Csaba Forster-Horvath1, Noah von Rotz2, Brian D Giordano3, Benjamin G Domb4. 1. Hip Unit, Orthopaedic Department, University Hospital Basel, Basel, Switzerland. Electronic address: dr_forster@icloud.com. 2. University of Basel, Basel, Switzerland. 3. Sports Medicine and Hip Preservation, University of Rochester Department of Orthopaedics, Rochester, New York, U.S.A. 4. American Hip Institute, Westmont, Illinois, U.S.A.; Hinsdale Orthopaedics, Westmont, Illinois, U.S.A.
Abstract
PURPOSE: To perform a systematic review comparing outcomes of labral debridement/segmental resection with labral reconstruction as part of a comprehensive treatment strategy for femoroacetabular impingement. METHODS: A systematic review was conducted according to established PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using defined inclusion and exclusion criteria. The study groups were divided into labral debridement/segmental resection (group 1) and labral reconstruction (group 2). Multiple search engines were queried (PubMed, Medline) for this analysis. RESULTS: After an exhaustive search of the available literature, 20 publications were included. Twelve studies explored outcomes after labral debridement/resection in a total of 400 hips, whereas 7 studies reported on outcomes after labral reconstruction in a total of 275 hips. One additional matched-pair control study compared labral resection (22 hips) with reconstruction (11 hips). The surgical intervention was a revision in 0% to 100% for group 1 versus 5% to 55% for group 2. A direct anterior approach was not performed in group 2, and cam-type impingement appeared to make up a larger percentage of group 1. The Tönnis grade ranged from 0 to 1 for group 1 versus 0.3 to 1.1 for group 2. Joint replacements were performed in 0% to 30% and 0% to 25%, respectively. The modified Harris Hip Score was the most widely used patient-reported outcome measure and suggested that labral reconstruction was not inferior to labral debridement/segmental resection. CONCLUSIONS: Clinical outcomes after labral debridement/segmental resection versus labral reconstruction were found to be comparable. In the setting of unsalvageable labral pathology, labral reconstruction was used more frequently as a revision option whereas debridement may be more commonly used in the index setting. LEVEL OF EVIDENCE: Level IV, systematic review of Level I, III, and IV studies.
PURPOSE: To perform a systematic review comparing outcomes of labral debridement/segmental resection with labral reconstruction as part of a comprehensive treatment strategy for femoroacetabular impingement. METHODS: A systematic review was conducted according to established PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using defined inclusion and exclusion criteria. The study groups were divided into labral debridement/segmental resection (group 1) and labral reconstruction (group 2). Multiple search engines were queried (PubMed, Medline) for this analysis. RESULTS: After an exhaustive search of the available literature, 20 publications were included. Twelve studies explored outcomes after labral debridement/resection in a total of 400 hips, whereas 7 studies reported on outcomes after labral reconstruction in a total of 275 hips. One additional matched-pair control study compared labral resection (22 hips) with reconstruction (11 hips). The surgical intervention was a revision in 0% to 100% for group 1 versus 5% to 55% for group 2. A direct anterior approach was not performed in group 2, and cam-type impingement appeared to make up a larger percentage of group 1. The Tönnis grade ranged from 0 to 1 for group 1 versus 0.3 to 1.1 for group 2. Joint replacements were performed in 0% to 30% and 0% to 25%, respectively. The modified Harris Hip Score was the most widely used patient-reported outcome measure and suggested that labral reconstruction was not inferior to labral debridement/segmental resection. CONCLUSIONS: Clinical outcomes after labral debridement/segmental resection versus labral reconstruction were found to be comparable. In the setting of unsalvageable labral pathology, labral reconstruction was used more frequently as a revision option whereas debridement may be more commonly used in the index setting. LEVEL OF EVIDENCE: Level IV, systematic review of Level I, III, and IV studies.
Authors: Joshua J Heerey; Joanne L Kemp; Andrea B Mosler; Denise M Jones; Tania Pizzari; Mark J Scholes; Rintje Agricola; Kay M Crossley Journal: Sports Med Date: 2019-06 Impact factor: 11.136
Authors: Darren de Sa; Jayson Lian; Andrew J Sheean; Kathleen Inman; Nicholas Drain; Olufemi Ayeni; Craig Mauro Journal: Orthop J Sports Med Date: 2018-09-21
Authors: David R Maldonado; Ajay C Lall; Rafael Walker-Santiago; Philip Rosinsky; Jacob Shapira; Jeffrey W Chen; Benjamin G Domb Journal: J Hip Preserv Surg Date: 2019-03-01