HSS Journal ®

, Volume 10, Issue 1, pp 18–24 | Cite as

Clinical and Morphologic Factors Associated with Suture Anchor Refixation of Labral Tears in the Hip

  • John A. Ruder
  • Erin Magennis
  • Anil S. Ranawat
  • Bryan T. Kelly
Original Article

Abstract

Background

The acetabular labrum is critical to hip function. Surgical options for treatment of a damaged labrum include removal, debridement, and refixation using suture anchors.

Questions/Purposes

The purpose of this study is to determine if certain patient demographic and osseous morphological factors result in increased labral damage requiring refixation.

Methods

Data was collected prospectively from a consecutive series of 334 procedures performed from August 2010 to June 2011 for femoroacetabular impingement. Demographic data, including age, sex, and race, was collected from patient charts. Three-dimensional (3D) CT scans were reviewed to retrieve alpha angles, acetabular version, femoral version, and lateral center edge angle on the symptomatic hip.

Results

In 238 (71.3%) of the procedures, the labrum required refixation using suture anchors with a mean of 2.74 anchors being used. Of males, 78.8% required suture anchors and 62.3% of females required suture anchors. Among procedures requiring suture anchors, significantly more suture anchors were used in males (2.92) than females (2.47). Regression analysis showed a positive association between alpha angle, acetabular retroversion at 1 and 2 o’clock, and the number of suture anchors used. The mean alpha angle in the cohort that required suture anchors (63.1°) was significantly greater than the cohort that did not (59.4°).

Conclusion

This study found femoral deformities to contribute more to labral damage than acetabular deformities and highlighted the importance of preoperative 3D CT scans. This study provides demographic and morphologic factors to review preoperatively to evaluate if extensive labral damage is present and if suture anchor refixation will be required.

Keywords

femoroacetabular impingement labral tears 3D CT scans labral repair hip pain 

Supplementary material

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References

  1. 1.
    Barton C, Salineros MJ, Rakhra KS, Beaule PE. Validity of the alpha angle measurement on plain radiographs in the evaluation of cam-type femoroacetabular impingement. Clinical Orthopaedics and Related Research. 2011; 469(2): 464-469.PubMedCrossRefGoogle Scholar
  2. 2.
    Beaule PE, Zaragoza E, Motamedi K, Copelan N, Dorey FJ. Three-dimensional computed tomography of the hip in the assessment of femoroacetabular impingement. Journal of Orthopaedic Research. 2005; 23(6): 1286-1292.PubMedGoogle Scholar
  3. 3.
    Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. The Journal of Bone and Joint Surgery British. 2005; 87(7): 1012-1018.CrossRefGoogle Scholar
  4. 4.
    Bedi A, Dolan M, Leunig M, Kelly BT. Static and dynamic mechanical causes of hip pain. Arthroscopy. 2010; 27(2): 235-251.PubMedCrossRefGoogle Scholar
  5. 5.
    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(10): 1135-1145.PubMedCrossRefGoogle Scholar
  6. 6.
    Clohisy JC, St John LC, Schutz AL. Surgical treatment of femoroacetabular impingement: a systematic review of the literature. Clin Orthop Relat Res. 2010; 468(2): 555-564.PubMedCrossRefGoogle Scholar
  7. 7.
    Ejnisman L, Philippon MJ, Lertwanich P. Acetabular labral tears: diagnosis, repair, and a method for labral reconstruction. Clin Sports Med. 2011; 30(2): 317-329.PubMedCrossRefGoogle Scholar
  8. 8.
    Ellis AR, Noble PC, Schroder SJ, Thompson MT, Stocks GW. The cam impinging femur has multiple morphologic abnormalities. J Arthroplasty. 2011; 26(6 Suppl): 59-65.PubMedCrossRefGoogle Scholar
  9. 9.
    Espinosa N, Beck M, Rothenfluh DA, Ganz R, Leunig M (2007) Treatment of femoro-acetabular impingement: preliminary results of labral refixation. Surgical technique. J Bone Joint Surg Am. 2007;89(Suppl 2 Pt.1):36–53.Google Scholar
  10. 10.
    Freehill MT, Safran MR. The labrum of the hip: diagnosis and rationale for surgical correction. Clin Sports Med. 2011; 30(2): 293-315.PubMedCrossRefGoogle Scholar
  11. 11.
    Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clinical Orthopaedics and Related Research. 2003; 417(417): 112-120.PubMedGoogle Scholar
  12. 12.
    Gu GS, Zhu D, Wang G, Wang CX. Roles of radiograph, magnetic resonance imaging, three-dimensional computed tomography in early diagnosis of femoro-acetabular impingement in 17 cases. Chinese Journal of Traumatology. 2009; 12(6): 375-378.PubMedGoogle Scholar
  13. 13.
    Henak CR, Ellis BJ, Harris MD, Anderson AE, Peters CL, Weiss JA. Role of the acetabular labrum in load support across the hip joint. J Biomech. 2011; 44(12): 2201-2206.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Heyworth BE, Dolan MM, Nguyen JT, Chen NC, Kelly BT. Preoperative three-dimensional CT predicts intraoperative findings in hip arthroscopy. Clinical Orthopaedics and Related Research. 2012; 470(7): 1950-1957.PubMedCrossRefGoogle Scholar
  15. 15.
    Johnson JK, Renner JB, Dahners LE. Anteroposterior thickening of the femoral neck with aging decreases the “offset” in men. The American Journal of Sports Medicine. 2012; 40(10): 2213-2217.PubMedCrossRefGoogle Scholar
  16. 16.
    Kalberer F, Sierra RJ, Madan SS, Ganz R, Leunig M. Ischial spine projection into the pelvis: a new sign for acetabular retroversion. Clinical Orthopaedics and Related Research. 2008; 466(3): 677-683.PubMedCrossRefGoogle Scholar
  17. 17.
    Kappe T, Kocak T, Bieger R, Reichel H, Fraitzl CR. Radiographic risk factors for labral lesions in femoroacetabular impingement. Clin Orthop Relat Res. 2011; 469(11): 3241-3247.PubMedCrossRefGoogle Scholar
  18. 18.
    Klingenstein GG, Zbeda RM, Bedi A, Magennis E, Kelly BT. Prevalence and preoperative demographic and radiographic predictors of bilateral femoroacetabular impingement. Am J Sports Med. 2013; 41(4): 762-768.PubMedCrossRefGoogle Scholar
  19. 19.
    Konan S, Rayan F, Haddad FS. Is the frog lateral plain radiograph a reliable predictor of the alpha angle in femoroacetabular impingement? The Journal of Bone and Joint Surgery British. 2010; 92(1): 47-50.CrossRefGoogle Scholar
  20. 20.
    Larson CM, Giveans MR. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement. Arthroscopy. 2009; 25(4): 369-376.PubMedCrossRefGoogle Scholar
  21. 21.
    Larson CM, Kelly BT, Stone RM. Making a case for anterior inferior iliac spine/subspine hip impingement: three representative case reports and proposed concept. Arthroscopy. 2011; 27(12): 1732.PubMedCrossRefGoogle Scholar
  22. 22.
    Lertwanich P, Ejnisman L, Torry MR, Giphart JE, Philippon MJ (2011) Defining a safety margin for labral suture anchor insertion using the acetabular rim angle. Am J Sports Med. 39 Suppl(39):111S-6S.Google Scholar
  23. 23.
    Leunig M, Ganz R. [FAI—concept and etiology]. Orthopade. 2009; 38(5): 394-401.PubMedCrossRefGoogle Scholar
  24. 24.
    Milone MT, Bedi A, Poultsides L, et al. Novel CT-based three-dimensional software improves the characterization of cam morphology. Clin Orthop Relat Res. 2013; 471(8): 2484-2491.PubMedCrossRefGoogle Scholar
  25. 25.
    Mintz DN, Hooper T, Connell D, Buly R, Padgett DE, Potter HG. Magnetic resonance imaging of the hip: detection of labral and chondral abnormalities using noncontrast imaging. Arthroscopy. 2005; 21(4): 385-393.PubMedCrossRefGoogle Scholar
  26. 26.
    Pfirrmann CW, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology. 2006; 240(3): 778-785.PubMedCrossRefGoogle Scholar
  27. 27.
    Philippon MJ, Arnoczky SP, Torrie A. Arthroscopic repair of the acetabular labrum: a histologic assessment of healing in an ovine model. Arthroscopy. 2007; 23(4): 376-380.PubMedCrossRefGoogle Scholar
  28. 28.
    Potter HG, Schachar J. High resolution noncontrast MRI of the hip. Journal of Magnetic Resonance Imaging. 2010; 31(2): 268-278.PubMedCrossRefGoogle Scholar
  29. 29.
    Qi LP, Li Y, Tang L, et al. Evaluation of dose reduction and image quality in chest CT using adaptive statistical iterative reconstruction with the same group of patients. Br J Radiol. 2012; 85(1018): e906-e911.PubMedCrossRefGoogle Scholar
  30. 30.
    Rakhra KS. Magnetic resonance imaging of acetabular labral tears. J Bone Joint Surg Am. 2011; 93(Suppl 2): 28-34.PubMedCrossRefGoogle Scholar
  31. 31.
    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(8): 1027-1032.PubMedCrossRefGoogle Scholar
  32. 32.
    Seldes RM, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald RH Jr. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clinical Orthopaedics and Related Research. 2001; 382(382): 232-240.PubMedCrossRefGoogle Scholar
  33. 33.
    Tannast M, Kubiak-Langer M, Langlotz F, Puls M, Murphy SB, Siebenrock KA. Noninvasive three-dimensional assessment of femoroacetabular impingement. Journal of Orthopaedic Research. 2007; 25(1): 122-131.PubMedCrossRefGoogle Scholar
  34. 34.
    Tokish JM, McBratney CM, Solomon DJ, Leclere L, Dewing CB, Provencher MT. Arthroscopic repair of circumferential lesions of the glenoid labrum: surgical technique. The Journal of Bone and Joint Surgery American Volume. 2010; 92(Suppl 1 Pt 2): 130-144.PubMedGoogle Scholar
  35. 35.
    Turker M, Kilicoglu O, Goksan B, Bilgic B. Vascularity and histology of fetal labrum and chondrolabral junction: its relevance to chondrolabral detachment tears. Knee Surg Sports Traumatol Arthrosc. 2012; 20(2): 381-386.PubMedCrossRefGoogle Scholar
  36. 36.
    Zaltz I, Kelly BT, Hetsroni I, Bedi A. The crossover sign overestimates acetabular retroversion. Clin Orthop Relat Res. 2013; 471(8): 2463-2470.PubMedCrossRefGoogle Scholar

Copyright information

© Hospital for Special Surgery 2013

Authors and Affiliations

  • John A. Ruder
    • 1
  • Erin Magennis
    • 2
  • Anil S. Ranawat
    • 2
  • Bryan T. Kelly
    • 2
  1. 1.University of Central Florida College of MedicineOrlandoUSA
  2. 2.Hospital for Special SurgeryNew YorkUSA

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