Does Labral Takedown Affect Results of Arthroscopic Acetabuloplasty and Labral Repair?
Abstract
Objectives: Arthroscopic treatment of patients with pincer-type and combined-type femoroacetabular impingement (FAI) frequently involves acetabuloplasty with labral detachment (takedown) and repair. Minimal data exists on the best method for managing the labrum during acetabuloplasty. The purpose of this study is to report outcomes for patients undergoing arthroscopic acetabuloplasty and labral repair without labral takedown and to compare this to a similar group of patients who underwent acetabuloplasty with labral takedown and refixation with a minimum two-year follow-up.
Methods: During the study period, between February 2008 and February 2011, data was collected on all patients treated with hip arthroscopy. Inclusion criteria for the study group were acetabuloplasty and labral repair without takedown, performed in cases with an intact chondro-labral junction. Exclusion criteria were patients with revisions or previous hip conditions. Patients without takedown were group matched to patients who had takedown. All patients were assessed pre- and postoperatively using four patient-reported outcome (PRO) measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score - Activity of Daily Living (HOS-ADL) and Sport-Specific Subscales (HOS-SSS). Pain was assessed with the visual analog scale (VAS).
Results: During the study period, 670 patients had arthroscopic surgery with labral treatment, of which 539 (80%) were available for follow-up. Out of these patients, 272 of these patients met the study inclusion criteria and 190 (70%) were available for two-year follow-up, 85 were in the labral repair without takedown group and 105 were in the takedown group. The mean age was 32.7 years in the group without takedown and 33.0 years in the patients with takedown, with no difference between groups (p=.853). For the without takedown group, 60 (71%) were females and 25 (29%) were males; for patients with takedown, 60 (57%) were females and 45 (43%) were male. For the without takedown group, the score improvement from pre-operative to two-year follow-up was 64.2 to 86.6 for mHHS, 60.5 to 83.8 for NAHS, 65.3 to 87.3 for HOS-ADL, and 45.0 to 75.1 for HOS-SSS. For the group undergoing takedown, the score improvement from pre-operative to two-year follow-up was 61.2 to 84.4 for mHHS, 59.0 to 84.0 for NAHS, 62.7 to 86.2 for HOS-ADL, and 40.1 to 74.1 for HOS-SSS. Both groups demonstrated statistically significant postoperative improvement in all scores (p<0.05). Pain scores significantly decreased from 5.7 to 2.6 in the group without takedown, and 6.3 to 2.6 for the takedown group (p<0.05). No differences in score improvement were found between the two groups.
Conclusions: Treatment of pincer- and combined-type impingement with arthroscopic acetabuloplasty and labral repair without takedown resulted in improved clinical outcomes and pain scores two years from surgery. Outcomes were equivalent to a matched control group of patients undergoing labral refixation with takedown.