Save the torn labrum in hips with borderline acetabular coverage.
BACKGROUND
Hip arthroscopy for labral tears improves short-term function, but reoperations occur in 5% to 47% of patients. The effect of borderline acetabular coverage on reoperation rate has been debated. Labral repair rather than débridement has been proposed to improve function, but the effect on reoperation rate is unclear.


OBJECTIVE
We determined whether (1) borderline compared to adequate acetabular coverage increased reoperations and (2) labral repair compared to débridement reduced reoperations.


METHODS
We retrospectively reviewed 106 patients (mean age, 39 years) who underwent hip arthroscopy for labral tears. Based on radiographs, we classified patients into those with borderline (n = 50) or adequate (n = 56) acetabular coverage. We further divided each group into those with labral débridement or repair: borderline acetabular coverage, n = 25 and 25, respectively; adequate acetabular coverage, n = 39 and 17, respectively. We assessed reoperations in borderline versus adequate acetabular coverage and labral débridement versus repair, modified Harris hip scores (mHHSs), and survival. Minimum followup was 12 months (mean, 33 months; range, 12-65 months).


RESULTS
Twenty-three of 106 patients had reoperations. Reoperation rate was higher with borderline than with adequate acetabular coverage. Reoperation rate was lower with labral repair than with débridement. Survival to reoperation was similar in the four subgroups although there was a tendency for early reoperation in patients with borderline acetabular coverage with débridement. Improvement in mean mHHS was comparable in the four subgroups.


CONCLUSIONS
We found borderline acetabular coverage increased reoperation rates. Labral repair reduced the likelihood of reoperation, especially in hips with borderline acetabular coverage. Hip arthroscopy for labral tears was associated with high reoperation rates in hips with borderline acetabular coverage.


METHODS
Level IV, prognostic study. See Instructions for Authors for a complete description of levels of evidence.
Department of Orthopaedics, Virginia Commonwealth University, West Hospital, 1200 East Broad Street, Richmond, VA 23298, USA.
Niraj V
NV
Kalore
William A
WA
Jiranek
D000077:Acetabulum / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D001182:Arthroscopy / Q000009:adverse effects; D003646:Debridement / Q000009:adverse effects; D005260:Female; D006621:Hip Joint / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007592:Joint Diseases / Q000473:pathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome