The Biomechanical Case for Labral Débridement.
ABSTRACT BACKGROUND: Labral repair is increasingly performed in conjunction with open and arthroscopic surgical procedures used to treat patients with mechanically related hip pain. The current rationale for labral repair is based on restoring the suction-seal function and clinical reports suggesting improved clinical outcome scores when acetabular rim trimming is accompanied by labral repair. However, it is unclear whether available scientific evidence supports routine labral repair. QUESTIONS/PURPOSES: The questions raised in this review were: (1) does labral repair restore normal histologic structure, tissue permeability, hip hydrodynamics, load transfer, and in vivo kinematics; and (2) does labral repair favorably alter the natural course of femoroacetabular impingement (FAI) treatment or age-related degeneration of the acetabular labrum? METHODS: An electronic literature search for the keywords acetabular labrum was performed. Three hundred fifty-five abstracts were reviewed and 52 selected for full-text review that described information concerning pertinent aspects of labral formation, development, degeneration, biomechanics, and clinical results of labral repair or resection. RESULTS: Several clinical studies support labral repair when performed in conjunction with acetabular rim trimming. Little data support or refute the use of routine labral repair for all patients with symptomatic labral damage associated with FAI. It is not known whether or how labral repair affects the natural course of FAI. CONCLUSIONS: Based on the current understanding of labral degenerative changes associated with mechanical hip abnormalities, the low biologic likelihood of restoring normal tissue characteristics, and mechanical data suggesting minimal consequence from small labral resections, routine labral repair over labral débridement is not supported.
- The Journal of Bone and Joint Surgery 01/2014; 96(2):e16. · 4.31 Impact Factor
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ABSTRACT: Treatment options for a symptomatic, torn, irreparable, or completely ossified acetabular labrum are limited to either excision and/or reconstruction with grafts. In a previous animal model, regeneration of the acetabular labrum after excision to the bony rim has been shown. In humans, less is known about the potential of regeneration of the labrum. Recent studies seem to confirm labral regrowth, but it is still unclear if wide excision might be a surgical option in cases where repair is not possible.Clinical Orthopaedics and Related Research 11/2014; · 2.88 Impact Factor
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ABSTRACT: This systematic review explored reported outcomes addressing femoroacetabular impingement (FAI), specifically those comparing labral debridement to labral repair. In addition, the quality of the evidence was evaluated for the purposes of making treatment recommendations. Three databases (MEDLINE, EMBASE, and PubMed) were searched for comparative studies involving labral repair and debridement during FAI surgery. Two reviewers conducted a title, abstract, and full-text review of eligible studies and the references of these studies. Inclusion and exclusion criteria were applied to the searched studies, data were extracted, and a quality assessment was completed for included studies. Six eligible studies involving 490 patients were identified. The most commonly reported outcome measure was the modified Harris hip score (MHHS) (50 %). All studies reported that labral repair had greater postoperative improvements in functional scores (modified Harris hip, non-arthritic hip, hip outcome, and Merle d'Aubigne scores) compared to labral debridement. Five studies reported statistically significant improvements with labral repair. MHHS were pooled to demonstrate a clinically important difference in favor of labral repair by 7.4 points in three studies. The mean individual study quality can be considered fair. However, the overall quality of the body of evidence in this review is rated as low according to GRADE guidelines. This review demonstrates a reporting of better clinical outcomes with labral repair compared to labral debridement in all studies with five of six studies reporting statistically significant improvements (of repair over debridement). However, given the lack of high quality evidence and associated limitations in study design, these results should be interpreted with caution. Consequently, definitive treatment recommendations require further investigation with well-conducted clinical trials. This systematic review enables the discussion of best evidence practice for the surgical managing of a labral tear associated with FAI. LEVEL OF EVIDENCE: III.Knee Surgery Sports Traumatology Arthroscopy 02/2014; · 2.68 Impact Factor