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Gillinov SM, Lee JS, Siddiq BS, Dowley KS, Torabian KA, Dean MC, Cherian NJ, Cote MP, Martin SD. Association Between Severity of Chondrolabral Junction Breakdown and Functional Outcomes After Hip Arthroscopy for Acetabular Labral Tears. Am J Sports Med 2024:3635465241255950. [PMID: 38872427 DOI: 10.1177/03635465241255950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
BACKGROUND Despite focus on surgical preservation of the chondrolabral junction (CLJ), the transition zone between the acetabular cartilage and labrum, the association between severity of CLJ breakdown and functional outcomes after hip arthroscopy remains unexplored. PURPOSE To assess the influence of CLJ breakdown on patient-reported outcome measures (PROMs) at a 24-month follow-up after hip arthroscopy for symptomatic labral tears. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective review of prospectively collected data was conducted to identify patients ≥18 years of age with a minimum 24-month follow-up who underwent hip arthroscopy by a single surgeon for the treatment of symptomatic labral tears secondary to femoroacetabular impingement. The Beck classification of transition zone cartilage was used to grade CLJ damage; patients with grades 0 to 2 were stratified into the mild CLJ damage cohort, and those with grades 3 and 4 were stratified into the severe CLJ damage cohort. PROMs were collected at baseline and at 3, 6, 12 months, and annually thereafter postoperatively. Linear mixed-effects models were used to compare PROMs. Rates of achieving clinically meaningful thresholds and subsequent surgery rates were also compared. RESULTS In total, 198 patients met the inclusion criteria, with a mean follow-up of 3.54 ± 1.26 years. A total of 95 patients with severe CLJ damage (mean age, 34.9 ± 10.5 years) were compared with 103 patients with mild CLJ damage (mean age, 38.2 ± 11.9 years). Hip Outcome Score-Activities of Daily Living (HOS-ADL), Non-Arthritic Hip Score (NAHS), and visual analog score for pain were inferior in the severe CLJ group at enrollment and all follow-up time points (P≤ .05). However, patients with severe CLJ breakdown exhibited greater improvements in HOS-ADL and NAHS at the 24-month follow-up and achieved clinically meaningful thresholds at equivalent rates to patients with mild CLJ breakdown. Subsequent surgery rates were 6.8% and 12.6% in patients with mild versus severe CLJ damage, respectively (P = .250). CONCLUSION Severe CLJ breakdown is associated with increased pain and decreased functional level preoperatively and up to 24 months after hip arthroscopy. Despite this, patients with severe CLJ breakdown experienced greater improvements in functional outcomes at a 24-month follow-up and achieved clinical thresholds at similar rates to patients with mild CLJ damage. Thus, while worse baseline pain and functional levels may indicate severe CLJ breakdown, these patients still benefit substantially from hip arthroscopy.
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Affiliation(s)
- Stephen M Gillinov
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jonathan S Lee
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bilal S Siddiq
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kieran S Dowley
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kaveh A Torabian
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael C Dean
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nathan J Cherian
- Department of Orthopaedic Surgery, University of Nebraska, Omaha, Nebraska, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Scott D Martin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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Dean MC, Cherian NJ, LaPorte ZL, Eberlin CT, Wang C, Torabian KA, Dowley KS, Kucharik MP, Abraham PF, Nazal MR, Martin SD. Association Between Chondrolabral Junction Breakdown and Conversion to Total Hip Arthroplasty After Hip Arthroscopy for Symptomatic Labral Tears: Minimum 8-Year Follow-up. Am J Sports Med 2024; 52:1153-1164. [PMID: 38476016 PMCID: PMC10986152 DOI: 10.1177/03635465241234258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/20/2023] [Indexed: 03/14/2024]
Abstract
BACKGROUND Arthroscopic treatment of femoroacetabular impingement (FAI) and symptomatic labral tears confers short- to midterm benefits, yet further long-term evidence is needed. Moreover, despite the physiological and biomechanical significance of the chondrolabral junction (CLJ), the clinical implications of damage to this transition zone remain understudied. PURPOSE To (1) report minimum 8-year survivorship and patient-reported outcome measures after hip arthroscopy for FAI and (2) characterize associations between outcomes and patient characteristics (age, body mass index, sex), pathological parameters (Tönnis angle, alpha angle, type of FAI, CLJ breakdown), and procedures performed (labral management, FAI treatment, microfracture). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This retrospective cohort study included patients who underwent primary hip arthroscopy for symptomatic labral tears secondary to FAI by a single surgeon between 2002 and 2013. All patients were ≥18 years of age with minimum 8-year follow-up and available preoperative radiographs. The primary outcome was conversion to total hip arthroplasty (THA), and secondary outcomes included revision arthroscopy, patient-reported outcome measures, and patient satisfaction. CLJ breakdown was assessed using the Beck classification. Kaplan-Meier estimates and weighted Cox regression were used to estimate 10-year survivorship (no conversion to THA) and identify risk factors associated with THA conversion. RESULTS In this study of 174 hips (50.6% female; mean age, 37.8 ± 11.2 years) with mean follow-up of 11.1 ± 2.5 years, the 10-year survivorship rate was 81.6% (95% CI, 75.9%-87.7%). Conversion to THA occurred at a mean 4.7 ± 3.8 years postoperatively. Unadjusted analyses revealed several variables significantly associated with THA conversion, including older age; higher body mass index; higher Tönnis grade; labral debridement; and advanced breakdown of the CLJ, labrum, or articular cartilage. Survivorship at 10 years was inferior in patients exhibiting severe (43.6%; 95% CI, 31.9%-59.7%) versus mild (97.9%; 95% CI, 95.1%-100%) breakdown of the CLJ (P < .001). Multivariable analysis identified worsening CLJ breakdown (weighted hazard ratio per 1-unit increase, 6.41; 95% CI, 3.11-13.24), older age (1.09; 95% CI, 1.04-1.14), and higher Tönnis grade (4.59; 95% CI, 2.13-9.90) as independent negative prognosticators (P < .001 for all). CONCLUSION Although most patients achieved favorable minimum 8-year outcomes, several pre- and intraoperative factors were associated with THA conversion; of these, worse CLJ breakdown, higher Tönnis grade, and older age were the strongest predictors.
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Affiliation(s)
- Michael C. Dean
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nathan J. Cherian
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, University of Nebraska, Omaha, Nebraska, USA
| | - Zachary L. LaPorte
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher T. Eberlin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Charles Wang
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kaveh A. Torabian
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kieran S. Dowley
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael P. Kucharik
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA
| | - Paul F. Abraham
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, USA
| | - Mark R. Nazal
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Scott D. Martin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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Lu V, Andronic O, Zhang JZ, Khanduja V. Outcomes of arthroscopy of the hip for femoroacetabular impingement based on intraoperative assessment using the Outerbridge classification. Bone Joint J 2023; 105-B:751-759. [PMID: 37399116 DOI: 10.1302/0301-620x.105b7.bjj-2022-0989.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Aims Hip arthroscopy (HA) has become the treatment of choice for femoroacetabular impingement (FAI). However, less favourable outcomes following arthroscopic surgery are expected in patients with severe chondral lesions. The aim of this study was to assess the outcomes of HA in patients with FAI and associated chondral lesions, classified according to the Outerbridge system. Methods A systematic search was performed on four databases. Studies which involved HA as the primary management of FAI and reported on chondral lesions as classified according to the Outerbridge classification were included. The study was registered on PROSPERO. Demographic data, patient-reported outcome measures (PROMs), complications, and rates of conversion to total hip arthroplasty (THA) were collected. Results A total of 24 studies were included with a total of 3,198 patients (3,233 hips). Patients had significantly less improvement in PROMs if they had Outerbridge grade III and IV lesions (p = 0.012). Compared with microfracture, autologous matrix-induced chondrogenesis (AMIC) resulted in significantly reduced rates of conversion to THA (p = 0.042) and of revision arthroscopy (p = 0.038). Chondral repair procedures in these patients also did not significantly reduce the rates of conversion to THA (p = 0.931), or of revision arthroscopy (p = 0.218). However, compared with microfracture, AMIC significantly reduced the rates of conversion to THA (p = 0.001) and of revision arthroscopy (p = 0.011) in these patients. Those with Outerbridge grade III and IV lesions also had significantly increased rates of conversion to THA (p = 0.029) and of revision arthroscopy (p = 0.023) if they had associated lesions of the acetabulum and femoral head. Those who underwent labral debridement had a significantly increased rate of conversion to THA compared with those who underwent labral repair (p = 0.015). Conclusion There is universal improvement in PROMs following HA in patients with FAI and associated chondral lesions. However, those with Outerbridge grade III and IV lesions had significantly less improvement in PROMs and a significantly increased rate of conversion to THA than those with Outerbridge grade I and II. This suggests that the outcome of HA in patients with FAI and severe articular cartilage damage may not be favourable.
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Affiliation(s)
- Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Octavian Andronic
- Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke's - Cambridge University Hospital, Cambridge, UK
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - James Z Zhang
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Vikas Khanduja
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke's - Cambridge University Hospital, Cambridge, UK
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Andronic O, Claydon-Mueller LS, Cubberley R, Karczewski D, Sunil-Kumar KH, Khanduja V. Inconclusive and Contradictory Evidence for Outcomes After Hip Arthroscopy in Patients With Femoroacetabular Impingement and Osteoarthritis of Tönnis Grade 2 or Greater: A Systematic Review. Arthroscopy 2022; 38:2307-2318.e1. [PMID: 35093497 DOI: 10.1016/j.arthro.2022.01.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/09/2022] [Accepted: 01/16/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate whether hip arthroscopy (HA) is effective in patients with femoroacetabular impingement and concomitant hip osteoarthritis (OA) of Tönnis grade 2 or greater. METHODS This review was registered in the International Prospective Register for Systematic Reviews and Meta-analysis (PROSPERO, CRD42020210936). It followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines and included multiple databases: MEDLINE, Embase, Web of Science Core Collection, and Cochrane Library. All studies in English or German from database inception to December 1, 2020, that investigated outcomes of HA in patients with OA of Tönnis grade 2 or greater were considered eligible. The risk of bias was assessed using the MINORS (Methodological Index for Non-randomized Studies) tool. Data heterogeneity was explored using the I2 test in a random-effects model. RESULTS Eleven studies met the eligibility criteria. The MINORS (Methodological Index for Non-randomized Studies) score averaged 68% (range, 46%-81%). A total of 616 hips, consisting of 247 hips of interest (Tönnis grade 2 or greater) and 369 controls, were included. The weighted estimated follow-up averaged 29.1 months (range, 12-84 months). Data on patient-reported outcome measures (PROMs) could be extracted for 6 of 11 studies, and date on conversion to total hip arthroplasty were available for 8 of 11. Four studies reported an overall improvement in PROMs after HA, and 2 highlighted a failure of improvement in PROMs. Failure of HA with conversion to total hip arthroplasty was observed at a rate of 0% to 9% in 4 studies, as opposed to proportions as high as 35% to 70% in the other 4 studies. There was a high level of heterogeneity, with a calculated I2 value of 89%. CONCLUSIONS There is currently contradictory and insufficient evidence regarding the efficacy of HA for hips with femoroacetabular impingement and concomitant OA of Tönnis grade 2 or greater. This is in the context of data with low levels of evidence, mainly consisting of retrospective case series (Level IV) with a high risk of bias and high heterogeneity (I2 of approximately 90%). LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Medical Technology Research Centre, Anglia Ruskin University, Chelmsford, England; Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke's-Cambridge University Hospital, Cambridge, England
| | | | - Rachael Cubberley
- Medical Technology Research Centre, Anglia Ruskin University, Chelmsford, England
| | - Daniel Karczewski
- Department of Trauma and Orthopaedics, Charitè University Medicine Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
| | - Karadi Hari Sunil-Kumar
- Medical Technology Research Centre, Anglia Ruskin University, Chelmsford, England; Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke's-Cambridge University Hospital, Cambridge, England
| | - Vikas Khanduja
- Medical Technology Research Centre, Anglia Ruskin University, Chelmsford, England; Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke's-Cambridge University Hospital, Cambridge, England.
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Zusmanovich M, Haselman W, Serrano B, Banffy M. The Incidence of Hip Arthroscopy in Patients With Femoroacetabular Impingement Syndrome and Labral Pathology Increased by 85% Between 2011 and 2018 in the United States. Arthroscopy 2022; 38:82-87. [PMID: 33964383 DOI: 10.1016/j.arthro.2021.04.049] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to investigate the incidence of hip arthroscopy in patients with labral pathology in the United States from 2011-2018 using a large national database. METHODS Patients who underwent hip arthroscopy from 2011-2018 were identified using Current Procedural Terminology (CPT) codes in the PearlDiver Patients Records Database (Colorado Springs, CO), which is a national database of orthopedic insurance records, including Medicare patients. The incidence of surgeries, age, and gender were all recorded. Groups were analyzed using SPSS version 24 (IBM, Armonk NY). CPT codes 29914/15/16 were introduced January 1, 2011 which is when we began our analysis. CPT-29999 and laterality were not assessed. RESULTS In total, 35,966 arthroscopies were identified between 2011 and 2018 from a randomly selected sample of 30 million orthopaedic patients from the PearlDiver Mariner dataset. The incidence increased by 85% from 2011 to 2018 (7.31 cases vs 13.54 cases per 100,000 patients). The distribution of the age of patients undergoing hip arthroscopy was bimodal with the mode of each peak at 18 years old and 42 years old, respectively. Females underwent surgery more frequently (67.9%) than males (32.1%). The most common CPT code for hip arthroscopy was 29914 (43.9) which corresponds to a hip arthroscopy with femoroplasty. CONCLUSIONS Our findings corroborate those of previous studies and support the increase in incidence of hip arthroscopy in the United States. We indicate an overall increase of 85% from 2011 to 2018 and support previous trends, such as higher incidence of hip arthroscopy in women. Our study also supports a decreasing mean age for patients, likely due to improved diagnostics and surgeon familiarity and comfort with the procedure. LEVEL OF EVIDENCE Level 3, Retrospective Comparative Study.
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Affiliation(s)
| | | | - Brian Serrano
- Cedars Sinai-Kerlan Jobe Institute, Los Angeles, California
| | - Michael Banffy
- Cedars Sinai-Kerlan Jobe Institute, Los Angeles, California
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Slullitel PA, Pascual-Garrido C. Editorial Commentary: Reach Over the Top and Preserve the Hip Labrum. Arthroscopy 2021; 37:552-553. [PMID: 33546793 DOI: 10.1016/j.arthro.2020.12.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 02/02/2023]
Abstract
There is increasing interest in fine tuning of hip arthroscopy to improve the long-term outcomes of femoroacetabular impingement (FAI) surgery. Recently, some advocated for rim trimming and labral refixation without taking down the labrum, using a so-called over-the-top technique. Although some studies have already reported on the outcomes of this procedure, very few have focused on how maintaining an unharmed chondrolabral junction may decrease cartilage wear over time. Preserving labral attachment should be the standard of care in the treatment of FAI, to keep the suction seal working normally.
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Slullitel P, Oñativia J, García-Mansilla A, Díaz-Dilernia F, Buttaro M, Zanotti G, Piccaluga F, Comba F. Is hip arthroscopy useful in the treatment of borderline dysplasia?: a case-control study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Slullitel PA, Oñativia JI, García-Mansilla A, Díaz-Dilernia F, Buttaro MA, Zanotti G, Piccaluga F, Comba F. Is hip arthroscopy useful in the treatment of borderline dysplasia?: a case-control study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:326-334. [PMID: 32792285 DOI: 10.1016/j.recot.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/13/2020] [Accepted: 04/26/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Since arthroscopy remains a controversial treatment of hip dysplasia, our objective was to analyse its clinical and radiological results in a cohort of patients with dysplasia and compare them to controls with femoroacetabular impingement (FAI). MATERIAL AND METHODS We retrospectively analysed a series of patients who underwent hip arthroscopy for the treatment of labral pathology; 29 of them with borderline hip dysplasia and 197 with FAI, comparing reoperations and joint survival. The diagnosis of borderline dysplasia was made with a lateral centre-edge angle greater than 18° but less than 25°. The average follow-up was 43 months. We performed a multivariate regression analysis to evaluate the association of reoperations with different demographic, radiological and intraoperative variables. RESULTS Seven complications were registered in the FAI group (1 medically treated superficial wound infection, 3 pudendal nerve paraesthesias, 1 deep vein thrombosis and 2 heterotopic ossifications) and none in the dysplasia group. While 5 patients from the FAI group required a new surgery, none of the dysplasia group was re-operated (p=.38). After adjusting for confounders, reoperation showed a very strong association with the finding of osteochondral lesions during index surgery, with a coefficient of .12 (p<.001, 95%CI=.06-.17). CONCLUSION Hip arthroscopy was useful in the treatment of borderline dysplasia, without non-inferior survival compared to the FAI group. We suggest indicating it carefully in dysplasia cases, whenever the symptoms of femoroacetabular friction prevail over those of instability.
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Affiliation(s)
- P A Slullitel
- Centro de Cadera, Instituto de Ortopedia Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - J I Oñativia
- Centro de Cadera, Instituto de Ortopedia Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A García-Mansilla
- Centro de Cadera, Instituto de Ortopedia Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - F Díaz-Dilernia
- Centro de Cadera, Instituto de Ortopedia Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M A Buttaro
- Centro de Cadera, Instituto de Ortopedia Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - G Zanotti
- Centro de Cadera, Instituto de Ortopedia Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - F Piccaluga
- Centro de Cadera, Instituto de Ortopedia Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - F Comba
- Centro de Cadera, Instituto de Ortopedia Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Malahias MA, Alexiades MM. The clinical outcome of chondrolabral-preserving arthroscopic acetabuloplasty for pincer- or mixed-type femoroacetabular impingement: A systematic review. Musculoskelet Surg 2019; 103:207-214. [PMID: 30850935 DOI: 10.1007/s12306-019-00594-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 03/02/2019] [Indexed: 06/09/2023]
Abstract
While preservation and repair of the acetabular labrum are increasingly being recognized as important goals in hip arthroscopy, controversies still exist regarding the clinical outcome of arthroscopic acetabuloplasty with chondrolabral preservation. A systematic review was conducted and implemented by two independent reviewers, who used the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews for their search. These databases were queried with the terms "arthroscopic acetabuloplasty" and "chondrolabral preservation" and "arthroscopic acetabular recession." From the 55 initial studies the reviewers finally chose and assessed five clinical studies which were eligible to their inclusion-exclusion criteria. The reviewed studies included in total 444 patients, mainly young, between 30 and 40 years old. The follow-up evaluation varied between 24 and 41 months, while all studies utilized at least a 24-month final end-point assessment. All five studies illustrated improved outcome with the use of chondrolabral preservation acetabuloplasty without labral detachment. The rate of complications was very low. The different techniques of arthroscopic acetabuloplasty combined with chondrolabral preservation illustrated encouraging results in patients suffering from pincer-type or mixed-type FAI. However, the available clinical evidence was limited and insufficient to establish any superiority of these techniques over the traditional labral detachment and sequential reattachment. In relation to the optimal treatment of FAI without isolated CAM, further research of higher quality is recommended to be conducted in order to lead to definitive conclusions.
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Affiliation(s)
- M-A Malahias
- International Centre for Hip, Knee and Foot Surgery, Sports Traumatology, ATOS Hospital Heidelberg, Schlossberg 21, 69117, Heidelberg, Germany.
| | - M M Alexiades
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Rehabilitation, Hospital for Special Surgery, Weill Cornell Medical College, 523 East 72 Street, New York, NY, 10021, USA
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Webb MSL, Devitt BM, O'Donnell JM. Preserving the chondrolabral junction reduces the rate of capsular adhesions. J Hip Preserv Surg 2019; 6:50-54. [PMID: 31069095 PMCID: PMC6501442 DOI: 10.1093/jhps/hnz005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/07/2019] [Accepted: 02/03/2019] [Indexed: 12/19/2022] Open
Abstract
The operative treatment of pincer-type femoroacetabular impingement (FAI) has become an increasingly more common procedure. Classically, the labrum is incised at the chondrolabral junction (CLJ), or a concurrent tear is extended to allow access to the acetabular rim facilitating acetabuloplasty. The labrum is subsequently repaired using suture anchors. More recently, acetabuloplasty has been performed without incising the labrum and negating the need to use suture anchors. The aim of this study is to determine whether preserving the CLJ reduces the incidence of revision hip arthroscopy for the treatment of capsulolabral adhesions. This retrospective study compared two cohorts of patients undergoing hip arthroscopy for pincer-type FAI from August 2002 to April 2015. The groups analysed were patients undergoing acetabuloplasty with labral repair (LR) and those with no labral repair (NLR). The revision rates and causes for revision were compared using the χ2 analysis. There were 1010 cases in total. Acetabuloplasty with LR was performed in 546 hips (519 patients), while acetabuloplasty with NLR was performed in 464 hips (431 patients). In the LR group, there were 54 (9.9%) revisions, 25 (46%) of which were due to capsulolabral adhesions. The NLR group had 36 (7.8%) revisions with six (17%) due to capsulolabral adhesions. Preserving the CLJ, thereby avoiding the need for drilling and the insertion of suture anchors, when performing an acetabuloplasty for pincer-type FAI, significantly reduces the rate of symptomatic adhesions requiring revision arthroscopy.
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Affiliation(s)
- Mark S L Webb
- Hip Arthroscopy Australia, 21 Erin Street, Richmond, Victoria, Australia.,Trauma & Orthopaedic Department, St. George's Hospital, Blackshaw Road, London, UK
| | - Brian M Devitt
- OrthoSport Victoria, Level 5, 89 Bridge Road, Richmond, Victoria, Australia
| | - John M O'Donnell
- Hip Arthroscopy Australia, 21 Erin Street, Richmond, Victoria, Australia
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