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Clinical Orthopaedics and Related Research®

Erschienen in:

01.12.2012 | Symposium: ABJS Carl T. Brighton Workshop on Hip Preservation Surgery

The Biomechanical Case for Labral Débridement

verfasst von: Ira Zaltz, MD

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 12/2012

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Abstract

Background

Labral repair is increasingly performed in conjunction with open and arthroscopic surgical procedures used to treat patients with mechanically related hip pain. The current rationale for labral repair is based on restoring the suction-seal function and clinical reports suggesting improved clinical outcome scores when acetabular rim trimming is accompanied by labral repair. However, it is unclear whether available scientific evidence supports routine labral repair.

Questions/Purposes

The questions raised in this review were: (1) does labral repair restore normal histologic structure, tissue permeability, hip hydrodynamics, load transfer, and in vivo kinematics; and (2) does labral repair favorably alter the natural course of femoroacetabular impingement (FAI) treatment or age-related degeneration of the acetabular labrum?

Methods

An electronic literature search for the keywords acetabular labrum was performed. Three hundred fifty-five abstracts were reviewed and 52 selected for full-text review that described information concerning pertinent aspects of labral formation, development, degeneration, biomechanics, and clinical results of labral repair or resection.

Results

Several clinical studies support labral repair when performed in conjunction with acetabular rim trimming. Little data support or refute the use of routine labral repair for all patients with symptomatic labral damage associated with FAI. It is not known whether or how labral repair affects the natural course of FAI.

Conclusions

Based on the current understanding of labral degenerative changes associated with mechanical hip abnormalities, the low biologic likelihood of restoring normal tissue characteristics, and mechanical data suggesting minimal consequence from small labral resections, routine labral repair over labral débridement is not supported.

Aydingöz U, Oztürk MH. MR imaging of the acetabular labrum: a comparative study of both hips in 180 asymptomatic volunteers. Eur Radiol. 2001;11:567–574.PubMedCrossRef

Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87:1012.PubMedCrossRef

Byrd JW, Jones KS. Hip arthroscopy for labral pathology: prospective analysis with 10-year follow-up. Arthroscopy. 2009;25:365–368.PubMedCrossRef

Cashin M, Uhthoff H, O’Neill M, Beaulé PE. Embryology of the acetabular labral-chondral complex. J Bone Joint Surg Br. 2008;90:1019–1024.PubMedCrossRef

Charbonnier C, Kolo FC, Duthon VB, Magnenat-Thalmann N, Becker CD, Hoffmeyer P, Menetrey J. Assessment of congruence and impingement of the hip joint in professional ballet dancers: a motion capture study. Am J Sports Med. 2011;39:557–566.PubMedCrossRef

Chegini S, Beck M, Ferguson SJ. The effects of impingement and dysplasia on stress distributions in the hip joint during sitting and walking: a finite element analysis. J Orthop Res. 2009;27:195–201.PubMedCrossRef

Clohisy JC, Dobson MA, Robison JF, Warth LC, Zheng J, Liu SS, Yehyawi TM, Callaghan JJ. Radiographic structural abnormalities associated with premature, natural hip-joint failure. J Bone Joint Surg Am. 2011;93(Suppl):23–29.CrossRef

Cotten A, Boutry N, Demondion X, Paret C, Dewatre F, Liesse A, Chastanet P, Fontaine C. Acetabular labrum: MRI in asymptomatic volunteers. J Comput Assist Tomogr. 1998;22:1–7.PubMedCrossRef

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 Relat Res. 2007:465;16–22.PubMed

10.

Daniel M, Iglic A, Kralj-Iglic V. Hip contact stress during normal and staircase walking: the influence of acetabular anteversion angle and lateral coverage of the acetabulum. J Appl Biomech. 2008;24:88–93.PubMed

11.

Dy CJ, Thompson MT, Crawford MJ, Alexander JW, McCarthy JC, Noble PC. Tensile strain in the anterior part of the acetabular labrum during provocative maneuvering of the normal hip. J Bone Joint Surg Am. 2008;90:1464–1472.PubMedCrossRef

12.

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

13.

Farjo LA, Glick JM, Sampson TG. Hip arthroscopy for acetabular labral tears. Arthroscopy. 1999;15:132–137.PubMedCrossRef

14.

Fergusion SJ, Bryant JT, Ganz R, Ito K. The acetabular labrum seal: a poroelastic finite element model. Clin Biomech. 2000;15:463–464.CrossRef

15.

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

16.

Ferguson SJ, Bryant JT, Ito K. The material properties of the bovine acetabular labrum. J Orthop Res. 2001;19:887–896.PubMedCrossRef

17.

Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res. 2008;466:264–272.PubMedCrossRef

18.

Greaves LL, Gilbart MK, Yung AC, Kozlowski P, Wilson DR. Effect of acetabular labral tears, repair and resection on hip cartilage strain: a 7T MR study. J Biomech. 2010;43:858–863.PubMedCrossRef

19.

Guevara CJ, Pietrobon R, Carothers JT, Olson SA, Vail TP. Comprehensive morphologic evaluation of the hip in patients with symptomatic labral tear. Clin Orthop Relat Res. 2006;453:277–285.PubMedCrossRef

20.

Haviv B, O’Donnell J. Arthroscopic treatment for acetabular labral tears of the hip without bony dysmorphism. Am J Sports Med. 2011;39(Suppl):79S–84S.PubMedCrossRef

21.

Henak CR, Ellis BJ, Harris MD, Anderson AE, Peters CL, Weiss JA. Role of the acetabular labrum in load support across the hip joint. J Biomech. 2011;44:2201–2206.PubMedCrossRef

22.

Hlavácek M. The influence of the acetabular labrum seal, intact articular superficial zone and synovial fluid thixotropy on squeeze-film lubrication of a spherical synovial joint. J Biomech. 2002:35;1325–1335.PubMedCrossRef

23.

Horii M, Kubo T, Hachiya Y, Nishimura T, Hirasawa Y. Development of the acetabulum and the acetabular labrum in the normal child: analysis with radial-sequence magnetic resonance imaging. J Pediatr Orthop. 2002;22:222–227.PubMedCrossRef

24.

Ishiko T, Naito M, Moriyama S. Tensile properties of the human acetabular labrum—the first report. J Orthop Res. 2005;23:1448–1453.PubMed

25.

Ito K, Leunig M, Ganz R. Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res. 2004;429:262–271.PubMedCrossRef

26.

Jacobsen S, Rømer L, Søballe K. Degeneration in dysplastic hips. A computer tomography study. Skeletal Radiol. 2005;34:778–784.PubMedCrossRef

27.

James S, Miocevic M, Malara F, Pike J, Young D, Connell D. MR imaging findings of acetabular dysplasia in adults. Skeletal Radiol. 2006;35:378–384.PubMedCrossRef

28.

Kain MS, Novais EN, Vallim C, Millis MB, Kim YJ. Periacetabular osteotomy after failed hip arthroscopy for labral tears in patients with acetabular dysplasia. J Bone Joint Surg Am. 2011;93(Suppl):257–261.CrossRef

29.

Kelly BT, Shapiro GS, Digiovanni CW, Buly RL, Potter HG, Hannafin JA. Vascularity of the hip labrum: a cadaveric investigation. Arthroscopy. 2005;21:3–11.PubMedCrossRef

30.

Kim YT, Azuma H. The nerve endings of the acetabular labrum. Clin Orthop Relat Res. 1995;320:176–181.PubMed

31.

Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome. J Bone Joint Surg Br. 1991;73:423–429.PubMed

32.

Konrath GA, Hamel AJ, Olson SA, Bay B, Sharkey NA. The role of the acetabular labrum and the transverse acetabular ligament in load transmission in the hip. J Bone Joint Surg Am. 1998;80:1781–1788.PubMed

33.

Larson CM, Giveans MR. Arthroscopic débridement versus refixation of the acetabular labrum associated with femoroacetabular impingement. Arthroscopy. 2009;25:369–376.PubMedCrossRef

34.

Larson CM, Giveans MR, Stone RM. Arthroscopic débridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: mean 3.5 year follow-up. Am J Sports Med. 2012;40:1015–1021.PubMedCrossRef

35.

Lecouvet FE, Van de Berg BC, Malghem J, Lebon CJ, Moysan P, Jamart J, Maldague BE. MR imaging of the acetabular labrum: variations in 200 asymptomatic hips. AJR Am J Roentgenol. 1996;167:1025.PubMed

36.

Leunig M, Beck M, Woo A, Dora C, Kerboull M, Ganz R. Acetabular rim degeneration: a constant finding in the aged hip. Clin Orthop Relat Res. 2003;413:201–207.PubMedCrossRef

37.

Leunig M, Podeszwa D, Beck M, Werlen S, Ganz R. Magnetic resonance arthrography of labral disorders in hips with dysplasia and impingement. Clin Orthop Relat Res. 2004;418:74–80.PubMedCrossRef

38.

Masłoń A, Grzegorzewski A, Lebiedziński R, Topol M. Vascularity of the hip labrum during the foetal period. Ann Anat. 2011;193:37–42.PubMedCrossRef

39.

Parvizi J, Bican O, Bender B, Mortazavi SM, Purtill JJ, Erickson J, Peters C. Arthroscopy for labral tears in patients with developmental dysplasia of the hip: a cautionary note. J Arthroplasty. 2009;24(Suppl):110–113.PubMedCrossRef

40.

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

41.

Ponseti IV. Morphology of the acetabulum in congenital dislocation of the hip. Gross, histological and roentgenographic studies. J Bone Joint Surg Am. 1978;60:586.PubMed

42.

Safran MR, Giordano G, Lindsey DP, Gold GE, Rosenberg J, Zaffagnini S, Giori NJ. Strains across the acetabular labrum during hip motion. Am J Sports Med. 2011;39(Suppl):92S–102S.PubMedCrossRef

43.

Santori N, Villar RN. Acetabular labral tears: result of arthroscopic partial limbectomy. Arthroscopy. 2000;16:11–15.PubMedCrossRef

44.

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;93:1027–1032.PubMedCrossRef

45.

Seldes RM, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald RH. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res. 2001;382:232–240.PubMedCrossRef

46.

Smith CD, Masouros S, Hill AM, Amis AA, Bull AM. A biomechanical basis for tears of the human acetabular labrum. Br J Sports Med. 2009;43:574–578.PubMedCrossRef

47.

Smith MV, Panchal HB, Thiele RA, Sekiya JK. Effect of acetabular labrum tears on hip stability and labral strain in a joint compression model. Am J Sports Med. 2011;39(Suppl):103S–110S.PubMedCrossRef

48.

Song Y, Ito H, Kourtis L, Safran MR, Carter DR, Giori NJ. Articular cartilage friction increases in hip joints after the removal of acetabular labrum. J Biomech. 2012:45;524–530.PubMedCrossRef

49.

Strayer LM Jr. The embryology of the human hip joint. Yale J Biol Med. 1943;16:13.PubMed

50.

Türker M, Kılıçoğlu O, Göksan B, Bilgiç B. Vascularity and histology of fetal labrum and chondrolabral junction: its relevance to chondrolabral detachment tears. Knee Surg Sports Traumatol Arthrosc. 2011;19:296–302.PubMedCrossRef

51.

Walker JM, Goldsmith CH. Morphometric study of the fetal development of the human hip joint: significance for congenital hip disease. Yale J Biol Med. 1981;54:411–437.PubMed

52.

Wenger DE, Kendell KR, Miner MR, Trousdale RT. Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop Relat Res. 2004;426:145.PubMedCrossRef

Titel: The Biomechanical Case for Labral Débridement
verfasst von: Ira Zaltz, MD
Publikationsdatum: 01.12.2012
Verlag: Springer-Verlag
Erschienen in: Clinical Orthopaedics and Related Research® / Ausgabe 12/2012
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-012-2446-9

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