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Clinical and Radiographic Predictors for Unsalvageable Labral Tear at the Time of Initial Hip Arthroscopic Management for Femoroacetabular Impingement.
Am J Sports Med 2019; 47(9):2029-2037AJ

Abstract

BACKGROUND

The acetabular labrum plays important roles in proprioception, nociception, synovial fluid seal effect, and static and dynamic joint stability and as a shock absorber. Clinical and radiographic risk factors for unsalvageable labral tear in femoroacetabular impingement (FAI) are not well established.

PURPOSE

To identify predictors of unsalvageable labral tear during initial hip arthroscopic management of FAI.

STUDY DESIGN

Case-control study; Level of evidence, 3.

METHODS

Patients were included who underwent primary hip arthroscopic treatment for FAI between March 2009 and March 2014. Patients were excluded who had <2-year follow-up, underwent bilateral surgery, or had a history of surgery, osteoarthritis (Tönnis grade 2 or 3), and other diagnoses, including lateral center-edge angle <25° diagnosed as developmental hip dysplasia. Patients were divided into 2 groups according to their labral condition: reconstruction and refixation. Unsalvageable labral tear was defined as any irreparable labral tear, including severe degenerative tear, frayed labrum, labral ossification, flattened labrum, and failed prior repair during surgery. Univariate and multivariate analyses identified risk factors for segmental labral reconstruction. Patient-reported outcome scores and postoperative revision rates were also assessed.

RESULTS

Twenty-five hips (18 male, 7 female) and 126 hips (65 male, 61 female) were included in the reconstruction and refixation groups, respectively. The mean ± SD ages were 52.6 ± 15.0 and 36.5 ± 16.1 years in the reconstruction and refixation groups, respectively. In the reconstruction group, the mean modified Harris Hip Score significantly improved from 67.3 ± 14.9 preoperatively to 95.0 ± 8.1 at final follow-up (P < .001), and the mean Nonarthritic Hip Score improved from 63.0 ± 18.3 preoperatively to 89.5 ± 10.1 at final follow-up (P < .001). In the refixation group, the mean modified Harris Hip Score significantly improved from 69.2 ± 18.6 preoperatively to 93.0 ± 11.2 at final follow-up (P < .001), and the mean Nonarthritic Hip Score improved from 60.7 ± 18.8 preoperatively to 88.6 ± 15.0 at final follow-up (P < .001). No significant difference was noted in patient-reported outcome scores and revision hip arthroscopy rates. The rate of conversion of total hip arthroplasty was higher in the reconstruction group than in the refixation group. Risk factors for unsalvageable labral tear were age ≥45 years (odds ratio [OR], 8.83; P < .007), body mass index ≥23.1 kg/m2 (OR, 13.05; P < .001), and vertical center anterior angle ≥36° (OR, 19.03; P < .001). Furthermore, in this study, unsalvageable labral tears were present in cases with at least 2 of the 3 risk factors.

CONCLUSION

Age ≥45 years, body mass index ≥23.1 kg/m2, and vertical center anterior angle ≥36° are risk factors for unsalvageable labral tear at initial hip arthroscopic surgery for patients with FAI.

Authors+Show Affiliations

Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan.Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu, Japan.Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan.Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan.Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan.Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu, Japan.Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31233328

Citation

Nakashima, Hirotaka, et al. "Clinical and Radiographic Predictors for Unsalvageable Labral Tear at the Time of Initial Hip Arthroscopic Management for Femoroacetabular Impingement." The American Journal of Sports Medicine, vol. 47, no. 9, 2019, pp. 2029-2037.
Nakashima H, Tsukamoto M, Ohnishi Y, et al. Clinical and Radiographic Predictors for Unsalvageable Labral Tear at the Time of Initial Hip Arthroscopic Management for Femoroacetabular Impingement. Am J Sports Med. 2019;47(9):2029-2037.
Nakashima, H., Tsukamoto, M., Ohnishi, Y., Utsunomiya, H., Kanezaki, S., Sakai, A., & Uchida, S. (2019). Clinical and Radiographic Predictors for Unsalvageable Labral Tear at the Time of Initial Hip Arthroscopic Management for Femoroacetabular Impingement. The American Journal of Sports Medicine, 47(9), pp. 2029-2037. doi:10.1177/0363546519856018.
Nakashima H, et al. Clinical and Radiographic Predictors for Unsalvageable Labral Tear at the Time of Initial Hip Arthroscopic Management for Femoroacetabular Impingement. Am J Sports Med. 2019;47(9):2029-2037. PubMed PMID: 31233328.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical and Radiographic Predictors for Unsalvageable Labral Tear at the Time of Initial Hip Arthroscopic Management for Femoroacetabular Impingement. AU - Nakashima,Hirotaka, AU - Tsukamoto,Manabu, AU - Ohnishi,Yasuo, AU - Utsunomiya,Hajime, AU - Kanezaki,Shiho, AU - Sakai,Akinori, AU - Uchida,Soshi, Y1 - 2019/06/24/ PY - 2019/6/25/pubmed PY - 2019/6/25/medline PY - 2019/6/25/entrez KW - acetabular labral refixation KW - acetabular labral segmental reconstruction KW - femoroacetabular impingement KW - hip arthroscopy SP - 2029 EP - 2037 JF - The American journal of sports medicine JO - Am J Sports Med VL - 47 IS - 9 N2 - BACKGROUND: The acetabular labrum plays important roles in proprioception, nociception, synovial fluid seal effect, and static and dynamic joint stability and as a shock absorber. Clinical and radiographic risk factors for unsalvageable labral tear in femoroacetabular impingement (FAI) are not well established. PURPOSE: To identify predictors of unsalvageable labral tear during initial hip arthroscopic management of FAI. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Patients were included who underwent primary hip arthroscopic treatment for FAI between March 2009 and March 2014. Patients were excluded who had <2-year follow-up, underwent bilateral surgery, or had a history of surgery, osteoarthritis (Tönnis grade 2 or 3), and other diagnoses, including lateral center-edge angle <25° diagnosed as developmental hip dysplasia. Patients were divided into 2 groups according to their labral condition: reconstruction and refixation. Unsalvageable labral tear was defined as any irreparable labral tear, including severe degenerative tear, frayed labrum, labral ossification, flattened labrum, and failed prior repair during surgery. Univariate and multivariate analyses identified risk factors for segmental labral reconstruction. Patient-reported outcome scores and postoperative revision rates were also assessed. RESULTS: Twenty-five hips (18 male, 7 female) and 126 hips (65 male, 61 female) were included in the reconstruction and refixation groups, respectively. The mean ± SD ages were 52.6 ± 15.0 and 36.5 ± 16.1 years in the reconstruction and refixation groups, respectively. In the reconstruction group, the mean modified Harris Hip Score significantly improved from 67.3 ± 14.9 preoperatively to 95.0 ± 8.1 at final follow-up (P < .001), and the mean Nonarthritic Hip Score improved from 63.0 ± 18.3 preoperatively to 89.5 ± 10.1 at final follow-up (P < .001). In the refixation group, the mean modified Harris Hip Score significantly improved from 69.2 ± 18.6 preoperatively to 93.0 ± 11.2 at final follow-up (P < .001), and the mean Nonarthritic Hip Score improved from 60.7 ± 18.8 preoperatively to 88.6 ± 15.0 at final follow-up (P < .001). No significant difference was noted in patient-reported outcome scores and revision hip arthroscopy rates. The rate of conversion of total hip arthroplasty was higher in the reconstruction group than in the refixation group. Risk factors for unsalvageable labral tear were age ≥45 years (odds ratio [OR], 8.83; P < .007), body mass index ≥23.1 kg/m2 (OR, 13.05; P < .001), and vertical center anterior angle ≥36° (OR, 19.03; P < .001). Furthermore, in this study, unsalvageable labral tears were present in cases with at least 2 of the 3 risk factors. CONCLUSION: Age ≥45 years, body mass index ≥23.1 kg/m2, and vertical center anterior angle ≥36° are risk factors for unsalvageable labral tear at initial hip arthroscopic surgery for patients with FAI. SN - 1552-3365 UR - https://www.unboundmedicine.com/medline/citation/31233328/Clinical_and_Radiographic_Predictors_for_Unsalvageable_Labral_Tear_at_the_Time_of_Initial_Hip_Arthroscopic_Management_for_Femoroacetabular_Impingement L2 - http://journals.sagepub.com/doi/full/10.1177/0363546519856018?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -