Labral Resection or Preservation During FAI Treatment? A Systematic Review
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Open and arthroscopic treatment of femoroacetabular impingement and resultant labral pathology has increased significantly over the past decade. Although the functional importance of the labrum and the labral seal has been established in biomechanical studies, good clinical results have been reported for both labral debridement and labral refixation.
The purpose of this paper is to summarize existing literature on the surgical treatment of labral pathology to provide treatment recommendations and direct future research. A systematic review was performed with the following research question in mind: Does preservation of the hip labrum improve outcomes as compared to labral debridement for the treatment of labral pathology?
The MEDLINE database was searched for level I, II, or III articles in English or German comparing labral debridement to labral refixation. Five studies were included in the analysis.
Good short-term results were reported for both groups. Three out of five papers report improved outcomes after labral refixation as compared to labral debridement.
In short-term follow-up, labral refixation appears to have slightly better outcomes than labral debridement. Studies with prospectively defined cohorts and longer follow-up are, however, necessary to provide definitive recommendations for labral treatment.
- Bedi A, Chen N, Robertson W, Kelly BT. The management of labral tears and femoroacetabular impingement of the hip in the young, active patient. Arthroscopy 2008;24:1135-1145. CrossRef
- Byrd JWT, Jones KS. Prospective analysis of hip arthroscopy wth 2-year follow-up. Arthroscopy 2000;16:578-587. CrossRef
- Christensen CP, Althausen PL, Mittleman MA, Lee J, McCarthy JC. The nonarthritic hip score: Reliable and validated. Clin Orthop Rel Res 2003;406:75-83. CrossRef
- Crawford MJ, Dy CJ, Alexander JW, Thompson M, Schroder SJ, Vega CE, Patel RV, Miller AR, McCarthy JC, Lowe WR, Noble PC. The biomechanics of the hip labrum and the stability of the hip. Clin Orthop Rel Res 2007;465-16-22.
- Dolan MM, Heyworth BE, Bedi A, Duke G, Kelly BT. CT reveals a high incidence of osseous abnormalities in hips with labral tears. Clin Orthop Rel Res 2011;469:831-838. CrossRef
- Englund M, Guermazi A, Lohmander LS. The meniscus in knee osteoarthritis. Rheum Dis Clin N Am 2009;35:579-590. CrossRef
- Espinosa N, Rothenfluh DA, Beck M, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: Preliminary results of labral refixation. J Bone Joint Surg Am 2006;88:925-935. CrossRef
- Ferguson SJ, Bryant JT, Ganz R, Ito K. The acetabular labrum seal: a poroelastic finite element model. Clin Biomech 2000;15:463-468. CrossRef
- Ferguson SJ, Bryant JT, Ganz R, Ito K. The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech 2000;33:953-960. CrossRef
- Ferguson SJ, Bryant JT, Ito K. The material properties of the bovine acetabular labrum. J Orthop Res 2001;19:887-896. CrossRef
- Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech 2003;36:171-178. CrossRef
- Greaves LL, Gilbart MK, Yung AC, Kozlowski P, Wilson DR. Effect of acetabular labral tears, repair and resection on hip cartilage strain: A 7T MRI study. J Biomech 2010;43:858-863. CrossRef
- Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Joint Surg Br 1991;73-B:423-429.
- Kolata G. Hip procedure grows popular despite doubt. The New York Times. http://www.nytimes.com/2011/11/16/health/hip-impingement-grows-popular-but-remains-unproven.html?ref=ginakolata Published November 15, 2011. Accessed December 4, 2011.
- Larson CM, Giveans MR. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement. Arthroscopy 2009;25:369-376. CrossRef
- Laude F, Sariali E. Treatment of FAI via a minimally invasive ventral approach with arthroscopic assistance. Technique and midterm results. [in German]. Orthopade 2009;38:419-428. CrossRef
- Laude F, Sariali E, Nogier A. Femoroacetabular impingement treatment using arthroscopy and anterior approach. Clin Orthop Rel Res 2009;467:747-752. CrossRef
- Merle d’Aubigné R, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 1954;36-A:451-475.
- Myers CA, Register BC, Lertwanich P, Ejnisman L, Pennington WW, Giphart JE, LaPrade RF, Philippon MJ. Role of the acetabular labrum and the iliofemoral ligament in hip stability. Am J Sports Med 2011; 39 Suppl 1:85S-91S. CrossRef
- Ng VY, Arora N, Best TM, Pan X, Ellis TJ. Efficacy of surgery for femoroacetabular impingement: A systematic review. Am J Sports Med 2010;38:2337-2345. CrossRef
- Petersen W, Petersen F, Tillmann B. Structure and vascularization of the acetabular labrum with regard to the pathogenesis and healing of labral lesions. Arch Orthop Trauma Surg 2003;123:283-288. CrossRef
- Philippon MJ, Arnoczky SP, Torrie A. Arthroscopic repair of the acetabular labrum: A histologic assessment of healing in an ovine model. Arthroscopy 2007;23:376-380. CrossRef
- Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction. Minimum two-year follow-up. J Bone Joint Surg Br 2009;91:16-23. CrossRef
- Putz R, Schrank C. Anatomie des labrokapsulären Komplexes. Orthopäde 1998;27:675-680.
- Robertson WJ, Kadrmas WR, Kelly BT. Arthroscopic management of labral tears in the hip. Clin Orthop Rel Res 2006;455:88-92.
- Salata MJ, Gibbs AE, Sekiya JK. A systematic review of clinical outcomes in patients undergoing menisectomy. Am J Sports Med 2010;38:1907-1916. CrossRef
- Schilders E, Dimitrakopoulou A, Bismil Q, Marchant P, Cooke C. Arthroscopic treatment of labral tears in femoroacetabular impingement. A comparative study of refixation and resection with a minimum two-year follow-up. J Bone Joint Surg Br 2011;93-B:1027-1032. CrossRef
- Seldes RM, Tank V, Hunt J, Katz M, Winiarsky R, Fitzgerald RH. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Rel Res 2001;382:232-240. CrossRef
- Tönnis D, Heinecke A, Nienhaus R, Thiele J. [Predetermination of arthrosis, pain and limitation of movement in congenital hip dyspasia (author’s transl)]. Z Orthop Ihre Grenzgeb 1979;117:808-815.German
- Tönnis D, Itoh K, Heinecke A, Behrens K. [The management of congenital hip luxation with arthrographic control, an individual risk-reducing and time-saving method. I. Choice of method and risk assessment based on arthrographic findings]. Z Orthop Ihre Grenzgeb 1984;122:50-61. German. CrossRef
- Wenger DE, Kendell KR, Miner MR, Trousdale RT. Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop Rel Res 2004;426:145-150. CrossRef
- Wright JB, Swiontkowski MF, Heckman JD. Introducing levels of evidence to the journal. J Bone Joint Surg Am 2003;85-A:1-3.
- Labral Resection or Preservation During FAI Treatment? A Systematic Review
HSS Journal ®
Volume 8, Issue 3 , pp 225-229
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- hip labrum
- labral repair
- labral refixation
- labral debridement
- femoroacetabular impingement
- Author Affiliations
- 1. Hospital for Special Surgery Center for Hip Preservation, 535 E. 70th St, 10021, NY, New York
- 2. Department of Orthopaedic Surgery, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland
- 3. University of Berne, Berne, Switzerland