Purpose: Suture anchors used for reinserting soft tissue on bony structures have been studied with the purpose of evaluating hold in bone. There has not however been any work on the influence of the eye design on suture resistance. The purpose of this work was to examine this aspect of the question.

Material and methods: The following anchors were tested: Statak 4 (Zimmer, Warsaw, IN, USA), Corkscrew 3.5, Fastak 2.4 (Arthrex, Naples, FL, USA), PeBA C 6.5 (OBL, Scottsdale, AZ, USA), Mitek GII 5Mitek, Norwood, MA, USA), Harpoon 2 (Arthrotek, Warsaw, IN? USA), Ultrafix (Linvatec, Largo, FL, USA), Vitis 3.5 AND 5 (Tornier, St Isnier, France). The following suture threads were used: Vicryl dec 5, Flexidene dec 5, PDS dec 4. Three types of tests were performed on an Instron 8500+. To study loading at thread rupture, a loop with a constant length was placed under traction in the axis of the anchor until thread rupture. Two measurement modalities were used. For the first, static tension was applied to increase the linear load at the rate of 1.25 mm/s. In the second, cyclic traction applied tension five times at a frequency of 1 Hz with 10N loading increments. To study thread weakening in relation to each anchor, we imposed a back and forth movement on the strand running through the eye using a sinusoidal 10 mm movement at a frequency of 0.03 Hz, one end of the thread being fixed and the other supporting a constant 20 N load. Each thread was tested in each anchor and each type of test was run three times.

Results: Load at rupture of each thread was not affected significantly by the design of the anchor eyes. Rupture generally occurred at the knot level, sometimes at the eye (Harpoon, Fastak, Vitis) for the Flexidene dec 5 thread. Conversely, there were important differences in the thread weakness tests: a knitted thread such as Vicryl was much stronger than the two other threads tested, irrespective of the anchor. Furthermore, resistance for the dynamic test was very variable for the different anchors: 100±20 cycles for corkscrew 3.5 and 3±1 cycles for Vitis 3.5 with Vicryl or 6+/1 cycles for Harpoon 2 with Flexidene.

Conclusion: The design and finishing of each eye had an effect on the resistance of thread moving through the eye. For anchors which weakened thread after a few back and forth movements, it can be assumed that simple knotting damages the thread to a point where early failure occurs at reinsertion. The best results were obtained when the anchor eye had a bevelled groove.

Purpose of the study: The aim of this work was to report our experience with arthroscopy for the treatment of acetabular labral lesions and identify prognostic factors determining mid- and long-term outcome.

Material and methods: Between August 1991 and December 1997, 12 patients (ten women, two men, mean age 39 years, age range 25–61 years) underwent arthroscopic treatment of an acetabular labrum lesion. All were reviewed at a mean 4 years follow-up (18 months-8 years). Half of the patients (n = 6) had a history of hip surgery: two femoral osteotomies and one acetabular bone block for congenital hip dislocation, two high-energy traumas and one traumatic dislocation. Clinical manifestations including pain (n = 12), a sensation of a snag (n = 10), or blockage (n = 8) had developed over a mean 15 months (2–24 months). Standard x-rays evidenced early signs of degenerative disease in four cases and acetabular dysplasia in four (5° < VCE < 18°), and were normal in four. Arthroscanography was performed in all cases and always evidenced a lesion of the anterior or anterosuperior part of the labrum, generally a fissuration (n = 7). The surgical procedure performed on an orthopedic table with traction on the limb lasted 45 to 75 min for regularization of the degenerated labrum in three patients, resection of the languette in six, the anse de seau in two or the labral notch in one. A short hospitalization (24 to 48 hours) was sufficient with immediate weight bearing with two canes. One patient developed sciatic paresia which regressed in 72 hours with vulvar edema due to excessive peroperative traction.

Results: Besides the labral lesion, the exploration also identified an associated chondral lesion in seven cases (acetabulum in two, femoral head in three, both in two) which had been suspected in six cases from preoperative imaging (osteoarthrosis in four, dysplasia in two) and which affected the final outcome. Four of these patients (osteoarthritis in two and dysplasia in two) worsened clinically and radiographically to the point where a total hip arthroplasty was required in three. Among the three other patients, two had residual pain (osteoarthritis in one and initial x-ray normal in one) with no radiographic deterioration and only one (osteoarthrtis) was totally relieved without any radiographic deterioration at six years follow-up. Among the five patients with no chondral lesions, three (with normal x-rays initially) were pain free at four years follow-up while the two others (dysplasia) had residual pain at two years follow-up with no sign of osteoarthrtis on the latest x-rays.

Discussion: Lesions of the acetabular labrum are uncommon but can be treated arthroscopically. Resection of the labral lesion is immediately effective but does not prevent long-term degradation of the joint if there is an associated chondral lesion.