ARTHROSCOPIC DEBRIDEMENT OF ACETABULAR LABRAL TEARS, INDICATIONS AND OUTCOME

Abstract

Arthroscopic labral debridement has become and accepted mode of treatment for acetabular labral tears (ALTs) and yet results in literature are few and conflicting especially with regards presence of cartilage damage and its influence on outcome.

Aim of our prospective cohort study was to look at outcome of ALTs post arthroscopic limbectomy using validated questionnaires at average of 2 years. We also looked at the sensitivity of MR arthrography in detecting ALTs and cartilage damage.

Consecutive cohort of 82 patients who were suspected of having ALTs by senior author had MR arthrography followed by hip arthroscopy. All patients filled out a WOMAC, NAHS scores before and after the operation. All patients who were followed up also filled an especially designed five-point functional questionnaire. At time of arthroscopy the presence of labral tear, its position in the acetabulum and degree of cartilage damage (based on Outerbridge classification) were recorded and correlated with Mra and patient outcome.

Seventy six patients were found to have a labral tear, with majority of these lesions in the anterior or antero-superior quadrant. 59% of patients were shown to have an associated degree of cartilage damage. Although overall all patients showed significant improvement in their functional scores, those with high grade cartilage damage had poorer results in comparison. We also found that patients with older age are at higher risk of requiring a THJR in the first 2 years following arthroscopy. MRa proved to a sensitive tool at detecting labral pathology but not so at identifying presence of cartilage damage.

Arthroscopic debridement of ALTs in patients presenting with mechanical hip symptoms provides good functional outcome, however it should be used with caution in those with high grade articular cartilage damage and older age group where there is higher likelihood of failure.