2021 Mar 1;29(1):e1-e8. Beaul PE, Speirs AD, Anwander H, et al. In addition, the failure rate or revision rate was 9.1% (4 hips) in the debridement group compared with 8.0% (4 hips) in the refixation group among Larson's study. Abrasion chondroplasty, acetabuloplasty, body mass index, Outerbridge grade, and radiographic femoroacetabular impingement were not found to be significantly associated with risk of THA. Herickhoff et al[24] found the intraoperative appearance of the labrum is the most important factor affecting surgical decision making. InThe Orthopaedic Journal of Sports Medicine, they show that patients who undergo labral repair are significantly less likely to require total hip arthroplasty (THA) than those who undergo labral debridement. [1012] In contrast, Espinosa et al[13] hold that patients treated with labral refixation/repair recovered earlier and had superior clinical and radiographie results when compared with patients who had undergone resection of a torn labrum. This research is supported by Hospital level subject of Tianjin Union Medical Center (2018YJ018 and 2019YJ005) and supported by the Fundamental Research Funds for the Central Universities, Nankai University (Grant Number 63191151). Results: J Bone Joint Surg Am. [25]. However, eight articles were excluded based on the previously established exclusion criteria (2 without available data, 4 meeting reports and 2 cadaveric comparisons). Authors Laude F, Sariali EA. The complications in five included studies also should be discussed. J Bone Joint Surg Am. Background: Arthroscopic labral debridement in the hip can be an effective treatment for labral tears but has demonstrated inferior outcomes compared with labral repair. femoroacetabular impingement; hip arthroscopy; labral debridement; labral repair; labral tear; total hip arthroplasty; total hip conversion. In cases in which the acetabular labrum is unsalvageable, labral reconstruction/repair is supported clinically and biomechanically as an option to optimize joint mechanics, improve function, and promote pain mitigation for select individuals. eCollection 2021 Jan. Lodhia P, McConkey MO, Leith JM, Maldonado DR, Brick MJ, Domb BG. Pre-operative and intra-operative, Decision bubble. Example #1: Arthroscopic Rotator Cuff Repair, Biceps Tenodesis, Subacromial Decompression, Debridement of the Labrum and Biceps Tendon. Both procedures have high success rates, reduce pain in the hip and improve the range of motion in the joint. In contrast, labral debridement focuses only on the shaving down of an area of the labrum and requires the use of no fixation devices. However, too less included articles lead to an unbelievable result, and the publication bias could not be ignored. Acetabular version and femoral torsion also depicted, Decision bubble. Labral debridement in our opinion is reserved for a select group of patients that are low demand, have adequate bony stability, and perhaps have mild degenerative changes and/or would be at risk for not healing/incorporating a labral graft. Maldonado DR, Chen SL, Yelton MJ, et al. 2006;88(5):925935. Ganz R, Parvizi J, Beck M, et al. However, Labral reconstruction/repair could re-create suction-seal effect, potentially reduce microinstability, and show trend to superior clinical outcome.[20]. Bethesda, MD 20894, Web Policies and transmitted securely. The difference of mHHS, VAS score, and satisfaction rate was statistically significant between LD and LR intervention, and arthroscopic LR could re-create suction-seal effect, potentially reduce microinstability, which demonstrated a trend toward better clinical efficacy and comparable safety compared with LD. Please enable scripts and reload this page. Clin Orthop Relat Res. YMR and ZXW conceived the design of the study. Anterior groin pain is frequently associated with intra-articular complaints, and a high number of patients diagnosed with labral tears will report this findings. Hip Labral Reconstruction with Capsular AutograftAugmentation. Data is temporarily unavailable. References from retrieved articles were also assessed to extend the search strategy. The indications to repair a torn acetabular labrum are highly variable among hip arthroscopic surgeons. [1]. Third, our study only included 3 articles for conducting funnel plot and the publication bias could not be ignored. eCollection 2022 Jul. Keyword Highlighting Purpose: Chondral injury repair Amenabar and O' Donnel [102] also reported (Figs. Preparation for labral debridement and repair may involve the following steps: First, the small sample size might have affected the significant difference between the two surgical procedures. [15] In addition, our results talked about comparison of failure rate of surgeries between LD and LR, and none difference was found between them. Federal government websites often end in .gov or .mil. ZXW, WXR, and YMR contributed equally to this work. More large-sample, multi-center, high-quality, RCTs are needed to verify the outcomes of this meta-analysis. Designed by nature the labrum deepens and seals the hip socket to firmly hold the head of the large leg bone (femur) in its socket. For the dichotomous outcome, we calculated the odds ratios (ORs) and 95% CIs. The hip fluid sealpart II: the effect of an acetabular labral tear, repair, resection, and reconstruction on hip stability to distraction. 02114 Background:While it is believed that good results can be achieved by arthroscopic debridement of partial-thickness tears (PTTs) of <50% tendon thickness, few studies have directly compared the trea. Labral debridement and repair is a surgical procedure to remove loose and damaged cartilage in the labrum and to secure the torn labrum to its normal attachment to the bone. Graft Options in Hip Labral Reconstruction. The secondary outcomes included: failure rate of surgeries and complications. Cadet ER, Chan AK, Vorys GC, et al. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Epub 2017 Nov 14. Other factors studied, but not significantly associated with risk of THA, were concomitant treatment with abrasion chondroplasty or acetabuloplasty, body mass index, Outerbridge grade, and femoroacetabular impingement evident on radiographs before arthroscopy. Clinical presentation of femoroacetabular impingement. Arthroscopic management of femoroacetabular impingement in athletes. The General Hospital Corporation. [14]. Comparison of postoperative mHHS between LD and LR was conducted between the two included studies,[15,18] which enrolled 127 patients (66 patients receiving LD and 61 patients receiving LR), as shown in Figure 4. Either arthroscopic labral debridement (LD) or labral repair (LR) technique for FAI patients is needed to choose. Hip Arthroscopy in Patients Age 40 or Older: A Systematic Review. PMC When is Labral Debridement and Repair Surgery Necessary? The datasets generated during and/or analyzed during the current study are publicly available. Each point represents a separate study for the indicated association. Scott D. Martin, MD, and colleagues report significant improvement in short-term improvement on International Hip Outcome Tool33 and other measures for 50 patients who had full-thickness chondral flaps preserved with bone marrow aspirate concentrate during hip arthroscopy, compared to 31 treated with microfracture. Would you like email updates of new search results? A P < .05, I2 > 50% was considered a significant heterogeneity, and random-effect models were applied. http://creativecommons.org/licenses/by/4.0. Dwyer MK, Tumpowsky C, Boone A, Lee J, McCarthy JC. Larson CM, Giveans MR, Stone RM. 2018 Dec;46(14):3437-3445. doi: 10.1177/0363546518809063. Am J Sports Med 2012;40:221823. The detail of selection process is listed in Figure 1. With compression and external rotation, LR has shown superiority to reconstruction and resection. In Revision Hip Arthroscopy, Labral Reconstruction Can Address a Deficient Labrum, but Labral Repair Retains Its Role for the Reparable Labrum: A Matched Control Study. Matthew JC, Christopher JD, Jerry WA, et al. Email Address A recent survey-based study by Herickhoff et al. 2020;99:19(e20141). Knee Surg Sports Traumatol Arthrosc 2007;15:10417. Please try after some time. Additional factors associated with a lower rate of hip survival were older age and osteoarthritis at the time of hip arthroscopy. HHS Vulnerability Disclosure, Help Although LD/segmental resection may successfully lead to symptom resolution, biomechanical testing supports the importance of labral preservation or reconstruction to optimize and normalize arthro kinematics. In Domb's study,[17] two patients in the arthroscopic labral reconstruction group had medial knee pain at the graft harvest site that resolved at 6 weeks follow-up. This website uses cookies. labral repair is performed when a patient sustains an injury to the acetabular labrum. Thirteen full-text articles were assessed for eligibility. An in vitro investigation of the acetabular labral seal in hip joint mechanics. It works best for smaller yet highly macerated tears and older patients looking for non-extensive surgical options. You may be trying to access this site from a secured browser on the server. The site is secure. Some limitations of this study should be noted. Accessibility [20]. China (e-mail: [emailprotected]). What are you searching for? Chen AW, Yuen LC, Ortiz-Declet V, Litrenta J, Maldonado DR, Domb BG. . One group of 22 patients had an arthroscopic subacromial decompression and rotator-cuff debridement; the other comparable group of 23 patients had open repair and acromioplasty. The funnel plot of the included studies is shown in Figure 9. sharing sensitive information, make sure youre on a federal Labral Pathology Debridement vs Repair and Labral Reconstruction | VuMedi An unanticipated problem was encountered, check back soon and try again Error Code: MEDIA_ERR_UNKNOWN Session ID: 2022-10-07:8a76460f2c8eb42de2156488 Player Element ID: vjs_video_3 Labral Pathology Debridement vs Repair and Labral Reconstruction simple debridement [75]. [12]. Return to sport and athletic function in an active population after primary arthroscopic labral reconstruction of the hip. Epub 2019 Jun 24. However, there have been no systematic, quantitative evaluations between two techniques. [2729] Interestingly, Menge et al[30] reported higher rates of conversion to THA were seen in older patients, patients treated with acetabular microfracture, and hips with 2 mm of joint space preoperatively, regardless of labral treatment. Before The authors have not conflicts of interest to disclose. fixation (Fig. Federal government websites often end in .gov or .mil. Clohisy JC, John LCS, Schutz AL. After an appropriate history has been obtained, the physical examination can assist the physician in further narrowing the diagnosis (, A focused physical examination should include evaluation of the lumbar spine, SI joints, and the femoroacetabular joint. Epub 2021 Nov 20. All Rights Reserved. Forest plot of comparison: the satisfaction rate between arthroscopic labral debridement (LD) and labral repair (LR) technique. Perets I, Rybalko D, Mu BH, Maldonado DR, Edwards G, Battaglia MR, Domb BG. Chen AW, Yuen LC, Ortiz-Declet V, Litrenta J, Maldonado DR, Domb BG. Publication bias was showed by the funnel plot. We assessed 5 studies[1418] including 1 RCT and 4 retrospective studies in this article. Ferguson SJ, Bryant JT, Ganz R, et al. [27]. B bethh05 Expert Orthop J Sports Med 2020;8: doi: 10.1177/2325967119900767. [29]. [11]. Two partners (ZXW and YMR) independently assessed the titles and abstracts of all the studies screened during initial search, and they excluded any clearly irrelevant studies using the inclusion criteria. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Please try again soon. Heterogeneity testing showed that there was no heterogeneity among the studies (P = .50, I2 = 0%), so the fixed-effect model was used to pool the data from the 2 studies. Labral debridement surgery is commonly performed for relatively large labral tears. Given the labrum's central role in hip biomechanics, there is increasing emphasis on labral preservation in the form of debridement and repair. 2020. Horner NS, Ekhtiari S, Simunovic N, Safran MR, Philippon MJ, Ayeni OR. Availability of supporting data: The present study was a review of previous published literatures. Otherwise fixed-effect models were used if there was no significant heterogeneity (P .05, I2 50%). The .gov means its official. Am J Sports Med 2009;37:17217. may email you for journal alerts and information, but is committed all adult patients (> 18 years) in whom an arthroscopic labral debridement (acetabular procedure recorded as 'debridement' or 'resection') or labral repair, in addition to any concurrent procedure to treat fai pathology, was recorded between 1 january 2012 and 31 july 2019, were extracted from the nahr dataset in august 2020 after the following [6]. Data were independently extracted using a standard data form for the first author's name, year of publication, sample size, gender, age, intervention, country, study design, follow-up, and relevant outcomes. Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: a prospective randomized study. Short-Term Complications of Hip Corticosteroid Injection Are Infrequent, Bone Marrow Aspirate Promising for Treating Hip Arthroscopy, This retrospective study compared two different arthroscopic treatments for acetabular labral tearsrepair vs. debridementusing an adjusted analysis to evaluate the long-term risk of conversion to total hip arthroplasty, Data were reviewed on 204 patients of a single surgeon: 105 who underwent labral debridement and 99 who underwent labral repair, In multivariable analysis, patients who underwent labral repair had a significantly lower risk of conversion to total hip arthroplasty compared with patients who underwent labral debridement (HR, 0.24; 95% CI, 0.070.74; P=0.014), Factors that significantly increased the risk of conversion to total hip arthroplasty were age at the time of arthroscopy (HR, 1.06 per year; P=0.002) and Tnnis grade (HR, 2.39; P=0.026), Technical advances in recent years have expanded the number of patients who can undergo labral repair, Labral debridement was performed if the labral tear was degenerative, hypoplastic, or isolated to a single plane involving <50% of the labrum105 patients (51.5%), Labral repair was performed if there was adequate healthy labral tissue for suture fixation or if the tear was complex with extension into the chondrolabral junction99 patients (48.5%), Labral debridement group23 patients (22%) at a mean of 3.7 years, Labral repair group5 patients (5%) at a mean of 3.7 years. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: mean 3.5-year follow-up. Particular attention should be placed on stride length, core balance, posture, and the duration of the stance phase of gait. The Authors. Clin Orthop Relat Res 2004;418:6773. BMJ Open Sport Exerc Med 2019;5:e000530. Arthrosc Tech. Some error has occurred while processing your request. Phone: 617-726-2000. . Methodological quality assessment of the five included studies is presented in Figure 2 and Table 3. Labral repair was associated with a significantly lower risk of conversion to THA compared with debridement (hazard ratio [HR] = 0.24; 95% CI, 0.07-0.74; P = .014). eCollection 2021 Jun. 12 A higher overall score indicates a lower risk of bias and a score of 5 or less (out of 9) corresponds to a high risk of bias. No significant difference in patient satisfaction was found between treatment groups, and for patients who did not convert to THA, there was no difference in mean patient-reported outcome scores at final follow-up. Hip capsule repair; Hip labral repair; Labral augmentation; Labral reconstruction. Wylie JD, Kim YJ. Conservative treatment consists of rest, non-steroidal anti-inflammatory medication, pain medications, modifications of activities, physical therapy, and intra-articular injection. [22]. Femoroacetabular impingement (FAI) is a common cause of hip pain and even tearing of the acetabular labrum in young adults and athletes. These include the urogenital system problems, sacroiliac (SI) joint pain, spinal pain, abdominal symptoms, soft tissue contusions, and abdominal wall pain. If debridement was the surgical treatment, rehabilitation will begin when the athletes pain allows. The study included 204 patients with an acetabular labral tear who underwent arthroscopy by Dr. Martin between April 2007 and October 2014, and had at least five years of clinical follow-up: 28 patients (14%) underwent THA within 10 years after hip arthroscopy: In a multivariable analysis, the researchers adjusted for all variables that were significantly different between treatment groups at baseline and those presumed to predict conversion to THA. Careers. The five studies were acquired from PubMed, Medline, Embase, and Cochrane Library. Among the RCT, Krych's study[16] clearly described randomization was carried out opening one of 36 sealed, opaque envelopes assigning by patients to receive either LR or debridement, but the surgeon and patient were not blinded, which could be regarded as a moderate quality study. 8600 Rockville Pike Your message has been successfully sent to your colleague. -, Conaway WK, Martin SD. ZXW and YMR performed and collected the data and contributed to the design of the study. RevMan statistical software 5.3 was used for meta-analysis. Labral tear is generally secondary to FAI, trauma, dysplasia, capsular laxity, and degeneration. HHS Vulnerability Disclosure, Help Keywords: All authors read and approved the final content of the manuscript. Preparation for labral debridement and repair may involve the following steps: An official website of the United States government. Comparison of failure rate of surgeries between LD and LR was conducted among the two included studies,[16,17] which included 132 patients (62 patients receiving LD and 70 patients receiving LR), as shown in Figure 7. [14,15,17] In Cetinkaya's study,[14] 6 patients developed transient nerve palsy; 2 femoral nerve palsy cases of which 1 required surgical release, 2 pudendal nerve cases and 2 obturator nerve palsy cases at an average of 3 months of follow-up. In addition, Tonnis grade, Outerbrideg grade, and Coleman Score of our included were also assessed in Table 2. Anatomically, the arthroscopic LR is closer to recovery normal acetabular labium structure, which contributes to the stability of the hip joint, the coordination of the movement and the secretion of the joint fluid. If there is a suspicion of an extra-articular component to the patient complaint, the history and physical examination must be adjusted appropriately (, The clinical evaluation of a patient with hip pain can be challenging and requires a systematic approach to the physical examination to aid the clinician in correctly identifying the source of the complaint. 1. The patient might have bony work done at the same time in order restore proper joint arthrokinematics. The shoulder may become unstable if the labral tear is larger. Femoroacetabular impingement treatment using arthroscopy and anterior approach. An official website of the United States government. However, larger studies with longer follow-up are needed. Surgical treatment of femoroacetabular impingement: a. The methodological quality of the trials indicated a low to moderate risk of bias. The pooled results of Non-Arthritic Hip Score (NAHS), failure rate of surgeries and complications showed that the differences were not statistically significant between the two interventions. [10]. The role and function of the acetabular labrum have been studied extensively in the past decade. Nakashima H, Tsukamoto M, Ohnishi Y, Utsunomiya H, Kanezaki S, Sakai A, Uchida S. Am J Sports Med. Either arthroscopic labral debridement (LD) or labral repair (LR) technique for FAI patients is needed to choose. This is the video of my bone scrape that was performed at the same time as having my labral tear repaired on my hip. China. and transmitted securely. ACETABULAR LABRAL TEARS:RESECTION VS.REPAIR 85 Table I. Outcomes Following Treatment of acetabular labral Tears. The failure rate of LR operation is higher than that of LD group due to the limitation of the operator's personal level. the acetabular labrum itself is a complex structure consisting of a fibrocartilaginous rim composed of circumferential collagen fibers spanning the entirety of the acetabulum, becoming contiguous with the transverse acetabular ligament (tal) and anchored through a well-defined 1 to 2 mm transitional zone of calcified cartilage at the acetabular Labral debridement/focal resection is technically uncomplicated, but does not re-create suction-seal effect, and may result in compromised load distribution, shear stress. In addition, newer reports have shown significantly improved outcomes and survivorship with capsule repair and therefore should be included in every hip arthroscopy. One or more of the authors has declared the following potential conflict of interest or source of funding: Support was received from the Conine Family Fund for Joint Preservation. The https:// ensures that you are connecting to the The overall estimate indicated that the pooled OR was 0.17 (95%CI = 0.070.43, P = .0002), suggesting that LD and LR treatment had a statistically significant difference, and LR performed better. While if a surgeon is willing to take on revision hip arthroscopy, augmentation and reconstruction are tools necessary to treat patients that require restoration of a labral seal and who are at risk for instability without a labrum. We considered all published and unpublished studies covering randomized controlled trials (RCTs), and observational studies including retrospective and prospective studies. The probability of the recurrence of the hip joint pain and the failure rate is small after LR than LD. The concept of femoroacetabular impingement: current status and future perspectives. This allows the labrum to function in its most important role of dissipating the high potential contact forces encountered by the hip joint during activity and weight bearing at any flexion angle. Submit, Originally published on The Orthopaedic Journal of Sports Medicine. Boston, Bookshelf Hip Int 2016;26:204. In total, 28 (13.7%) of the 204 patients underwent conversion to THA within 10 years after hip arthroscopy (labral repair: 5 [5.0%] vs labral debridement: 23 [21.9%]). The labral surface immediately adjacent to the articular cartilage of the femoral head becomes continuous with the hyaline articular cartilage of the acetabular surface through a similar transitional zone (, The complete physiological function of the labrum is not completely defined, but it appears to serve multiple purposes, including a limitation of extreme range of motion and deepening the acetabulum to enhance the stability of the hip joint. These symptoms may arise from both an intra-articular and an extra-articular source, and care must be taken to appropriately direct the diagnostic algorithm to successfully locate the source of the complaint and guide therapeutic interventions. Capsular Reconstruction of the Hip Using Modified Kite Technique: A Technical Guide for Efficient Graft Management and Fixation. There is evidence that some complex tears and/or hypoplastic labrums can be repaired with local capsular autografts or with allografts/autografts from tensor fascia lata, semi-tendinosus, rectus femoris, gracilis, iliotibial band or dermal tissue. A heterogeneity test showed that there was no heterogeneity among studies (P = .94, I2 = 0%), so the random-effect model was used. Kelly BT, Weiland DE, Schenker ML, et al. your express consent. Recent findings: Copyright 2007-2022. Published by Wolters Kluwer Health, Inc. 1. insufficient clinical outcome data in studies and. . Michael P. Kucharik, MD, a former research fellow with theSports Medicine Servicein theDepartment of Orthopaedicsat Massachusetts General Hospital,Scott D. Martin, MD, director of the Joint Preservation Service at the Hospital, and colleagues from the Sports Medicine Service demonstrated a clear difference between the two labral treatments in a retrospective cohort study. Unable to load your collection due to an error, Unable to load your delegates due to an error. YMR, WXR and MQT prepared and revised the manuscript. 2019 Jul;47(9):2029-2037. doi: 10.1177/0363546519856018. The shoulder may become unstable if the labral tear is larger. In terms of the difficulty of operation, the difficulty of LR is higher than that of LD. Submit. Linear decision algorithms do not capture the interaction of multiple variables and may underestimate the complexity of decision-making. Am J Sports Med 2014;42:12230. Domb BG, El Bitar YF, Stake CE, et al. The ability to perform complex arthroscopic procedures of the hip such as labral augmentation and reconstruction is essential for hip arthroscopists in the revision setting, with patient selection and indications for various labral treatments the key driver for improved short- and mid-term clinical outcomes. The criterion for reconstruction is narrower than augmentation and the indications for reconstruction do not overlap those of repair and should be considered substitutive of repair. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. We believe an adequate understanding of the anatomic subtleties, pathologic changes, biomechanical forces, and advanced reconstructive techniques allows repair to be performed in most, if not all, rotator cuff tears of . The overall estimate showed that the difference between the two groups was statistically significant (MD = 1.14, 95%CI = 0.511.77, P = .0004). Kassarjian A, Yoon LS, Belzile E, et al. Labral preservation is believed to be important because of the role the labrum plays in maintaining a healthy joint. Thus, the role for labral debridement has become unclear. If this is the case, the labral tear may need to be repaired with suture anchors, rather than simply removing the damaged portion of the labrum. If this is the case, the labral tear may need to be repaired with suture anchors, rather than simply removing the damaged portion of the labrum. Dustin Woyski declares that he has no conflicts of interest. Among the most studies, the heterogeneity results were not obviously altered after sequentially omitting each study, indicating that our results were statistically reliable. Arthroscopy 2005;21:1496504. The data were extracted by two of the coauthors independently and were analyzed by RevMan5.3. Arthrosc J Arthrosc Relat Surg 2013;29:4653. Surgical correction of cam deformity in association with femoroacetabular impingement and its impact on the degenerative process within the hip joint. 20.4c and 20.4d) is performed at . [9]. the individual's goals for activity following Shoulder Arthroscopic . Chin Med J 2019;132:2119. 2017;6(6):e2265e2269. Modifications to this guideline may be necessary dependent on physician specific instruction, location of repair, concomitant injuries or additional procedures performed. Yearbook Orthop 2007;2007:167. If there was repair of either the biceps or glenoid, rehabilitation will start in approximately 4-6 weeks. However, biomechanical studies conflict when comparing the effects of these surgical options on cartilage preservation. When fail to respond to conservative treatment, surgical treatment including LD and LR is often indicated. Arthroscopy. All surgical techniques including the arthroscopic labral resection/debridement technique and the arthroscopic labral refixation/repair/reconstruction technique were considered. Methods: The five studies were acquired from PubMed, Medline, Embase, and Cochrane Library. FAI is the common cause of hip pain for young people, especially athletes. This retrospective study compared two different arthroscopic treatments for acetabular labral tearsrepair vs. debridementusing an adjusted analysis to evaluate the long-term risk of conversion to total hip arthroplasty Data were reviewed on 204 patients of a single surgeon: 105 who underwent labral debridement and 99 who underwent labral repair All patients had been diagnosed as FAI on the basis of history, positive impingement signs on examination, and radiographic evidence and the presence of labral tear/pathology was required on magnetic resonance imaging (MRI), regardless of the etiology of the disease, associated pathology, gender, and age. Arthroscopic Acetabular Labral Repair Versus Labral Debridement: Long-term Survivorship and Functional Outcomes Arthroscopic Acetabular Labral Repair Versus Labral Debridement: Long-term Survivorship and Functional Outcomes Orthop J Sports Med. Scanaliato JP, Green CK, Salfiti CE, Wolff AB. Leunig M, Beaul PE, Ganz R, et al. Studies have demonstrated that labral repair has improved outcomes over labral debridement, with results of labral reconstruction in a revision approaching those of labral repair. -, Crawford MJ, Dy CJ, Alexander JW, et al. Arthrosc Tech. Study No. Acetabular labral debridement/segmental resection versus reconstruction in the comprehensive treatment of symptomatic femoroacetabular impingement: a. AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Epub 2016 Sep 10. We conducted this systematic review and meta-analysis to compare the clinical outcomes of arthroscopic LD versus LR intervention. 2009;25(4):365368. Codes are: 29827, 29828, and 29826. The average follow-up duration ranged from 26.4 to 58.3 months. Herickhoff, Paul K, Safran MR. Surgical decision making for acetabular labral tears: an international perspective. Search for Similar Articles FOIA The pain associated with an intra-articular source may less commonly radiate to the posterior hip, buttock, greater trochanter, medial thigh, or knee. [30]. Methods: Last but not least, the included studies were mostly observational studies and not RCTs, and they largely relied on retrospectively collected data, resulting in a high risk of selection bias. Search Survivorship and Outcomes 10 Years Following Hip Arthroscopy for Femoroacetabular Impingement: Labral Debridement Compared with Labral Repair. PMC government site. Orthop J Sports Med 2018;6: doi: 10.1177/2325967118797324. Background: Menge TJ, Briggs KK, Dornan GJ, McNamara SC, Philippon MJ. Labral debridement is a minimally invasive surgery performed to trim the torn or weakened areas of the labrum that can get caught in the joint and cause further complications. doi: 10.1016/j.eats.2020.09.031. Based on the titles and abstracts review, 141 irrelevant articles and 5 systematic reviews of them were excluded. Labral and sciatic nerve neuropraxia (one hip). A standard radiographic series should include anteroposterior pelvis and lateral views (, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Hip Arthroscopy for Nonstructural Pathology, Arthroscopic Double-Row Rotator Cuff Repair, Surgical Hip Dislocation for the Treatment of Femoroacetabular Impingement and Slipped Capital Femoral Epiphysis, Master Techniques in Orthopaedic Surgery: Sports Medicine. 5. 2018 Feb;46(2):297-304. doi: 10.1177/0363546517739566. Am J Sports Med. Studies have shown that the labrum contributes approximately 22% of the articulating surface of the hip and increases the volume of the acetabulum by 33% (. eCollection 2020 Dec. Singh H, DeFroda SF, Gursoy S, Vadhera AS, Perry AK, Nho SJ, Chahla J. Arthrosc Tech. In total, 28 (13.7%) of the 204 patients underwent conversion to THA within 10 years after hip arthroscopy (labral repair: 5 [5.0%] vs labral debridement: 23 [21.9%]). The arthroscopic LR technique is recommended as the optical choice for acetabular labrum tear with FAI. Distraction testing has shown that labral reconstruction and repair are superior to segmental resection,[21] whereas axial compression tests are controversial. 2021 Feb;14(1):16-26. doi: 10.1007/s12178-020-09690-4. Long-term studies have failed to demonstrate a difference between these treatments in terms of conversion to total hip arthroplasty (THA). NCI CPTC Antibody Characterization Program. The pooled result showed that the difference was not statistically significant between the LD group and the LR group (MD = 5.0, 95% CI = 10.570.56, P = .08). Am J Sports Med 2012;25:101521. Two patients in the arthroscopic segmental labral resection group had superficial wound infections that were treated successfully with oral antibiotics. Arthroscopic labral repair in the hip: surgical technique and review of the literature. Wolters Kluwer Health Preparation of the Labral Debridement and Repair Surgery. Clin Orthop Relat Res 2009;467:61622. The highly organized composition of the labral fibers provides exceptional radial tensile stiffness, while its low permeability assists in maintaining the articular fluid homeostasis. Funnel plot to test for publication bias. For more information, please refer to our Privacy Policy. The site is secure. The hip labrum is a ring of strong cartilage that rims the outer edge of the hip socket (acetabulum). This was a retrospective cohort study of patients who underwent hip arthroscopy by a single surgeon between April 2007 and October 2014. [3,4] The acetabular labrum is an important structure that deepens the acetabular socket and ensures adequate load distribution within the hip joint. 22 demonstrated that 4 variables known before surgery were identified as being important to the decision-making of the majority of hip arthroscopists. J Hip Preserv Surg. 2021 Jan 20;10(1):e209-e216. [25,26] Long-term follow-up results with higher quality studies will be necessary to further define the role of labral reconstruction in hip preservation surgery. [16]. The examination of the hip can be complicated by the relatively common incidence of referred pain from genitourinary, visceral, and gynecologic etiologies to the area in question (, In patients with unilateral complaints, all objective examinations should be compared to the contralateral side. Knee Surg Sports Traumatol Arthrosc 2014;22:7229. Patients who underwent labral repair were less likely to convert to THA compared with patients who underwent labral debridement, despite adjustment for differences in baseline patient characteristics and preexisting pathology. Among the observational studies, the NewcastleOttawa Scale including the exposed cohort, the non-exposed cohort, ascertainment of exposure, outcome of interest, comparability, assessment of outcome, length of follow-up, and adequacy of follow-up, was used to assess the risk of bias. Highlight selected keywords in the article text. Study design: The clinical outcomes of the studies were evaluated mainly based on NAHS, mHHS, VAS score, satisfaction rate, and complications. [15]. Hypothesis/Purpose: The purpose was to evaluate the outcomes of a selective debridement with labral preservation (SDLP) group with a minimum 5-year follow-up. The points in the funnel plot were almost symmetrically distributed. . 4. Coughlin RP, Ayeni OR. There is less evidence regarding the clinical usefulness of signs, symptoms, and examination in accurately detecting labral tears without further diagnostic testing. Krych AJ, Thompson M, Knutson Z, et al. Sensitivity analysis proved the stability of the pooled results and there were too less included articles to verify the publication bias. Between June 2007 and June 2009, 36 female patients undergoing arthroscopic hip treatment for pincer- or combined-type femoroacetabular impingement were randomized to 2 treatment groups at the time of surgery: labral repair or labral debridement. Regarding procedures performed, all patients underwent capsular plication with 19 patients having a labral repair, 7 patients with partial labrectomy, 25 patients receiving chondroplasty, 29 patients having ligamentum teres debridement, and 5 patients having loose body removal. This evidence-based Shoulder Arthroscopic Labral debridement rehabilitation guideline is criterion- . Philippon MJ, Nepple JJ, Campbell KJ, et al. Clinical and Radiographic Predictors for Unsalvageable Labral Tear at the Time of Initial Hip Arthroscopic Management for Femoroacetabular Impingement. The difference of modified Harris Hip Score (mHHS), the Visual Analogue Scale (VAS) score and satisfaction rate was statistically significant between LD and LR intervention, and LR treatment was more effective. Arthroscopic treatment for labral tears includes debridement and repair. Cohort study; Level of evidence, 3. [23] Although labral preservation has been shown to produce durable results and, at this time, seems to be preferable to debridement/segmental resection, certain clinical circumstances may preclude labral preservation. -, Byrd JWT, Jones KS. Investigation of the preservation of the fluid seal effect in the repaired, partially resected, and reconstructed acetabular labrum in a cadaveric hip model. [Research progress in arthroscopic treatment of acetabular labrum injury]. Preparation of the Labral Debridement and Repair Surgery. In conjunction with the TAL, it contains an inherent elasticity that allows excellent conformity with the articular surfaces during range of motion while providing for minor joint incongruities. Up to now, some clinical studies compared radiographic and functional outcomes between arthroscopic LD and LR techniques. [26]. Risk of bias summary: this risk of bias tool incorporates the assessment of randomization (sequence generation and allocation concealment), blinding (participants and outcome assessors), incomplete outcome data, selective outcome reporting, and other risk of bias. On the whole, 8 (8%) complications under LD surgery was reported and 5 (5.3%) complications under LR surgery was reported in 3 included studies. Bookshelf However, the most important initial step in the evaluation of hip pain is the history and clinical examination (, A labral tear can be the result of a traumatic event, usually involving an external rotation force with the hip in a hyperextended position (, Reported symptoms of a labral tear may include pain, clicking, mechanical locking, instability, a feeling of giving way, or joint stiffness. Pre-operative and intra-operative decision-making for surgical management of labral pathology can, Labral repair ( a ), labral augmentation ( b ), and autograft labral, MeSH Abbreviations: FAI = femoroacetabular impingement, LD = labral debridement, LR = labral repair, MD = mean difference, mean difference = confidence interval, mHHS = modified Harris Hip Score, MRI = magnetic resonance imaging, NAHS = Non-Arthritic Hip Score, ORs = odds ratios, RCTs = randomized controlled trials, VAS = Visual Analogue Scale. of Patients Mean Follow-up Mean age Treatment Results Other Fitzgerald, CORR 199552 55 53 months (4-216) Labral debridement (arthrotomy and arthroscopy) 89% symptom free, 13% had no improvement No improvement related to . Purpose of review: In conclusion, arthroscopic LD and LR are viable options for the treatment of acetabular labrum tear with FAI. The vertical line represents the mean effects size. Curr Rev Musculoskelet Med. sharing sensitive information, make sure youre on a federal [23]. FOIA In addition, newer reports have shown significantly improved outcomes and survivorship with capsule repair and therefore should be included in every hip arthroscopy. This paper does not involve research on humans. Espinosa N, Beck M, Rothenfluh DA, et al. LR treatment is more effective and have comparable complications compared with LD treatment, which indicates that the arthroscopic LR technique could be recommended as the optical choice for FAI. Cochrane Collaboration's Risk of Bias Tool and NewcastleOttawa Scale were used to assess risk of bias. Clin Orthop Relat Res 2003;417:112. official website and that any information you provide is encrypted One additional function of the examination is to guide the physician in ordering appropriate diagnostic tests to identify and confirm the source of symptoms (, Imaging of the hip is a routine part of the diagnostic algorithm for management of intra-articular pathology and includes plain radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance arthrography (MRA). Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Arthroscopic acetabular labral reconstruction: a review. The pooled result showed that the difference was not statistically significant between the LD group and the LR group (OR = 0.37, 95% CI = 0.091.50, P = .16). The continuous variables would be conducted by mean difference (MD) and 95% confidence interval (CI). Before [8]. Accessibility Richard Mather is a Board or committee member for Arthroscopy Association of North America and the North Carolina Orthopaedic Association, is a paid consultant for Stryker and KNG Health Consulting, and has received research supports from Zimmer and Reflexion Health. Forest plot of comparison: the Non-Arthritic Hip Score (NAHS) between arthroscopic labral debridement (LD) and labral repair (LR) technique. See this image and copyright information in PMC. Cochrane Collaboration's Risk of Bias Tool was manipulated for the appraisal of RCT study quality. 2021 Apr 21;7(4):611-620. doi: 10.1093/jhps/hnab003. 8600 Rockville Pike [5]. [18]. 3. Clin Orthop Relat Res 2008;465:1622. 2018 Feb;46(2):297-304. doi: 10.1177/0363546517739566. Get new journal Tables of Contents sent right to your email inbox, http://creativecommons.org/licenses/by/4.0, May 2020 - Volume 99 - Issue 19 - p e20141, Arthroscopic labral debridement versus labral repair for patients with femoroacetabular impingement: A meta-analysis, Articles in Google Scholar by Zhan-Xiong Wu, MD, Other articles in this journal by Zhan-Xiong Wu, MD, Vitamin K2 (Menaquinone-7) supplementation does not affect vitamin K-dependent coagulation factors activity in healthy individuals, Digital ischaemia aetiologies and mid-term follow-up: A cohort study of 323 patients, Operative vs conservative treatment in distal radius fractures: A protocol, Anatomical variants of dorsal scapular nerve in relation to the middle scalene muscle in Japanese population, Estimation of ultrasound reference values for the ulnar nerve fascicular number and cross-sectional area in young males: A cross-sectional study. Hip Groin Pain Athlete 2019;12142. In Figure 8, three included studies[14,15,17] consisting of 194 FAI patients (100 patients received LD and 94 patients received LR technique) reported complications. Knee Surg Sports Traumatol Arthrosc 2014;22:7306. doi: 10.1097/JSA.0000000000000282. Practitioners would not record any codes for the Labrum/Biceps debridement as it's only one discrete site. Sports Med Arthrosc Rev. [19]. According to the mechanism of injury, FAI can be divided into three types: cam type, pincer type, and mixed type. The labrum or biceps must scar down and begin to heal so that the stress of rehabilitation does not re-injure the athlete. [28]. Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. 2021 May 17;10(6):e1547-e1551. Martin RRL, Kelly BT, Philippon MJ. 2017 Jun 21;99(12):997-1004. doi: 10.2106/JBJS.16.01060. . Additional factors associated with risk of conversion to THA included older age at the time of arthroscopy (HR = 1.06 per year; 95% CI, 1.02-1.11; P = .002) and Tnnis grade (HR = 2.39; CI, 1.14-5.41; P = .026). Restoration of Labral Function in Primary Hip Arthroscopy From Labral Repair to LabralReconstruction. Please enable it to take advantage of the complete set of features! Comparison of postoperative NAHS between LD and LR was conducted among the two included studies,[15,18] which included 126 patients (75 patients receiving LD and 51 patients receiving LR), as shown in Figure 3. Hip Labral Repair The hip is a ball and socket joint. 20.4b) should be conducted as it is Conversion to total hip arthroplasty occurred in associated with superior results compared with three patients. Surgical treatment of labral damage due to FAI can be either labral debridement (LD) or labral repair (LR), and is still controversial. Pathologic alterations of the acetabular labrum have classically been associated with developmental disorders of the hip including Legg-Calve-Perthes disease, developmental dislocation, and acetabular dysplasia. The doctor basically did a debridement of a labral tear, and a chondroplasty of the femoral head and acetabulum. Epub 2018 Nov 12. Hip arthroscopy for labral pathology: prospective analysis with 10-year follow-up. What Is the Association Between Articular Cartilage Damage and Subsequent THA 20 Years After Hip Arthroscopy for Labral Tears? Our meta-analysis results showed that the differences were not statistically significant between the two interventions for NAHS. After removing duplicates, 159 literatures were remained. The difference of mHHS, VAS score, and satisfaction rate was statistically significant between LD and LR intervention, and the LR technique proved it had a higher efficacy. One patient in the LD group and one patient in the labral fixation group had undergone revision in Cetinkaya's study. One should also take care to notice evidence of scoliosis, limb-length discrepancy, muscular deficit, or joint contractures (, While the physical examination is a critical component to diagnosis, it should be noted that multiple studies have found that the diagnostic accuracy of clinical findings may be variable. Labral Debridement vs Repair. Medicine. [19] In this study, we identified 1 RCT and 4 observational studies for investigating the clinical outcomes of arthroscopic LD versus LR intervention. Arthroscopic labral reconstruction is superior to segmental resection for irreparable labral tears in the hip: a matched-pair controlled study with minimum 2-year follow-up. Factors significantly associated with a greater risk of conversion to THA were older age at the time of arthroscopy (HR, 1.06 per year; P=0.002) and Tnnis grade* (HR, 2.39; P=0.026). 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