All-suture anchors in arthroscopic acetabular labral repair: our experience
Main Article Content
labral, repair, arthroscopy, hip, all-suture, anchors
Background: Over the past years, the role of the acetabular labrum in hip joint biomechanics and its relations with joint health has been of particular interest. There is a good clinical improvement of patients in whom the acetabular labrum is preserved during arthroscopic hip surgery. The purpose of this study is to report the results of arthroscopic repair of labral tears at a medium term follow up. Materials and methods: We performed a retrospective review of all cases that underwent hip arthroscopy at our Institution from January 2013 until December 2018. There were 24 patients, 13 males and 11 females, and their mean age at the time of surgery was 29, 42 years (range, 19 to 43 years). All patients were treated by the same surgeon with an extracapsular OUT-IN approach. Suture was performed using a non-absorbable suture anchor all-suture. Clinical assessment was performed at December 2019 using a modified Harris hip score (mHHS), hip outcomes score activities of daily living (HOS ADL), hip outcomes score activities of sport scale (HOS SS). All patients with acetabular labrum injury had femoro-acetabular impingement. Results: The mean overall values in the preoperative period were 67.21 ± 10.31 for mHHS, 70.04 ± 12.11 for HOS-ADL and 60.06 ± 14.58 for HOS –SS. The results obtained in the re-evaluations of patients in December 2019 with a mean follow-up of 38, 3 months (minimum 1 year) are on average 82.17 ± 11.36 for mHHS, 83.00 ± 12.80 for HOS-ADL and 76.09 ± 18.52 for HOS-SS. Conclusions: The progress of knowledge and the advancement of diagnostic and therapeutic skills has led to a greater awareness of the importance of treating acetabular labrum tears. Arthroscopic treatment with suture appear to be a good option for these patients and we had encouraging results in our center.
2. Lee AJJ, Armour P, Thind D, Coates MH, Kang ACL. The prevalence of acetabular labral tears and associated pathology in a young asymptomatic population Bone Joint J May 2015, 97-B;5:623–627.
3. McCarthy JC, Noble PC, Schuck MR, Wright J, Lee J. The Otto E. Aufranc Award: the role of labral lesions to development of early degenerative hip disease. Clin Orthop Relat Res 2001;393:25–37.
4. Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech 2003;36:171–178.
5. Ferguson SJ, Bryant JT, Ganz R, Ito K. The acetabular labrum seal: a poroelastic finite element model. Clin Biomech (Bristol, Avon) 2000;15:463–468.
6. Ferguson SJ, Bryant JT, Ganz R, Ito K. The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech 2000;33:953–960.
7. Nepple JJ, Philippon MJ, Campbell KJ, et al. The hip fluid seal--Part II: The effect of an acetabular labral tear, repair, resection, and reconstruction on hip stability to distraction. Knee Surg Sports Traumatol Arthrosc 2014;22:730–736.
8. Smith MV, Panchal HB, Ruberte Thiele RA, Sekiya JK. Effect of acetabular labrum tears on hip stability and labral strain in a joint compression model. Am J Sports Med 2011;39(Suppl):103S–110S.
9. Lee S, Wuerz TH, Shewman E, et al. Labral reconstruction with iliotibial band autografts and semitendinosus allografts improves hip joint contact area and contact pressure: an in vitro analysis. Am J Sports Med 2015;43:98–104.
10. Su T, Chen GX, Yang L. Diagnosis and treatment of labral tear. Chin Med J (Engl). 2019 Jan 20;132(2):211-219.
11. Wenger D, Kendell K, Miner M, Trousdale RT. Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop Relat Res 2004; 426:145–150.
12. Pogliacomi F., Costantino C., Pedrini M.F., Pourjafar S., De Filippo M., Ceccarelli F. Anterior groin pain in athlete as consequence of bone diseases: aetiopathogenensis, diagnosis and principles of treatment.
Medicina dello Sport, 2014, 67(1), 1-27.
13. Pogliacomi F., Costantino C., Pedrini M.F., Pourjafar S., De Filippo M., Ceccarelli F.
Anterior groin pain in athletes as a consequence of intra-articular diseases: aetiopathogenensis, diagnosis and principles of treatment. Medicina dello Sport, 2014, 67(3), 341-68.
14. Pogliacomi F., Pedrini M.F., Pourjafar S., Pellegrini A., Paraskevopoulos A., Costantino C., Ceccarelli F. Pubalgia and soccer: real problem or overestimated? Medicina dello Sport, 2015; 68(4): 651-62.
15. Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med 2009;2:105–117.
16. Reiman MP, Mather RC, Hash TW, Cook CE. Examination of acetabular labral tear: a continued diagnostic challenge. Br J Sports Med. 2014 Feb;48(4):311-9.
17. Woyski D., Mather RC. Surgical Treatment of Labral Tears: Debridement, Repair, Reconstruction. Curr Rev Musculoskelet Med. 2019 Sep;12(3):291-299.
18. Lage LA1, Patel JV, Villar RN. The acetabular labral tear: an arthroscopic classification. Arthroscopy. 1996 Jun;12(3):269-72.
19. Di Benedetto P1, Barbattini P, Povegliano L, Beltrame A, Gisonni R, Cainero V, Causero A. Extracapsular vs standard approach in hip arthroscopy. Acta Biomed. 2016 Apr 15;87 Suppl 1:41-5.
20. Philippon MJ, Briggs KK, Hay CJ, Kuppersmith DA, Dewing CB, Huang MJ. Arthroscopic labral reconstruction in the hip using iliotibial band autograft: technique and early outcomes. Arthroscopy. 2010;6:750–6.
21. Griffin DR, Dickenson EJ, Wall PDH, UK FASHIoN group. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome: a multicenter randomized controlled trial. Lancet. 2018;10136:2225–35
22. Chandrasekaran S, Lodhia P, Suarez-Ahedo C, Vemula SP, Martin TJ, Domb BG. Symposium: evidence for the use of intra-articular cortisone or hyaluronic acid injection in the hip. J Hip Preserv Surg. 2015;(1):5–15
23. Palmer AJR, Ayyar Gupta V, Fernquest S, FAIT Study Group. Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicenter randomized controlled trial. BMJ. 2019;364:I185
24. Krych AJ, Thompson M, Knutson Z, Scoon J, Coleman SH. Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: a prospective randomized study. Arthroscopy. 2013;1:46–53
25. Menge TJ, Briggs KK, Dornan GJ, McNamara SC, Philippon MJ. Survivorship and outcomes 10 years following hip arthroscopy for femoroacetabular impingement: labral debridement compared with labral repair. J Bone Joint Surg Am. 2017;12:997–1004
26. Larson CM, Giveans MR, Stone RM. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: mean 3.5-year follow-up. Am J Sports Med. 2012;40(5):1015–21.
27. Larson CM, Giveans MR. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement. Arthroscopy. 2009;25(4):369-376.
28. Byrd JW, Jones KS. Hip arthroscopy for labral pathology: prospective analysis with 10-year follow-up. Arthroscopy. 2009;25(4): 365–8.
29. Maldonado DR, Chen SL, Yelton MJ, Rosinsky PJ, Walker-Santiago R, Shapira J, Lall AC, Domb BG. Return to Sport and Athletic Function in an Active Population After Primary arthroscopic Labral Reconstruction of the Hip. Orthop J Sports Med. 2020 Feb 5;8(2):2325967119900767.
30. Rahl MD, LaPorte C, Steinl GK, O'Connor M, Lynch TS, Menge TJ. Outcomes After Arthroscopic Hip Labral Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med. 2019 Oct 21:363546519878147.
31. Scanaliato JP, Christensen DL, Salfiti C, Herzog MM, Wolff AB. Primary circumferential acetabular labral reconstruction: achieving outcomes similar to primary labral repair despite more challenging patient characteristics. Am J Sports Med. 2018;9:2079–88
32. Domb BG, Yuen LC, Ortiz-Declet V, Litrenta J, Perets I, Chen AW. Arthroscopic Labral Base Repair in the Hip: 5-Year Minimum Clinical Outcomes. Am J Sports Med. 2017 Oct;45(12):2882-2890.
33. Sawyer GA, Briggs KK, Dornan GJ, Ommen ND, Philippon MJ. Clinical Outcomes After Arthroscopic Hip Labral Repair Using Looped Versus Pierced Suture Techniques. Am J Sports Med. 2015 Jul;43(7):1683-8.
34. Jackson TJ, Hanypsiak B, Stake CE, Lindner D, El Bitar YF, Domb BG. Arthroscopic labral base repair in the hip: clinical results of a described technique. Arthroscopy. 2014 Feb;30(2):208-13.
35. Lee JW, Hwang DS, Kang C, Hwang JM, Chung HJ. Arthroscopic Repair of Acetabular Labral Tears Associated with Femoroacetabular Impingement: 7-10 Years of Long-Term Follow-up Results. Clin Orthop Surg. 2019 Mar;11(1):28-35.
36. Mehta N, Chamberlin P, Marx RG, Hidaka C, Ge Y, Nawabi DH, et al. Defining the learning curve for hip arthroscopy: a threshold analysis of the volume-outcomes relationship. Am J Sports Med. 2018;6:1284–93