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Surgical management of labral tears during femoroacetabular impingement surgery: a systematic review

  • O. R. AyeniEmail author
  • J. Adamich
  • F. Farrokhyar
  • N. Simunovic
  • S. Crouch
  • M. J. Philippon
  • M. Bhandari
Hip

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Femoroacetabular impingement Labrum Systematic review Hip Evidence 

Notes

Acknowledgments

M. Bhandari is funded in part by a Canada Research Chair.

Conflict of interest

The authors report that they have no conflict of interest in the authorship and publication of this article.

Supplementary material

167_2014_2886_MOESM1_ESM.pdf (159 kb)
Supplementary material 1 (PDF 158 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • O. R. Ayeni
    • 1
    Email author
  • J. Adamich
    • 1
  • F. Farrokhyar
    • 2
  • N. Simunovic
    • 2
  • S. Crouch
    • 2
  • M. J. Philippon
    • 3
  • M. Bhandari
    • 1
    • 2
  1. 1.Division of Orthopaedic Surgery, Department of SurgeryMcMaster UniversityHamiltonCanada
  2. 2.Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada
  3. 3.Steadman Philippon Research InstituteVailUSA

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