title: Arthroscopic acetabuloplasty and labral refixation without labral detachment.
abstract: BACKGROUND
  Arthroscopic acetabuloplasty was initially described with detachment of the labrum to access the acetabular rim for resection, followed by labral refixation. Recent technical improvements have made it possible to perform acetabuloplasty and labral refixation without labral detachment when the chondrolabral junction is intact.
  
  
  OBJECTIVE
  To compare outcomes for patients undergoing arthroscopic acetabuloplasty and labral refixation without labral detachment (study group), as well as compare this with a group of patients who underwent acetabuloplasty with labral refixation and labral detachment (control group) with a minimum 2-year follow-up.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  During the study period, data were prospectively collected on all patients treated with hip arthroscopy. Inclusion criteria for the study group were acetabuloplasty and labral refixation without detachment, performed in cases with an intact chondrolabral junction. Patients were then compared with a control group of patients who had acetabuloplasty with labral detachment and refixation. All patients were assessed pre- and postoperatively using 4 patient-reported outcome (PRO) measures and a visual analog scale (VAS) for pain, as well as monitored for revision surgery.
  
  
  RESULTS
  In the study group, the preoperative to postoperative score changed from 64.2 to 86.6 for modified Harris Hip Score (mHHS), 60.5 to 83.8 for Nonarthritic Hip Score (NAHS), 65.3 to 87.3 for Hip Outcome Score-Activity of Daily Living (HOS-ADL), 45 to 75.1 for Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), and 5.7 to 2.6 for VAS. In the control group, the preoperative to postoperative score changed from 61.2 to 84.4 for mHHS, 59 to 84 for NAHS, 62.7 to 86.2 for HOS-ADL, 40.1 to 74.1 for HOS-SSS, and 6.3 to 2.8 for VAS. There was no difference between preoperative and postoperative PRO scores. The preoperative VAS score was lower in the study group than in the control group (P=.04). The control group demonstrated larger mean preoperative anterior center edge angles (ACEA) (33.8° vs 29.5°) and mean alpha angles (60.5° vs 53.5°) than the study group (P<.05). There was no statistically significant difference in the change in PRO or VAS scores between groups. Both groups demonstrated significant improvement from preoperative to 2-year follow-up for all 4 PRO scores (P<.05) and decrease in VAS (P<.05). One patient in the study group converted to total hip arthroplasty. Seven patients underwent revision hip arthroscopy in the study group, and 8 patients in the control group underwent revision hip arthroscopy. There was no difference in revision rates between groups.
  
  
  CONCLUSIONS
  Treatment of pincer- and combined-type impingement with arthroscopic acetabuloplasty and labral refixation without detachment, when possible, resulted in similar patient outcomes compared with acetabuloplasty with labral detachment. We may conclude that in cases where the chondrolabral junction remains intact, acetabuloplasty and labral refixation without detachment is a viable option.
authors.affiliation: Hinsdale Orthopaedics, American Hip Institute in Chicago, Westmont, Illinois, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Redmond
authors.affiliation: Hinsdale Orthopaedics, American Hip Institute in Chicago, Westmont, Illinois, USA.
authors.forename: Youssef F
authors.initials: YF
authors.lastname: El Bitar
authors.affiliation: Hinsdale Orthopaedics, American Hip Institute in Chicago, Westmont, Illinois, USA.
authors.forename: Asheesh
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Hinsdale Orthopaedics, American Hip Institute in Chicago, Westmont, Illinois, USA.
authors.forename: Christine E
authors.initials: CE
authors.lastname: Stake
authors.forename: S Pavan
authors.initials: SP
authors.lastname: Vemula
authors.affiliation: Hinsdale Orthopaedics, American Hip Institute in Chicago, Westmont, Illinois, USA DrDomb@americanhipinstitute.org.
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Domb
mesh_terms: D065526:Acetabuloplasty / Q000379:methods*; D000203:Activities of Daily Living; D000328:Adult; D018771:Arthralgia / Q000209:etiology; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D057925:Femoracetabular Impingement / Q000150:complications / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: acetabuloplasty; femoroacetabular impingement; hip arthroscopy; hip labrum; labral detachment; labral refixation; labral repair; labral takedown; pincer impingement