Better improvement seen with refixation vs. debridement of acetabular labrum

Arthroscopic labral refixation after femoroacetabular impingement yielded good outcomes at 3.5 years.

Better improvement seen with refixation vs. debridement of acetabular labrum

Arthroscopic labral refixation after femoroacetabular impingement yielded good outcomes at 3.5 years.

Christopher M. Larson

A comparision of arthroscopic debridement and refixation of the acetabular labrum for femoroacetabular impingement showed that the refixation technique consistently produces good to excellent results at a mean follow-up of 3.5 years, according to investigators in Minnesota.

“This updated study with a mean 3.5-year follow-up further supports the importance of labral refixation and preservation as part of a hip joint preservation procedure for [femoroacetabular impingement] FAI,” Christopher M. Larson, MD, told Orthopedics Today.

He presented the results at the 2011 Annual Meeting of the American Orthopaedic Society for Sports Medicine.

Original study

The original study with a mean 19-month follow-up compared arthroscopic labral debridement and refixation in 80 hips. That study yielded good to excellent results in 67% of the debridement group and 90% of the refixation group, Larson said in his presentation.

To continue with the team’s original hypothesis that labral refixation would produce positive outcomes compared to labral debridement when performed as part of an arthroscopic joint preservation procedure for FAI, investigators ensured the second single-surgeon study matched the first as closely as possible. They included 100 hips in the new study, adding an additional 15 consecutive labral refixations; 94% of them were followed for a minimum of 2 years. The debridement group contained 44 hips with a mean follow-up of 44 months, while the refixation group included 50 hips with a mean follow-up of 41 months.

A patient’s right hip after rim resection and focal labral excision is seen here.	Shown is a right hip after rim resection and labral refixation.
A preoperative radiograph of an AP pelvis reveals acetabular retroversion.	This preoperative lateral radiograph reveals cam-type femoroacetabular impingement.
A postoperative AP pelvis is shown after undergoing rim resection, labral refixation and femoral resection.	This postoperative radiograph shows a hip after femoral resection. Images: Larson CM

For the study, refixation meant that the labrum during one procedure is released away from the acetabular rim, followed by rim resection, then labral repair or refixation. There was only one procedure and none of the patients had a prior hip surgery.

Larson and colleagues included pincer-type and combined pincer and cam-type impingement cases in the recent study. Pincer-type impingement was managed with rim resection and labral debridement or refixation.

Latest results

The investigators determined patients’ preoperative and postoperative Visual Analog Scale (VAS) scores for pain, SF-12 scores and modified Harris Hip scores, as well as alpha angles on anteroposterior (AP) and lateral radiographic views.

Preoperatively, there were no significant differences between the groups based on the change in alpha angles on AP or lateral radiographs of the femoral resection, age, gender, outcome scores, FAI classification or Tönnis grade in patients, according to the abstract.

The results showed a 1% increase in good to excellent results from the previous study for the debridement group and a 2% increase from their previous study in the refixation group with no significant difference in failure rates. VAS, SF-12 and modified Harris Hip scores were also better in the refixation group after 3.5 years of follow-up.

Larson noted in his presentation the biggest limitation of the study was the historic control group. In addition, he said that as the understanding of FAI has evolved, so have the techniques to manage the impingement, which resulted in slightly different management techniques for this particular study. – by Jeff Craven

Reference:

• Larson CM, Giveans MR. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: Minimum 2-year follow-up. Paper #30. Presented at the 2011 Annual Meeting of the American Orthopaedic Society for Sports Medicine. July 7-10. San Diego.

• Christopher M. Larson, MD, can be reached at Minnesota Sports Medicine, 775 Prairie Center Drive, Suite 250, Eden Prairie, MN 55344; 952-944-2519; email: chrislarson@ocpamn.com.
• Disclosure: Larson is on the editorial board for Arthroscopy. He is a stockholder in A2.