Skip to main content
Erschienen in: HSS Journal ® 3/2012

01.10.2012 | Current Topics Concerning Joint Preservation and Minimally Invasive Surgery of the Hip

Labral Resection or Preservation During FAI Treatment? A Systematic Review

verfasst von: Lisa M. Tibor, MD, Michael Leunig, MD

Erschienen in: HSS Journal ® | Ausgabe 3/2012

Einloggen, um Zugang zu erhalten

Abstract

Background

Open and arthroscopic treatment of femoroacetabular impingement and resultant labral pathology has increased significantly over the past decade. Although the functional importance of the labrum and the labral seal has been established in biomechanical studies, good clinical results have been reported for both labral debridement and labral refixation.

Questions/Purposes

The purpose of this paper is to summarize existing literature on the surgical treatment of labral pathology to provide treatment recommendations and direct future research. A systematic review was performed with the following research question in mind: Does preservation of the hip labrum improve outcomes as compared to labral debridement for the treatment of labral pathology?

Methods

The MEDLINE database was searched for level I, II, or III articles in English or German comparing labral debridement to labral refixation. Five studies were included in the analysis.

Results

Good short-term results were reported for both groups. Three out of five papers report improved outcomes after labral refixation as compared to labral debridement.

Conclusions

In short-term follow-up, labral refixation appears to have slightly better outcomes than labral debridement. Studies with prospectively defined cohorts and longer follow-up are, however, necessary to provide definitive recommendations for labral treatment.
Literatur
1.
Zurück zum Zitat 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;24:1135-1145.PubMedCrossRef 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;24:1135-1145.PubMedCrossRef
2.
Zurück zum Zitat Byrd JWT, Jones KS. Prospective analysis of hip arthroscopy wth 2-year follow-up. Arthroscopy 2000;16:578-587.PubMedCrossRef Byrd JWT, Jones KS. Prospective analysis of hip arthroscopy wth 2-year follow-up. Arthroscopy 2000;16:578-587.PubMedCrossRef
3.
Zurück zum Zitat Christensen CP, Althausen PL, Mittleman MA, Lee J, McCarthy JC. The nonarthritic hip score: Reliable and validated. Clin Orthop Rel Res 2003;406:75-83.CrossRef Christensen CP, Althausen PL, Mittleman MA, Lee J, McCarthy JC. The nonarthritic hip score: Reliable and validated. Clin Orthop Rel Res 2003;406:75-83.CrossRef
4.
Zurück zum Zitat Crawford MJ, Dy CJ, Alexander JW, Thompson M, Schroder SJ, Vega CE, Patel RV, Miller AR, McCarthy JC, Lowe WR, Noble PC. The biomechanics of the hip labrum and the stability of the hip. Clin Orthop Rel Res 2007;465-16-22. Crawford MJ, Dy CJ, Alexander JW, Thompson M, Schroder SJ, Vega CE, Patel RV, Miller AR, McCarthy JC, Lowe WR, Noble PC. The biomechanics of the hip labrum and the stability of the hip. Clin Orthop Rel Res 2007;465-16-22.
5.
Zurück zum Zitat Dolan MM, Heyworth BE, Bedi A, Duke G, Kelly BT. CT reveals a high incidence of osseous abnormalities in hips with labral tears. Clin Orthop Rel Res 2011;469:831-838.CrossRef Dolan MM, Heyworth BE, Bedi A, Duke G, Kelly BT. CT reveals a high incidence of osseous abnormalities in hips with labral tears. Clin Orthop Rel Res 2011;469:831-838.CrossRef
6.
Zurück zum Zitat Englund M, Guermazi A, Lohmander LS. The meniscus in knee osteoarthritis. Rheum Dis Clin N Am 2009;35:579-590.CrossRef Englund M, Guermazi A, Lohmander LS. The meniscus in knee osteoarthritis. Rheum Dis Clin N Am 2009;35:579-590.CrossRef
7.
Zurück zum Zitat Espinosa N, Rothenfluh DA, Beck M, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: Preliminary results of labral refixation. J Bone Joint Surg Am 2006;88:925-935.PubMedCrossRef Espinosa N, Rothenfluh DA, Beck M, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: Preliminary results of labral refixation. J Bone Joint Surg Am 2006;88:925-935.PubMedCrossRef
8.
Zurück zum Zitat Ferguson SJ, Bryant JT, Ganz R, Ito K. The acetabular labrum seal: a poroelastic finite element model. Clin Biomech 2000;15:463-468.CrossRef Ferguson SJ, Bryant JT, Ganz R, Ito K. The acetabular labrum seal: a poroelastic finite element model. Clin Biomech 2000;15:463-468.CrossRef
9.
Zurück zum Zitat Ferguson SJ, Bryant JT, Ganz R, Ito K. The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech 2000;33:953-960.PubMedCrossRef Ferguson SJ, Bryant JT, Ganz R, Ito K. The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech 2000;33:953-960.PubMedCrossRef
10.
Zurück zum Zitat Ferguson SJ, Bryant JT, Ito K. The material properties of the bovine acetabular labrum. J Orthop Res 2001;19:887-896.PubMedCrossRef Ferguson SJ, Bryant JT, Ito K. The material properties of the bovine acetabular labrum. J Orthop Res 2001;19:887-896.PubMedCrossRef
11.
Zurück zum Zitat Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech 2003;36:171-178.PubMedCrossRef Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech 2003;36:171-178.PubMedCrossRef
12.
Zurück zum Zitat Greaves LL, Gilbart MK, Yung AC, Kozlowski P, Wilson DR. Effect of acetabular labral tears, repair and resection on hip cartilage strain: A 7T MRI study. J Biomech 2010;43:858-863.PubMedCrossRef Greaves LL, Gilbart MK, Yung AC, Kozlowski P, Wilson DR. Effect of acetabular labral tears, repair and resection on hip cartilage strain: A 7T MRI study. J Biomech 2010;43:858-863.PubMedCrossRef
13.
Zurück zum Zitat Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Joint Surg Br 1991;73-B:423-429. Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Joint Surg Br 1991;73-B:423-429.
15.
Zurück zum Zitat Larson CM, Giveans MR. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement. Arthroscopy 2009;25:369-376.PubMedCrossRef Larson CM, Giveans MR. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement. Arthroscopy 2009;25:369-376.PubMedCrossRef
16.
Zurück zum Zitat Laude F, Sariali E. Treatment of FAI via a minimally invasive ventral approach with arthroscopic assistance. Technique and midterm results. [in German]. Orthopade 2009;38:419-428.PubMedCrossRef Laude F, Sariali E. Treatment of FAI via a minimally invasive ventral approach with arthroscopic assistance. Technique and midterm results. [in German]. Orthopade 2009;38:419-428.PubMedCrossRef
17.
Zurück zum Zitat Laude F, Sariali E, Nogier A. Femoroacetabular impingement treatment using arthroscopy and anterior approach. Clin Orthop Rel Res 2009;467:747-752.CrossRef Laude F, Sariali E, Nogier A. Femoroacetabular impingement treatment using arthroscopy and anterior approach. Clin Orthop Rel Res 2009;467:747-752.CrossRef
18.
Zurück zum Zitat Merle d’Aubigné R, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 1954;36-A:451-475. Merle d’Aubigné R, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 1954;36-A:451-475.
19.
Zurück zum Zitat Myers CA, Register BC, Lertwanich P, Ejnisman L, Pennington WW, Giphart JE, LaPrade RF, Philippon MJ. Role of the acetabular labrum and the iliofemoral ligament in hip stability. Am J Sports Med 2011; 39 Suppl 1:85S-91S.PubMedCrossRef Myers CA, Register BC, Lertwanich P, Ejnisman L, Pennington WW, Giphart JE, LaPrade RF, Philippon MJ. Role of the acetabular labrum and the iliofemoral ligament in hip stability. Am J Sports Med 2011; 39 Suppl 1:85S-91S.PubMedCrossRef
20.
Zurück zum Zitat Ng VY, Arora N, Best TM, Pan X, Ellis TJ. Efficacy of surgery for femoroacetabular impingement: A systematic review. Am J Sports Med 2010;38:2337-2345.PubMedCrossRef Ng VY, Arora N, Best TM, Pan X, Ellis TJ. Efficacy of surgery for femoroacetabular impingement: A systematic review. Am J Sports Med 2010;38:2337-2345.PubMedCrossRef
21.
Zurück zum Zitat Petersen W, Petersen F, Tillmann B. Structure and vascularization of the acetabular labrum with regard to the pathogenesis and healing of labral lesions. Arch Orthop Trauma Surg 2003;123:283-288.PubMedCrossRef Petersen W, Petersen F, Tillmann B. Structure and vascularization of the acetabular labrum with regard to the pathogenesis and healing of labral lesions. Arch Orthop Trauma Surg 2003;123:283-288.PubMedCrossRef
22.
Zurück zum Zitat Philippon MJ, Arnoczky SP, Torrie A. Arthroscopic repair of the acetabular labrum: A histologic assessment of healing in an ovine model. Arthroscopy 2007;23:376-380.PubMedCrossRef Philippon MJ, Arnoczky SP, Torrie A. Arthroscopic repair of the acetabular labrum: A histologic assessment of healing in an ovine model. Arthroscopy 2007;23:376-380.PubMedCrossRef
23.
Zurück zum Zitat Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction. Minimum two-year follow-up. J Bone Joint Surg Br 2009;91:16-23.PubMedCrossRef Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction. Minimum two-year follow-up. J Bone Joint Surg Br 2009;91:16-23.PubMedCrossRef
24.
Zurück zum Zitat Putz R, Schrank C. Anatomie des labrokapsulären Komplexes. Orthopäde 1998;27:675-680.PubMed Putz R, Schrank C. Anatomie des labrokapsulären Komplexes. Orthopäde 1998;27:675-680.PubMed
25.
Zurück zum Zitat Robertson WJ, Kadrmas WR, Kelly BT. Arthroscopic management of labral tears in the hip. Clin Orthop Rel Res 2006;455:88-92. Robertson WJ, Kadrmas WR, Kelly BT. Arthroscopic management of labral tears in the hip. Clin Orthop Rel Res 2006;455:88-92.
26.
Zurück zum Zitat Salata MJ, Gibbs AE, Sekiya JK. A systematic review of clinical outcomes in patients undergoing menisectomy. Am J Sports Med 2010;38:1907-1916.PubMedCrossRef Salata MJ, Gibbs AE, Sekiya JK. A systematic review of clinical outcomes in patients undergoing menisectomy. Am J Sports Med 2010;38:1907-1916.PubMedCrossRef
27.
Zurück zum Zitat 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-B:1027-1032.CrossRef 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-B:1027-1032.CrossRef
28.
Zurück zum Zitat Seldes RM, Tank V, Hunt J, Katz M, Winiarsky R, Fitzgerald RH. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Rel Res 2001;382:232-240.CrossRef Seldes RM, Tank V, Hunt J, Katz M, Winiarsky R, Fitzgerald RH. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Rel Res 2001;382:232-240.CrossRef
29.
Zurück zum Zitat Tönnis D, Heinecke A, Nienhaus R, Thiele J. [Predetermination of arthrosis, pain and limitation of movement in congenital hip dyspasia (author’s transl)]. Z Orthop Ihre Grenzgeb 1979;117:808-815.GermanPubMed Tönnis D, Heinecke A, Nienhaus R, Thiele J. [Predetermination of arthrosis, pain and limitation of movement in congenital hip dyspasia (author’s transl)]. Z Orthop Ihre Grenzgeb 1979;117:808-815.GermanPubMed
30.
Zurück zum Zitat Tönnis D, Itoh K, Heinecke A, Behrens K. [The management of congenital hip luxation with arthrographic control, an individual risk-reducing and time-saving method. I. Choice of method and risk assessment based on arthrographic findings]. Z Orthop Ihre Grenzgeb 1984;122:50-61. German.PubMedCrossRef Tönnis D, Itoh K, Heinecke A, Behrens K. [The management of congenital hip luxation with arthrographic control, an individual risk-reducing and time-saving method. I. Choice of method and risk assessment based on arthrographic findings]. Z Orthop Ihre Grenzgeb 1984;122:50-61. German.PubMedCrossRef
31.
Zurück zum Zitat Wenger DE, Kendell KR, Miner MR, Trousdale RT. Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop Rel Res 2004;426:145-150.CrossRef Wenger DE, Kendell KR, Miner MR, Trousdale RT. Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop Rel Res 2004;426:145-150.CrossRef
32.
Zurück zum Zitat Wright JB, Swiontkowski MF, Heckman JD. Introducing levels of evidence to the journal. J Bone Joint Surg Am 2003;85-A:1-3.PubMed Wright JB, Swiontkowski MF, Heckman JD. Introducing levels of evidence to the journal. J Bone Joint Surg Am 2003;85-A:1-3.PubMed
Metadaten
Titel
Labral Resection or Preservation During FAI Treatment? A Systematic Review
verfasst von
Lisa M. Tibor, MD
Michael Leunig, MD
Publikationsdatum
01.10.2012
Verlag
Springer-Verlag
Erschienen in
HSS Journal ® / Ausgabe 3/2012
Print ISSN: 1556-3316
Elektronische ISSN: 1556-3324
DOI
https://doi.org/10.1007/s11420-012-9294-8

Weitere Artikel der Ausgabe 3/2012

HSS Journal ® 3/2012 Zur Ausgabe

Current Topics Concerning Joint Preservation and Minimally Invasive Surgery of the Hip

Ceramic-Ceramic Bearing: Too Unpredictable to Use it Regularly

Current Topics Concerning Joint Preservation and Minimally Invasive Surgery of the Hip

The Accuracy of the Use of Functional Hip Motions on Localization of the Center of the Hip

Current Topics Concerning Joint Preservation and Minimally Invasive Surgery of the Hip

Neck-Preserving Femoral Stems

Current Topics Concerning Joint Preservation and Minimally Invasive Surgery of the Hip

Effect of Pelvic Osteotomy in the Skeletally Immature on Acetabular Coverage

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.