BACKGROUND:
Recent advances in the understanding of the anatomy and function of the
acetabular labrum suggest that it is important for normal joint function. We
found no available data regarding whether labral refixation after treatment of
femoro-acetabular impingement affects the clinical and radiographic
results.
METHODS:
We retrospectively reviewed the clinical and radiographic results of
fifty-two patients (sixty hips) with femoro-acetabular impingement who
underwent arthrotomy and surgical dislocation of the hip to allow trimming of
the acetabular rim and femoral osteochondroplasty. In the first twenty-five
hips, the torn labrum was resected (Group 1); in the next thirty-five hips,
the intact portion of the labrum was reattached to the acetabular rim (Group
2). At one and two years postoperatively, the Merle d'Aubigné clinical
score and the Tönnis arthrosis classification system were used to compare
the two groups.
RESULTS:
At one year postoperatively, both groups showed a significant improvement
in their clinical scores (mainly pain reduction) compared with their
preoperative values (p = 0.0003 for Group 1 and p < 0.0001 for Group 2). At
two years postoperatively, 28% of the hips in Group 1 (labral resection) had
an excellent result, 48% had a good result, 20% had a moderate result, and 4%
had a poor result. In contrast, in Group 2 (labral reattachment), 80% of the
hips had an excellent result, 14% had a good result, and 6% had a moderate
result. Comparison of the clinical scores between the two groups revealed
significantly better outcomes for Group 2 at one year (p = 0.0001) and at two
years (p = 0.01). Radiographic signs of osteoarthritis were significantly more
prevalent in Group 1 than in Group 2 at one year (p = 0.02) and at two years
(p = 0.009).
CONCLUSIONS:
Patients treated with labral refixation recovered earlier and had superior
clinical and radiographic results when compared with patients who had
undergone resection of a torn labrum. Although the results must be considered
preliminary, we now recommend refixation of the intact portion of the labrum
after trimming of the acetabular rim during surgical treatment of
femoro-acetabular impingement.