The Clinical Outcome of Chondrolabral-preserving Arthroscopic Acetabuloplasty for Pincer- or Mixed-type femoroacetabular Impingement: A Systematic Review

Overview

Journal Musculoskelet Surg

Date 2019 Mar 10

PMID 30850935

Authors

M-A Malahias

M M Alexiades

Affiliations

Soon will be listed here.

Abstract

While preservation and repair of the acetabular labrum are increasingly being recognized as important goals in hip arthroscopy, controversies still exist regarding the clinical outcome of arthroscopic acetabuloplasty with chondrolabral preservation. A systematic review was conducted and implemented by two independent reviewers, who used the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews for their search. These databases were queried with the terms "arthroscopic acetabuloplasty" and "chondrolabral preservation" and "arthroscopic acetabular recession." From the 55 initial studies the reviewers finally chose and assessed five clinical studies which were eligible to their inclusion-exclusion criteria. The reviewed studies included in total 444 patients, mainly young, between 30 and 40 years old. The follow-up evaluation varied between 24 and 41 months, while all studies utilized at least a 24-month final end-point assessment. All five studies illustrated improved outcome with the use of chondrolabral preservation acetabuloplasty without labral detachment. The rate of complications was very low. The different techniques of arthroscopic acetabuloplasty combined with chondrolabral preservation illustrated encouraging results in patients suffering from pincer-type or mixed-type FAI. However, the available clinical evidence was limited and insufficient to establish any superiority of these techniques over the traditional labral detachment and sequential reattachment. In relation to the optimal treatment of FAI without isolated CAM, further research of higher quality is recommended to be conducted in order to lead to definitive conclusions.

References

Nwachukwu B, McCormick F, Martin S . Arthroscopic technique for chondrolabral capsular preservation during labral repair and acetabular osteoplasty. Arthrosc Tech. 2013; 2(3):e213-6. PMC: 3834728. DOI: 10.1016/j.eats.2013.02.010. View

Larson C, Guanche C, Kelly B, Clohisy J, Ranawat A . Advanced techniques in hip arthroscopy. Instr Course Lect. 2009; 58:423-36. View

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339:b2700. PMC: 2714672. DOI: 10.1136/bmj.b2700. View

Espinosa N, Beck M, Rothenfluh D, Ganz R, Leunig M . Treatment of femoro-acetabular impingement: preliminary results of labral refixation. Surgical technique. J Bone Joint Surg Am. 2007; 89 Suppl 2 Pt.1:36-53. DOI: 10.2106/JBJS.F.01123. View

M Ilizaliturri Jr V, Joachin P, Acuna M . Description and mid-term results of the 'over the top' technique for the treatment of the pincer deformity in femoroacetabular impingement. J Hip Preserv Surg. 2016; 2(4):369-73. PMC: 4732377. DOI: 10.1093/jhps/hnv058. View

Cross M, Fabricant P, Maak T, Kelly B . Impingement (acetabular side). Clin Sports Med. 2011; 30(2):379-90. DOI: 10.1016/j.csm.2011.01.002. View

Crawford E, Welton K, Kweon C, Kelly B, Larson C, Bedi A . Arthroscopic Treatment of Pincer-Type Impingement of the Hip. JBJS Rev. 2016; 3(8). DOI: 10.2106/JBJS.RVW.N.00096. View

Krych A, Thompson M, Knutson Z, Scoon J, Coleman S . Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: a prospective randomized study. Arthroscopy. 2013; 29(1):46-53. DOI: 10.1016/j.arthro.2012.07.011. View

Kalhor M, Horowitz K, Beck M, Nazparvar B, Ganz R . Vascular supply to the acetabular labrum. J Bone Joint Surg Am. 2010; 92(15):2570-5. DOI: 10.2106/JBJS.I.01719. View

10.

Locks R, Utsunomiya H, Bolia I, Mannava S, Chahla J, Philippon M . Arthroscopic Focal Subspinal Decompression and Management of Pincer-Type Femoroacetabular Impingement. Arthrosc Tech. 2017; 6(4):e1029-e1034. PMC: 5621484. DOI: 10.1016/j.eats.2017.03.016. View

11.

Gosvig K, Jacobsen S, Sonne-Holm S, Palm H, Troelsen A . Prevalence of malformations of the hip joint and their relationship to sex, groin pain, and risk of osteoarthritis: a population-based survey. J Bone Joint Surg Am. 2010; 92(5):1162-9. DOI: 10.2106/JBJS.H.01674. View

12.

Ferguson S, Bryant J, Ganz R, Ito K . The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech. 2000; 33(8):953-60. DOI: 10.1016/s0021-9290(00)00042-7. View

13.

Field R, Rajakulendran K . The labro-acetabular complex. J Bone Joint Surg Am. 2011; 93 Suppl 2:22-7. DOI: 10.2106/JBJS.J.01710. View

14.

Philippon M, Stubbs A, Schenker M, Maxwell R, Ganz R, Leunig M . Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review. Am J Sports Med. 2007; 35(9):1571-80. DOI: 10.1177/0363546507300258. View

15.

Redmond J, El Bitar Y, Gupta A, Stake C, Vemula S, Domb B . Arthroscopic acetabuloplasty and labral refixation without labral detachment. Am J Sports Med. 2014; 43(1):105-12. DOI: 10.1177/0363546514555330. View

16.

Nicholls A, Kiran A, Pollard T, Hart D, Arden C, Spector T . The association between hip morphology parameters and nineteen-year risk of end-stage osteoarthritis of the hip: a nested case-control study. Arthritis Rheum. 2011; 63(11):3392-400. PMC: 3494291. DOI: 10.1002/art.30523. View

17.

Gedouin J, Duperron D, Langlais F, Thomazeau H . Update to femoroacetabular impingement arthroscopic management. Orthop Traumatol Surg Res. 2010; 96(3):222-7. DOI: 10.1016/j.otsr.2009.12.002. View

18.

Philippon M, Schenker M . A new method for acetabular rim trimming and labral repair. Clin Sports Med. 2006; 25(2):293-7, ix. DOI: 10.1016/j.csm.2005.12.005. View

19.

Kelly B, Shapiro G, DiGiovanni C, Buly R, Potter H, Hannafin J . Vascularity of the hip labrum: a cadaveric investigation. Arthroscopy. 2005; 21(1):3-11. DOI: 10.1016/j.arthro.2004.09.016. View

20.

Ayeni O, Wong I, Chien T, Musahl V, Kelly B, Bhandari M . Surgical indications for arthroscopic management of femoroacetabular impingement. Arthroscopy. 2012; 28(8):1170-9. DOI: 10.1016/j.arthro.2012.01.010. View