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Arthroscopic Repair versus Debridement of Labral Tears in Patients With Femoroacetabular Impingement: A Prospective Study (SS-36)
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ABSTRACTS
2 (p⬍0.01). The average age at the time of surgery was 58.2 years (range: 39 to 78 years) in group 1, and 54.3 years (range: 17 to 77 years) in group 2 (p⬍0.01). BMI was 26.7⫾3.4 in group 1, and 24.9⫾3.1 in group 2 (p⬍0.01). KLG was 1.4⫾0.8 in group 1, and 0.9⫾0.6 in group 2 (p⬍0.01). With regard to anatomical factors, only M.A.A showed significantly increased varus alignment in group 1 (4.5o⫾3.4o) than group 2 (2.4o⫾2.7o) (p⬍0.01). Environmental factors showed no differences in occupational, table use or not, and bed use or not, except sport activity level. There were 41 patients (42.7%) in group 1 and 77 patients (20.6%) in group 2, who did not participate in any recreational activity (p⬍0.01). Logistic regression analysis showed that female gender was associated with a 5.9-fold increase in risk (p⫽0.001), a varus M.A.A with a 3.3-fold increase (p⫽0.003), a more than 30 kg/m2 in BMI with a 4.9-fold increase (p⫽0.031). Conclusion: This study showed that MMPRT had significant advancing age, female gender preference, high BMI, increased KLG, varus M.A.A, low sport activity level. The contributing risk factors were gender, BMI, and M.A.A. Interestingly, oriental specific lifestyles like the cross legged position and kneeling showed no contribution to increased MMPRT. This suggests that intrinsic risk factors (similar to those that predispose to osteoarthritis) predispose to MMPRT. Arthroscopic Repair versus Debridement of Labral Tears in Patients With Femoroacetabular Impingement: A Prospective Study (SS-36) MISTY SURI, M.D., PRESENTING AUTHOR W. STEPHEN CHOATE, M.D. STEPHANIE PAWLAK, B.A. DERYK JONES, M.D. Introduction: The purpose of this study was to compare, prospectively, the outcomes of labral debridement with those of labral repair in the arthroscopic treatment of femoroacetabular impingement (FAI). Methods: We prospectively assessed 83 patients (88 hips) who underwent arthroscopic management of femoroacetabular impingement with associated labral pathology from February 2009 to February 2011. Patients with labral tears suitable for repair (group R), as determined intraoperatively, were compared with patients who underwent labral debridement (group D) with a minimum of 6 months follow-up. Excluding patients with ⬍ 6 months follow-up (n ⫽ 10), previous surgeries on the operative hip (n ⫽ 7), deformity cases (n ⫽ 6), revisions (n ⫽ 5), and microfracture cases (n ⫽ 5), there were 55 hips (repair ⫽ 37, debridement ⫽ 18) eligible for anal-
ysis. Outcomes were measured preoperatively and postoperatively with the modified Harris Hip Score (mHHS), Short Form-12, and Visual Analog Scale for pain. Outcome differences between the groups were assessed using the Wilcoxon Rank Sum Test. In addition, progression analysis of groups R and D outcomes, at each time-point, was performed using Generalized Estimating Equations (GEE) regression methods. Results: The mean age was 39.8 years in group R, with a mean follow-up of 13 months (range, 6 months - 2 years). The mean age was 45.5 years in group D, also with a mean follow-up of 13 months (range, 6 months 2 years). The debridement group was noted to have a larger percentage of hips with advanced arthritis (p ⫽ 0.0089). Otherwise, baseline demographics and preoperative functional/pain scores were not significantly different between the two groups. At the most recent follow-up visits, all median outcome scores were significantly improved (p⬍0.01) in both groups. Comparative analysis of final median scores revealed no differences between the groups at final follow-up. Regression analysis comparing mean values at different time-points showed a slight trend towards better outcomes in the repair hips for all subjective measures. Group R had significantly higher SF-12 MCS scores at 6 weeks (p⫽0.0154), 3 months (p⫽0.0130), and 6 months (p⫽0.0486); however, this difference was eliminated at final follow-up (p⫽0.2465). Otherwise, no significant differences in mean scores were determined between the groups at any time-point. Good to excellent results were similarly noted in 15 hips (83.3%) in the debridement group and 33 hips (89.1%) in the repair group. Age ⱕ 30 was the only factor found to be predictive of a good outcome (p ⫽ 0.003). Subanalysis failed to demonstrate advanced arthritis to be a predictor of poor outcome. However, a non-significant trend towards a higher failure rate was seen in Group D (p⫽0.056). Conclusion: This study is the first to compare, prospectively, the results of labral repair and debridement in the arthroscopic treatment of FAI. Preliminary results indicate that equivalent short-term outcomes can be expected with either repair or debridement, as indicated by intraoperative assessment, when treating labral pathology in association with FAI. Trends toward higher failure rates in patients undergoing labral debridement are likely to become significant with longer follow-up. Arthroscopic Treatment of Femoroacetabular Impingement (FAI): Midterm Results (Three to Six Years Follow-up) (SS-37) RODRIGO MARDONES, M.D., PRESENTING AUTHOR CATALINA LARRAIN, M.D.
ABSTRACTS
2 (p⬍0.01). The average age at the time of surgery was 58.2 years (range: 39 to 78 years) in group 1, and 54.3 years (range: 17 to 77 years) in group 2 (p⬍0.01). BMI was 26.7⫾3.4 in group 1, and 24.9⫾3.1 in group 2 (p⬍0.01). KLG was 1.4⫾0.8 in group 1, and 0.9⫾0.6 in group 2 (p⬍0.01). With regard to anatomical factors, only M.A.A showed significantly increased varus alignment in group 1 (4.5o⫾3.4o) than group 2 (2.4o⫾2.7o) (p⬍0.01). Environmental factors showed no differences in occupational, table use or not, and bed use or not, except sport activity level. There were 41 patients (42.7%) in group 1 and 77 patients (20.6%) in group 2, who did not participate in any recreational activity (p⬍0.01). Logistic regression analysis showed that female gender was associated with a 5.9-fold increase in risk (p⫽0.001), a varus M.A.A with a 3.3-fold increase (p⫽0.003), a more than 30 kg/m2 in BMI with a 4.9-fold increase (p⫽0.031). Conclusion: This study showed that MMPRT had significant advancing age, female gender preference, high BMI, increased KLG, varus M.A.A, low sport activity level. The contributing risk factors were gender, BMI, and M.A.A. Interestingly, oriental specific lifestyles like the cross legged position and kneeling showed no contribution to increased MMPRT. This suggests that intrinsic risk factors (similar to those that predispose to osteoarthritis) predispose to MMPRT. Arthroscopic Repair versus Debridement of Labral Tears in Patients With Femoroacetabular Impingement: A Prospective Study (SS-36) MISTY SURI, M.D., PRESENTING AUTHOR W. STEPHEN CHOATE, M.D. STEPHANIE PAWLAK, B.A. DERYK JONES, M.D. Introduction: The purpose of this study was to compare, prospectively, the outcomes of labral debridement with those of labral repair in the arthroscopic treatment of femoroacetabular impingement (FAI). Methods: We prospectively assessed 83 patients (88 hips) who underwent arthroscopic management of femoroacetabular impingement with associated labral pathology from February 2009 to February 2011. Patients with labral tears suitable for repair (group R), as determined intraoperatively, were compared with patients who underwent labral debridement (group D) with a minimum of 6 months follow-up. Excluding patients with ⬍ 6 months follow-up (n ⫽ 10), previous surgeries on the operative hip (n ⫽ 7), deformity cases (n ⫽ 6), revisions (n ⫽ 5), and microfracture cases (n ⫽ 5), there were 55 hips (repair ⫽ 37, debridement ⫽ 18) eligible for anal-
ysis. Outcomes were measured preoperatively and postoperatively with the modified Harris Hip Score (mHHS), Short Form-12, and Visual Analog Scale for pain. Outcome differences between the groups were assessed using the Wilcoxon Rank Sum Test. In addition, progression analysis of groups R and D outcomes, at each time-point, was performed using Generalized Estimating Equations (GEE) regression methods. Results: The mean age was 39.8 years in group R, with a mean follow-up of 13 months (range, 6 months - 2 years). The mean age was 45.5 years in group D, also with a mean follow-up of 13 months (range, 6 months 2 years). The debridement group was noted to have a larger percentage of hips with advanced arthritis (p ⫽ 0.0089). Otherwise, baseline demographics and preoperative functional/pain scores were not significantly different between the two groups. At the most recent follow-up visits, all median outcome scores were significantly improved (p⬍0.01) in both groups. Comparative analysis of final median scores revealed no differences between the groups at final follow-up. Regression analysis comparing mean values at different time-points showed a slight trend towards better outcomes in the repair hips for all subjective measures. Group R had significantly higher SF-12 MCS scores at 6 weeks (p⫽0.0154), 3 months (p⫽0.0130), and 6 months (p⫽0.0486); however, this difference was eliminated at final follow-up (p⫽0.2465). Otherwise, no significant differences in mean scores were determined between the groups at any time-point. Good to excellent results were similarly noted in 15 hips (83.3%) in the debridement group and 33 hips (89.1%) in the repair group. Age ⱕ 30 was the only factor found to be predictive of a good outcome (p ⫽ 0.003). Subanalysis failed to demonstrate advanced arthritis to be a predictor of poor outcome. However, a non-significant trend towards a higher failure rate was seen in Group D (p⫽0.056). Conclusion: This study is the first to compare, prospectively, the results of labral repair and debridement in the arthroscopic treatment of FAI. Preliminary results indicate that equivalent short-term outcomes can be expected with either repair or debridement, as indicated by intraoperative assessment, when treating labral pathology in association with FAI. Trends toward higher failure rates in patients undergoing labral debridement are likely to become significant with longer follow-up. Arthroscopic Treatment of Femoroacetabular Impingement (FAI): Midterm Results (Three to Six Years Follow-up) (SS-37) RODRIGO MARDONES, M.D., PRESENTING AUTHOR CATALINA LARRAIN, M.D.