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, 3 (1), 28-34

Clinical Diagnosis and Arthroscopic Treatment of Acetabular Labral Tears

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Clinical Diagnosis and Arthroscopic Treatment of Acetabular Labral Tears

Wei-guo Wang et al. Orthop Surg.

Abstract

Objective: To investigate the clinical diagnosis and arthroscopic treatment of acetabular labral tears.

Methods: Twenty-one patients with unilateral acetabular labral tears hospitalized from November 2008 to December 2009 were included in this retrospective study. A definitive diagnosis was made preoperatively on the basis of physical examination, plain radiography and magnetic resonance arthrography (MRA). All cases were treated with arthroscopic surgeries: labral debridement (14 cases), labral debridement plus femoral osteoplasty (5 cases), and labral repair plus osteoplasty (2 cases). All patients were followed-up and the results evaluated using the visual analogue scale (VAS) and Harris hip score.

Results: A positive flexion, abduction and internal rotation (FADIR) impingement sign was found in all 21 affected hips, a positive flexion, abduction and external rotation (FABER) impingement sign in 15, and a positive McCarthy test in 9. Plain radiography showed 11 cases had cam type impingement, in 6 of whom it was combined with pincer type impingement; and 2 cases had acetabular retroversion alone. Labral tears were observed on MRA in all cases and were all confirmed by arthroscopy. All patients were followed up for an average of 11.6 months (range, 6 to 19 months). The VAS decreased from (5.3 ± 1.3) preoperatively to (1.4 ± 0.9) 6 months postoperatively. The mean Harris hip score improved from (63 ± 9) preoperatively to (84 ± 10) 6 months postoperatively. All these differences were statistically significant.

Conclusions: Acetabular labral injury is closely correlated with femoro-acetabular impingement. Impingement tests and MRA have high sensitivity and accuracy in clinical diagnosis of labral tears. Arthroscopic debridement, repair and osteoplasty for labral tears results in a good early outcome.

Figures

Figure 1
Figure 1
Measurement of the α angle on X‐ray film.
d: the critical point where the distance between the anterior border of the neck and the center of the head just exceeds the head radius; hc: center of the head; nc: midpoint of the femoral neck at its narrowest point; r: radius of the head.
Figure 2
Figure 2
AP radiograph of the right hip. A cross‐over sign indicating retroversion of the acetabulum is shown (dashed line).
Figure 3
Figure 3
(a) Axial oblique and (b) radial MRA images of the hip. Arrows show infiltration of the contrast agent into the acetabulum‐labrum junction, which indicates labral tears (Czerny IIIA).
Figure 4
Figure 4
Arthroscopic findings and treatment of labral tears. (a) Partial labral tear; (b) Full‐thickness labral tear with a totally separated flap; (c) Osteoplasty of the head‐neck junction; (d) Repaired labrum.
AC, acetabular cartilage; CI, cam type osteophyte in head‐neck junction; FH, femoral head; LT, labral tears; RL, repaired labrum.

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