Sage Journals: Discover world-class research

Abstract

Background:

There is high interest but very little evidence to support labral reconstruction of the hip.

Purpose/Hypothesis:

The purpose of this study was to determine the clinical effectiveness of arthroscopic hip labral reconstruction using gracilis autograft in the multistep surgeries for femoroacetabular impingement (FAI). The hypothesis was that patients undergoing arthroscopic hip labral reconstruction with gracilis autograft would have improvement in symptoms and function attributable to this procedure.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A comparative retrospective review at a large medical facility was performed of patients who underwent labral reconstruction with a gracilis autograft (RECON group) and those who underwent labral refixation (REFIX group) between October 2008 and November 2009. Inclusion criteria were adult patients having undergone arthroscopic surgery for symptomatic cam-pincer FAI without advanced radiographic osteoarthritis, who had both acetabular and femoral osteoplasties with a minimum 2-year follow-up. Patient satisfaction and preoperative and postoperative nonarthritic hip scores (NAHS) were obtained. Predictive modeling, linear regression, and a nested case-control study were performed.

Results:

A total of 54 patients met the inclusion criteria. The RECON group (n = 8; mean age, 34.6 years; range, 18-58 years) with an average 30-month follow-up (range, 24-37 months) and 100% participation reported a high level of patient satisfaction (7 high, 1 moderate). The mean NAHS improved by 50.5 points (P = .008) in the RECON group and 22.5 points (P < .0001) in the REFIX group; however, the preoperative NAHS was lower (P < .05) in the RECON group than in the REFIX group. Only the surgery group (RECON vs REFIX) and the preoperative NAHS were significantly associated with the NAHS at follow-up. The predictive model and linear regression revealed a 15.0- and 14.6-point increase, respectively, in the postoperative NAHS in the RECON group compared with the REFIX group. There were no major complications, revision surgeries, or conversion arthroplasties after labral reconstruction.

Conclusion:

Arthroscopic hip labral reconstruction with gracilis tendon autograft is a safe and effective procedure. Patients undergoing labral reconstruction may not necessarily have outcomes inferior to those of patients undergoing labral refixation despite more severe initial labral insufficiency.

Keywords

hip arthroscopic surgery femoroacetabular impingement labral reconstruction labral grafting labral tear gracilis

Get full access to this article

View all access options for this article.

References

Benali

Katthagen

. Hip subluxation as a complication of arthroscopic debridement. Arthroscopy. 2009;25(4):405-407.

Byrd

Jones

. Hip arthroscopy for labral pathology: prospective analysis with 10-year follow-up. Arthroscopy. 2009;25(4):365-368.

Christensen

Althausen

Mittleman

Lee

McCarthy

. The nonarthritic hip score: reliable and validated. Clin Orthop Relat Res. 2003;406:75-83.

Clohisy

St John

Schutz

. Surgical treatment of femoroacetabular impingement: a systematic review of the literature. Clin Orthop Relat Res. 2010;468(2):555-564.

Crawford

Alexander

. The 2007 Frank Stinchfield Award. The biomechanics of the hip labrum and the stability of the hip. Clin Orthop Relat Res. 2007;465:16-22.

Espinosa

Rothenfluh

Beck

Ganz

Leunig

. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am. 2006;88(5):925-935.

Ferguson

Bryant

Ganz

Ito

. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;36(2):171-178.

Gerhardt

Johnson

Atkinson

. Characterisation and classification of the neural anatomy in the human hip joint. Hip Int. 2012;22(1):75-81.

Haemer

Carter

Giori

. The low permeability of healthy meniscus and labrum limit articular cartilage consolidation and maintain fluid load support in the knee and hip [published online March 3, 2012]. J Biomech. doi:10.1016/j.jbiomech.2012.02.015.

10.

Larson

Giveans

. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement. Arthroscopy. 2009;25(4):369-376.

11.

Larson

Giveans

Stone

. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: mean 3.5-year follow-up. Am J Sports Med. 2012;40(5):1015-1021.

12.

Larson

Giveans

Taylor

. Does arthroscopic FAI correction improve function with radiographic arthritis? Clin Orthop Relat Res. 2011;469(6):1667-1676.

13.

Matsuda

. Acute iatrogenic dislocation following hip impingement arthroscopic surgery. Arthroscopy. 2009;25(4):400-404.

14.

Matsuda

. Arthroscopic hip labral reconstruction: graft choices, techniques, and advances. Techniques in Orthopedics. 2012;27(3):184-192.

15.

Matsuda

. Arthroscopic labral reconstruction with gracilis autograft. Arthroscopy Techniques. 2012;1(4):e15-e21.

16.

Matsuda

. Protrusio acetabuli: contraindication or indication for hip arthroscopy? And the case for arthroscopic management of global pincer impingement. Arthroscopy. 2012;28(6):882-888.

17.

Matsuda

Carlisle

Arthurs

Wierks

Philippon

. Comparative systematic review of the open dislocation, mini-open, and arthroscopic surgeries for femoroacetabular impingement. Arthroscopy. 2011;27(2):252-269.

18.

McCarthy

Jarrett

Ojeifo

Lee

Bragdon

. What factors influence long-term survivorship after hip arthroscopy? Clin Orthop Relat Res. 2011;469(2):362-371.

19.

Philippon

Briggs

Hay

Kuppersmith

Dewing

Huang

. Arthroscopic labral reconstruction in the hip using iliotibial band autograft: technique and early outcomes. Arthroscopy. 2010;26(6):750-756.

20.

Philippon

Briggs

Yen

Kuppersmith

. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br. 2009;91(1):16-23

21.

Sierra

Trousdale

. Labral reconstruction using the ligamentum teres capitis: report of a new technique. Clin Orthop Relat Res. 2009;467(3):753-759.

22.

Song

Ito

Kourtis

Safran

Carter

Giori

. Articular cartilage friction increases in hip joints after the removal of acetabular labrum. J Biomech. 2012;45(3):524-530.

23.

Walker

Pagnotto

Trousdale

Sierra

. Preliminary pain and function after labral reconstruction during femoroacetabular impingement surgery [published online August 4, 2012]. Clin Orthop Rel Res. doi:10.1007/s11999-012-2506-1.

24.

Wenger

Kendall

Miner

Trousdale

. Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop Relat Res. 2004;426:145-150.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

Arthroscopic Hip Labral Reconstruction With a Gracilis Autograft Versus Labral Refixation

Abstract

Background:

Purpose/Hypothesis:

Study Design:

Methods:

Results:

Conclusion:

Keywords

Get full access to this article

References

Supplementary Material