopy 2024; 40:1793-1804. [PMID: 38061686 DOI: 10.1016/j.arthro.2023.11.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 11/07/2023] [Accepted: 11/19/2023] [Indexed: 12/31/2023]
Abstract
PURPOSE To examine the associations between hip labral width and patient-reported outcomes, clinical threshold achievement rates, and rate of reoperation among patients with femoroacetabular impingement syndrome (FAIS) who underwent hip arthroscopy and labral repair at minimum 5-year follow-up. METHODS Patients were identified from a prospective database who underwent primary hip arthroscopy for treatment of labral tears and FAIS. Modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) were recorded preoperatively and at 5-year follow-up. Achievement of the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) was determined using previously established values. Labral width magnetic resonance imaging measurements were performed by 2 independent readers at standardized "clockface" locations. Patients were stratified into 3 groups at each position: lower-width (<½ SD below mean), middle-width (within ½ SD of mean), and upper-width (>½ SD above mean). Multivariable regression was used to evaluate associations of labral width with patient-reported outcomes and reoperation rate. RESULTS Seventy-three patients (age: 41.0 ± 12.0 years; 68.5% female) were included. Inter-rater reliability for labral width measurements was high at all positions (intraclass correlation coefficient 0.94-0.96). There were no significant intergroup differences in mHHS/NAHS improvement (P > .05) or in achievement rates of MCID/SCB/PASS at each clockface position (P > .05). Eleven patients (15.1%) underwent arthroscopic revision and 4 patients (5.5%) converted to total hip arthroplasty. Multivariable analysis found lower-width groups at 11:30 (odds ratio 1.75, P = .02) and 3:00 (odds ratio 1.59, P = .04) positions to have increased odds of revision within 5 years; however, labral width was not associated with 5-year improvement in mHHS/NAHS, achievement of MCID/PASS/SCB, or conversion to total hip arthroplasty (P > .05). CONCLUSIONS Hip labral width <½ SD below the mean measured on preoperative magnetic resonance imaging at 11:30- and 3:00-clockface positions was associated with increased odds of reoperation after arthroscopic labral repair and treatment of FAIS. Labral width was not associated with 5-year improvement of mHHS, NAHS, achievement of clinical thresholds, or conversion to arthroplasty. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Zachary I Li
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Dhruv S Shankar
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Kinjal D Vasavada
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Berkcan Akpinar
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Lawrence J Lin
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Mohammad M Samim
- Department of Radiology, New York University Langone Health, New York, New York, U.S.A
| | - Christopher J Burke
- Department of Radiology, New York University Langone Health, New York, New York, U.S.A
| | - Thomas Youm
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A..
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Kaplan DJ, Fenn TW, Gursoy S, Mameri ES, Rice MW, Chapman RS, Shewman EF, Nho SJ. Labral Augmentation With Either Iliotibial Band Allograft or Dermis Allograft Perform Similarly Regarding Peak Force, Displacement, and Work to Labral Repair in Suction Seal Restoration: A Biomechanical Study. Arthroscopy 2024:S0749-8063(24)00073-2. [PMID: 38311265 DOI: 10.1016/j.arthro.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 01/01/2024] [Accepted: 01/14/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To investigate whether allograft substitutes may be used to restore suctional seal properties with labral augmentation, the purpose of the current study was to evaluate the biomechanical properties of the labral suction seal under several scenarios, including: (1) intact labrum, (2) rim preparation, (3) labral repair, (4) labral augmentation with iliotibial band (ITB), and (5) labral augmentation with a dermis allograft. METHODS Eleven hemi-pelvises were dissected to the level of the labrum and placed in a material testing system for biomechanical axial distraction. Each specimen was compressed to 250 newtons (N) and distracted at 10 mm/s while load, crosshead displacement, and time were continuously recorded. For each of the 5 labral states, 3 testing repetitions were performed. Peak force (N, newtons), displacement at peak force (mm, millimeter), and work (N-mm, newton, millimeter) were calculated and normalized to the intact state of each specimen. RESULTS Eleven specimens were tested and 8 specimens (age: 58.6 ± 5.4 years, body mass index: 28.6 ± 6.8 kg/m2; 4 female patients; 5 right hips) were included in final analyses. Expressed as a percentage relative to the intact state, the average normalized peak force, displacement at peak force, and work for each labral state were as follows: intact (100.0% ± 0% for all), rim preparation (89.0% ± 9.2%, 93.3% ± 20.6%, 85.1% ± 9.0%), repair (61.3% ± 17.9%, 88.4% ± 36.9%, 58.1% ± 16.7%), ITB allograft (62.7% ± 24.9%, 83.9% ± 21.6%, 59.4% ± 22.4%), and dermis allograft (57.8% ± 27.2%, 88.2% ± 29.5%, 50.0% ± 20.1%). Regarding peak force, intact state was significantly greater compared with the labral repair, augmentation with ITB, and augmentation with the dermis allograft states (P < .001). No significant differences were demonstrated between displacement at peak force (P = .561). Regarding work, both intact state and rim preparation states were significantly greater than the repair, ITB augmentation, and dermis allograft augmentation states (P < .001). In all outcome measures, the dermis allograft augmentation performed with no statistical difference to the ITB augmentation state. CONCLUSIONS Labral repair and labral augmentation with either ITB allograft or the dermis allograft resulted in significantly lower peak force and work to equilibrium compared with the intact and rim prep states. There was no statistical difference between repair and augmentation states as well as no statistical difference between ITB allograft and dermal allograft at time zero. CLINICAL RELEVANCE This study compares biomechanical properties of the suction seal of the hip comparing labral states including intact, rim preparation, repair, and augmentation, which can be used for surgical decision-making.
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Affiliation(s)
- Daniel J Kaplan
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Thomas W Fenn
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Safa Gursoy
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.; Department of Orthopaedic Surgery, Faculty of Medicine, Acibadem University, Istanbul, Turkey
| | - Enzo S Mameri
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.; Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil; Instituto Brasil de Tecnologias da Saúde, Rio de Janeiro, RJ, Brazil
| | - Morgan W Rice
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Reagan S Chapman
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Elizabeth F Shewman
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A..
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Tian K, Gao G, He TC, Dong H, Zhang S, Zhang W, Wang J, Xu Y. Modified Technique for Labral Reconstruction of Hip Joint Using Autologous Iliotibial Band (ITB)-Make Labral Reconstruction Stress-Free. Arthrosc Tech 2023; 12:e1615-e1622. [PMID: 37780653 PMCID: PMC10533942 DOI: 10.1016/j.eats.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/11/2023] [Indexed: 10/03/2023] Open
Abstract
Current treatments for labral tear include surgical debridement, arthroscopic repair, and labral reconstruction. Although labral debridement and labral suture repair are suitable for most patients, labral reconstruction is the first treatment option when there is extensive labral degeneration or defect. Often, however, the labral degeneration or defect is only detected intraoperatively; therefore, the surgeon should always have a backup plan. The current labral reconstruction technique has shortcomings such as long operation time, difficult autograft harvesting, cumbersome graft preparation, and the need for a large surgical incision and re-sterilization and draping. To address these problems, we developed a modified technique for draping and surgery. This technique ensures preparedness for labral reconstruction during each hip arthroscopic surgery. The method also simplifies the steps for autologous iliotibial band graft harvesting and shortens operative time. We have achieved satisfactory clinical results with use of this technique over the past 2 years. In this Technical Note, we describe our technique. This modified labral reconstruction technique greatly improves surgical efficiency and could be a promising surgical technique for hip labral reconstruction.
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Affiliation(s)
- Kang Tian
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Department of Sports Medicine, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Guanying Gao
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Tong-Chuan He
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Orthopaedic Surgery and Rehabilitation Medicine, Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois, U.S.A
| | - Hanmei Dong
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Siqi Zhang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Weiguo Zhang
- Department of Sports Medicine, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Jianquan Wang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Yan Xu
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
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