Labral Tears


131 Labral Tears


Chetan Gohal MD1, Nolan S. Horner MD1, and Marc R. Safran MD2


1 Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada


2 Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA


Clinical scenario



  • An athletic 38‐year‐old woman presents with insidious onset, moderately severe, groin pain that is activity related, especially when she is walking or pivoting on the right leg.
  • Pain is worse going from sitting to standing. She also has night pain.
  • The patient’s pain is reproduced when her hip is positioned in a flexed, adducted, and internally rotated (FADIR) position. X‐rays are unremarkable.
  • A magnetic resonance arthrogram (MAR) is performed of her right hip which reveals a labral tear.

Top three questions



  1. In patients undergoing surgical treatment for a labral tear of the hip, do patients treated with labral repair have superior functional outcome scores to those treated with labral debridement?
  2. In patients undergoing surgical treatment for an irreparable labral tear of the hip, do patients treated with labral reconstruction have superior functional outcome scores to those treated with labral debridement or a match‐controlled labral repair group?
  3. In patients undergoing surgical treatment for a labral tear of the hip, do younger patients have superior functional outcome scores and lower rates of conversion to hip arthroplasty compared to older patients?

Question 1: In patients undergoing surgical treatment for a labral tear of the hip, do patients treated with labral repair have superior functional outcome scores to those treated with labral debridement?


Rationale


Compelling data on labral repair versus debridement will allow surgeons to perform the procedure which yields better results.


Clinical comment


The labrum of the hip has multiple functions, including increasing the surface area and volume of the acetabulum,1 acts as a seal against synovial fluid flow in and out of the hip central compartment,2 and may assume a load‐sharing and stabilization role.3 Therefore, when deciding how much labrum to debride and whether to repair the labrum, one should consider the function of the intact labrum and therefore the possible consequences of a partial or complete labrectomy.


Available literature and quality of the evidence



  • Level I: 1 randomized controlled trial (RCT).
  • Level III: 2 retrospective comparative cohort studies.

Findings


Krych et al. published an RCT comparing arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement (FAI). At a mean 32 months’ follow‐up the repair group had significantly better Hip Outcome Scores (HOS) and subjective outcome scores.4 Larson et al. had similar findings in their retrospective comparative cohort study comparing labral repair versus debridement.5 The labral repair group was found to have improved Visual Analog Scale (VAS) scores and functional outcome scores at 3.5 year follow‐up.


A retrospective comparative cohort study published by Chen et al. compared outcomes between a labral debridement group using narrow indications and a matched‐pair labral repair group.6 Patients were only eligible for labral debridement in this study if they had a stable labrum with minor damage, and minimal intrasubstance abnormalities. In this study there was no significant difference in a number of functional outcome scores and patient satisfaction between the two groups.


Resolution of clinical scenario



  • Level I evidence suggests that patients treated with labral repair will in general have superior outcomes to those treated with labral debridement.
  • Level III evidence suggests that labral debridement provides comparable outcomes to labral repair in patients with a stable labrum with minor damage, and minimal intrasubstance abnormalities.

Question 2: In patients undergoing surgical treatment for an irreparable labral tear of the hip, do patients treated with labral reconstruction have superior functional outcome scores to those treated with labral debridement or a match‐controlled labral repair group?


Rationale


Identifying which surgical procedure produce superior outcomes for patients with irreparable labral tears will allow surgeons to provide the best treatment option.


Clinical comment


Arthroscopic labral repair has evolved over the years as an effective treatment for hip labral tears, with consistent results of high patient satisfaction, decreasing revision rates, and improved patient‐reported outcome (PRO) scores.5,7,8 Certain tear patterns or poor tissue quality are not always amenable to repair, in which case surgical options include labral reconstruction or labral debridement.9 Labral reconstruction is a more costly and technically demanding procedure than labral debridement. Labral reconstruction aims to restore the natural biomechanics of the labrum while decreasing pain associated with resection of damaged labral tissue.10 Determining whether labral reconstruction produces superior outcomes is important to determine its overall effectiveness in comparison to labral debridement.


Available literature and quality of the evidence

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Nov 28, 2021 | Posted by in ORTHOPEDIC | Comments Off on Labral Tears

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