Prognostic value of chondral defects on the outcome after arthroscopic treatment of acetabular labral tears.
Pathology of the acetabular labrum plays an increasing role in the treatment of hip pain. Hip arthroscopy has proven its clinical value as a useful procedure for successful treatment of labral tears. Until today, only a few studies have investigated the influence of articular cartilage defects on the clinical outcome of partial arthroscopic labrum resection in a larger patient population. We prospectively evaluated patients with an intraoperatively proven labral lesion/tear without any radiological and arthroscopical sign of a concomitant bony femoroacetabular impingement or hip dysplasia for a minimum postoperative follow-up of 2 years. Cartilage defects were classified according to Outerbridge and divided into two subgroups: Outerbridge < or = 1 and Outerbridge > or = 2, respectively. To evaluate combined results, various established scoring systems (visual analogue scale, modified Harris Hip Score, Larson Hip Score) were used. Out of 54 originally enrolled patients, 50 individuals (29 female, 21 male) with a median age of 33 years (range 15-49) were available for follow-up after a mean of 34 (range 24-48) months. At follow-up, the total study population experienced significant improvement in pain and in the combined evaluation scales (Larson Hip Score/MHHS). When patients were categorized into two subgroups, either with intraoperatively present or absent articular cartilage defects, our data indicated that subjects with no degenerative changes of the articular cartilage surface significantly improved in the applied clinically scoring systems. In contrast, in patients with an articular cartilage lesion during hip arthroscopy score values had a tendency to be unimproved or even deteriorated at follow-up. Regression analysis revealed a significant negative correlation between postoperative outcome and the grading of the coexistent articular cartilage defect. On the basis of our investigation, we conclude that partial arthroscopic resection of a torn labrum without attending bone deformity (dysplasia or femoroacetabular impingement) can reveal good and satisfied results. Depending on the extent of a coexisting articular cartilage defect subjective clinical results are compromised.
Streich
Nikolaus A
NA
Department of Orthopedic Sports Medicine, University of Heidelberg, Schlierbacher Landstrasse 200a, Heidelberg 69118, Germany. Nikolaus.Streich@ok.uni-heidelberg.de
Gotterbarm
Tobias
T
Barié
Alexander
A
Schmitt
Holger
H
D000077:Acetabulum / Q000293:injuries* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods; D002357:Cartilage Diseases / Q000601:surgery*; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods* / Q000534:rehabilitation; D017060:Patient Satisfaction; D011446:Prospective Studies; D020127:Recovery of Function; D055815:Young Adult