The Journal of Bone and Joint Surgery (American). 2006;88:925-935.
doi:10.2106/JBJS.E.00290
© 2006 The Journal of Bone and Joint Surgery, Inc.
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Treatment of Femoro-Acetabular Impingement: Preliminary Results of Labral Refixation

Norman Espinosa, MD1, Dominique A. Rothenfluh, MD2, Martin Beck, MD2, Reinhold Ganz, MD1 and Michael Leunig, MD3

1 Department of Orthopaedics, University of Zürich, Balgrist, Forchstrasse 340, CH-8008, Zürich, Switzerland. E-mail address for N. Espinosa: norman.espinosa{at}balgrist.ch
2 Department of Orthopaedic Surgery, University of Berne, Inselspital, CH-3010, Berne, Switzerland
3 Department of Orthopaedics, Schulthess Clinic, Lengghalde 2, CH-8008, Zürich, Switzerland. E-mail address: michael.leunig{at}kws.ch

Investigation performed at Department of Orthopaedic Surgery, University of Berne, Inselspital, Berne, Switzerland

A video supplement to this article will be available from the Video Journal of Orthopaedics. A video clip will be available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

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.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.


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Letters to the Editor:

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Treatment of Femoro-Acetabular Impingement
Mr Jibanananda Satpathy, MS, MRCS
JBJS Online, 25 May 2006 [Full text]
Dr. Espinosa et al, reply to Mr. Satpathy
Norman Espinosa, MD, et al.
JBJS Online, 7 Jun 2006 [Full text]