The management of labral tears and femoroacetabular impingement of the hip in the young, active patient.
OBJECTIVE
The purpose of this systematic review was to determine (1) the quality of the literature assessing outcomes after surgical treatment of labral tears and femoroacetabular impingement (FAI), (2) patient satisfaction after open or arthroscopic intervention, and (3) differences in outcome with open or arthroscopic approaches.


METHODS
Computerized literature databases were searched to identify relevant articles from January 1980 to May 2008. Studies were eligible for inclusion if they had a level I, II, III, or IV study design and if the patient population had a labral tear and/or FAI as the major diagnosis. Patients with severe pre-existing osteoarthritis or acetabular dysplasia were excluded.


RESULTS
Of the 19 articles with reported outcomes after surgery, none used a prospective study design and only 1 met the criteria for level III basis of evidence. Open surgical dislocation with labral debridement and osteoplasty is successful, with a good correlation between patient satisfaction and favorable outcome scores. The studies reviewed support that 65% to 85% of patients will be satisfied with their outcome at a mean of 40 months after surgery. A common finding in all series, however, was an increased incidence of failure among patients with substantial pre-existing osteoarthritis. Arthroscopic treatment of labral tears is also effective, with 67% to 100% of patients being satisfied with their outcomes.


CONCLUSIONS
The quality of literature reporting outcomes of surgical intervention for labral tears and FAI is limited. Although open surgical dislocation with osteoplasty is the historical gold standard, the scientific data do not show that open techniques have outcomes superior to arthroscopic techniques.


METHODS
Level IV, systematic review.
Bedi
Asheesh
A
Sports Medicine & Shoulder Surgery Service, Hospital for Special Surgery, New York, New York 10021, USA.
Chen
Neal
N
Robertson
William
W
Kelly
Bryan T
BT
D001182:Arthroscopy / Q000009:adverse effects / Q000379:methods; D005270:Femur Head / Q000000981:diagnostic imaging / Q000601:surgery; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000601:surgery; D025981:Hip Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D006874:Hydrostatic Pressure; D004204:Joint Dislocations / Q000601:surgery; D011859:Radiography; D016896:Treatment Outcome