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股関節唇損傷

著者: 内田宗志 産業医科大学若松病院 整形外科

監修: 酒井昭典 産業医科大学 整形外科学教室

著者校正/監修レビュー済:2022/05/25
参考ガイドライン:
  1. 日本整形外科学会日本股関節学会:変形性股関節症診療ガイドライン 改訂第2版
患者向け説明資料

概要・推奨   

  1. 股関節唇損傷は、変形性股関節症の前駆病態として、その発生機序が明らかとなってきた。
  1. 画像診断と鏡視下手術の発展により容易に診断が可能である。 
  1. 股関節唇損傷は、大腿骨寛骨臼インピンジメントや寛骨臼形成不全と合併されることが多く、骨形態も注意深く診断する必要がある(推奨度1)
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薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、 著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※同効薬・小児・妊娠および授乳中の注意事項等は、海外の情報も掲載しており、日本の医療事情に適応しない場合があります。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適応の査定において保険適応及び保険適応外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適応の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
内田宗志 : 特に申告事項無し[2022年]
監修:酒井昭典 : 特に申告事項無し[2022年]

改訂のポイント:
  1. 変形性股関節症診療ガイドラインに則って見直しを行った

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 股関節唇は、寛骨臼の周囲を環状に付着している繊維軟骨である。大腿骨頭を環状に被覆し、シーリングすることで、股関節を安定させる機能を有する。
 
股関節唇の解剖

a:股関節唇の横断面 b:股関節唇の関節鏡像

出典

img1:  The labrum of the hip: diagnosis and rationale for surgical correction.
 
 Clin Sports Med. 2011 Apr;30(2):293-315.・・・
 
股関節唇の肉眼解剖

股関節の大腿骨頭を脱臼させた状態。

出典

img1:  著者提供
 
 
 
  1. 股関節唇損傷は、その繊維軟骨が損傷し、股関節痛や引っかかり感を呈する病気である。
 
股関節唇損傷の関節鏡写真

股関節鏡から確認された上方股関節唇損傷および軟骨解離の所見

出典

img1:  著者提供
 
 
 
  1. そのほとんどが、股関節の骨形態異常(臼蓋形成不全、Legg-Calve-Perthes病、大腿骨頭すべり症、Femoroacetabular impingement 股関節インピンジメント)に起因する。MRなどの画像診断や関節鏡が発展した今もなお、診断が難しく見逃されることが多い。臼蓋縁の関節唇近傍の軟骨損傷が合併していることが多い。
 
臼蓋形成不全の病態メカニズム

股関節唇損傷の原因となる臼蓋形成不全

出典

img1:  著者提供
 
 
 
  1. Legg-Calve-Perthes disease
  1. ペルテス病の病態説明
  1. 成長期に大腿骨頭の骨化核の虚血性壊死を生じる病気。3年程度の経過で最終的に骨壊死は自然に治癒するが、骨頭変形などによって股関節に永続的に障害を残すことが多い病気。
  1. 成人したのち、大腿骨頭のペルテス変形によってインピンジメントをおこし、二次性FAIになり股関節唇損傷の原因と成ることが多い。
 
Legg-Calve-Perthes disease

 
Femoroacetabular impingement

Femoroacetabular impingementのメカニズム cam とPincer
股関節唇損傷の原因となるFAI

出典

img1:  著者提供
 
 
 
  1. 多くは緩徐に症状が進行するが、頻度としては少ない(9%)ものの外傷を契機に発症することもあり、詳しい病歴の聴取が必要である[1][2]
問診・診察のポイント  
問診:
  1. 発症時期を確認する。〔いつから、どのように〕

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文献 

Michael Leunig, Paul E Beaulé, Reinhold Ganz
The concept of femoroacetabular impingement: current status and future perspectives.
Clin Orthop Relat Res. 2009 Mar;467(3):616-22. doi: 10.1007/s11999-008-0646-0. Epub 2008 Dec 10.
Abstract/Text Femoroacetabular impingement (FAI) is a recently proposed mechanism causing abnormal contact stresses and potential joint damage around the hip. In the majority of cases, a bony deformity or spatial malorientation of the femoral head or head/neck junction, acetabulum, or both cause FAI. Supraphysiologic motion or high impact might cause FAI even with very mild bony alterations. FAI became of interest to the medical field when (1) evidence began to emerge suggesting that FAI may initiate osteoarthritis of the hip and when (2) adolescents and active adults with groin pain and imaging evidence of FAI were successfully treated addressing the causes of FAI. With an increased recognition and acceptance of FAI as a damage mechanism of the hip, defined standards of assessment and treatment need to be developed and established to provide high accuracy and precision in diagnosis. Early recognition of FAI followed by subsequent behavioral modification (profession, sports, etc) or even surgery may reduce the rate of OA due to FAI.

PMID 19082681
R Stephen J Burnett, Gregory J Della Rocca, Heidi Prather, Madelyn Curry, William J Maloney, John C Clohisy
Clinical presentation of patients with tears of the acetabular labrum.
J Bone Joint Surg Am. 2006 Jul;88(7):1448-57. doi: 10.2106/JBJS.D.02806.
Abstract/Text BACKGROUND: The clinical presentation of a labral tear of the acetabulum may be variable, and the diagnosis is often delayed. We sought to define the clinical characteristics associated with symptomatic acetabular labral tears by reviewing a group of patients who had an arthroscopically confirmed diagnosis.
METHODS: We retrospectively reviewed the records for sixty-six consecutive patients (sixty-six hips) who had a documented labral tear that had been confirmed with hip arthroscopy. We had prospectively recorded demographic factors, symptoms, physical examination findings, previous treatments, functional limitations, the manner of onset, the duration of symptoms until the diagnosis of the labral tear, other diagnoses offered by health-care providers, and other surgical procedures that these patients had undergone. Radiographic abnormalities and magnetic resonance arthrography findings were also recorded.
RESULTS: The study group included forty-seven female patients (71%) and nineteen male patients (29%) with a mean age of thirty-eight years. The initial presentation was insidious in forty patients, was associated with a low-energy acute injury in twenty, and was associated with major trauma in six. Moderate to severe pain was reported by fifty-seven patients (86%), with groin pain predominating (sixty-one patients; 92%). Sixty patients (91%) had activity-related pain (p < 0.0001), and forty-seven patients (71%) had night pain (p = 0.0006). On examination, twenty-six patients (39%) had a limp, twenty-five (38%) had a positive Trendelenburg sign, and sixty-three (95%) had a positive impingement sign. The mean time from the onset of symptoms to the diagnosis of a labral tear was twenty-one months. A mean of 3.3 health-care providers had been seen by the patients prior to the definitive diagnosis. Surgery on another anatomic site had been recommended for eleven patients (17%), and four had undergone an unsuccessful operative procedure prior to the diagnosis of the labral tear. At an average of 16.4 months after hip arthroscopy, fifty-nine patients (89%) reported clinical improvement in comparison with the preoperative status.
CONCLUSIONS: The clinical presentation of a patient who has a labral tear may vary, and the correct diagnosis may not be considered initially. In young, active patients with a predominant complaint of groin pain with or without a history of trauma, the diagnosis of a labral tear should be suspected and investigated as radiographs and the history may be nonspecific for this diagnosis.
LEVEL OF EVIDENCE: Diagnostic Level IV. See Instructions to Authors for a complete description of levels of evidence.

PMID 16818969
John C Clohisy, Evan R Knaus, Devyani M Hunt, John M Lesher, Marcie Harris-Hayes, Heidi Prather
Clinical presentation of patients with symptomatic anterior hip impingement.
Clin Orthop Relat Res. 2009 Mar;467(3):638-44. doi: 10.1007/s11999-008-0680-y. Epub 2009 Jan 7.
Abstract/Text Femoroacetabular impingement (FAI) is considered a cause of labrochondral disease and secondary osteoarthritis. Nevertheless, the clinical syndrome associated with FAI is not fully characterized. We determined the clinical history, functional status, activity status, and physical examination findings that characterize FAI. We prospectively evaluated 51 patients (52 hips) with symptomatic FAI. Evaluation of the clinical history, physical exam, and previous treatments was performed. Patients completed demographic and validated hip questionnaires (Baecke et al., SF-12, Modified Harris hip, and UCLA activity score). The average patient age was 35 years and 57% were male. Symptom onset was commonly insidious (65%) and activity-related. Pain occurred predominantly in the groin (83%). The mean time from symptom onset to definitive diagnosis was 3.1 years. Patients were evaluated by an average 4.2 healthcare providers prior to diagnosis and inaccurate diagnoses were common. Thirteen percent had unsuccessful surgery at another anatomic site. On exam, 88% of the hips were painful with the anterior impingement test. Hip flexion and internal rotation in flexion were limited to an average 97 degrees and 9 degrees, respectively. The patients were relatively active, yet demonstrated restrictions of function and overall health. These data may facilitate diagnosis of this disorder.

PMID 19130160
Abstract/Text Patient outcome following total hip arthroplasty (THA) was evaluated using a previously described patient assessment outcome index questionnaires. The questionnaire was distributed to 263 patients who underwent cementless THA. One hundred and three patients responded to the self-administered questionnaire and had updated clinical evaluation. We obtained a modified Harris Hip Score (HHS) based on patient assessments of their own pain and function and compared it with the clinical HHS obtained at the patients' last office visit. The mean follow up period was 4 years. Statistical analysis was performed between the two scores. The correlation between the scores from the self-administered questionnaire and the patients' last office visit revealed a fairly low correlation coefficient (r = 0.467, p < 0.001). Relative lack of correlation between the HHS's obtained from these two sources was especially noted for patients with a pain score of 30 points or less. These 26 patients were subsequently interviewed in detail about their pain to further explain these differences. The etiology of the perceived "hip pain" was found to be secondary to trochanteric bursitis in 13 patients, lumbar spondylosis in 7 patients, arthrosis of the contralateral hip in 5 patients, and from other causes in 8 patients. Pain that was hip related (anterior thigh or groin) was present in only 5 out of the 26 patients with a pain score of 30 or less. Another source of discrepancy between the total scores of the HHS was found to be on behalf of the physician in evaluating the presence of a limp. We also found that patients' expectations had changed from their preoperative expectations. Although outcome measures developed and administered by clinicians are subject to bias from several sources, results of this study suggest that self administered patient outcome measures also have their limitations. The validity of self-administered patient outcome questionnaires can be severely impacted by the patients' understanding of the questions asked, as even the most seemingly simple questions are subject to misinterpretation.

PMID 12724955
Christian P Christensen, Peter L Althausen, Murray A Mittleman, Jo-ann Lee, Joseph C McCarthy
The nonarthritic hip score: reliable and validated.
Clin Orthop Relat Res. 2003 Jan;(406):75-83. doi: 10.1097/01.blo.0000043047.84315.4b.
Abstract/Text The purpose of the current study was to assess the validity, internal consistency, and reproducibility of a short, self-administered hip score designed for use in younger patients with higher demands and expectations than older patients with degenerative joint disease. Validity and internal consistency was studied with 48 consecutive patients with a mean age of 33 years with intractable hip pain and normal plain radiographs. Reproducibility was assessed from data on an additional random sample of 17 patients with hip pain. The Pearson correlation coefficients were 0.82 and 0.59 between the nonarthritic hip score and the Harris hip score and Short Form-12, respectively showing validity. Cronbach's coefficient alpha measuring the internal consistency within each of the score's four domains ranged from 0.69 to 0.92. The test and retest reproducibility ranged from 0.87 to 0.95 for the four subsets and was 0.96 overall. This short, self-administered questionnaire regarding hip pain in young patients with increased activity demands and high treatment expectations is valid compared with previous measures of hip performance, is internally consistent, and is reproducible.

PMID 12579003
Damian R Griffin, Nicholas Parsons, Nicholas G H Mohtadi, Marc R Safran, Multicenter Arthroscopy of the Hip Outcomes Research Network
A short version of the International Hip Outcome Tool (iHOT-12) for use in routine clinical practice.
Arthroscopy. 2012 May;28(5):611-6; quiz 616-8. doi: 10.1016/j.arthro.2012.02.027.
Abstract/Text PURPOSE: The purpose of this study was to develop and validate a shorter version of the 33-item International Hip Outcome Tool (iHOT-33) that could be easily used in routine clinical practice to measure both health-related quality of life and changes after treatment in young, active patients with hip disorders.
METHODS: A development dataset (104 patients) was explored with forward-selection linear regression analysis to choose a reduced item set for the new scale. This was tested in a validation dataset (1,833 patients) and responsiveness subset (80 patients) to measure agreement between the shorter and longer versions and to test the sensitivity of the shorter instrument to change after treatment.
RESULTS: Twelve items were chosen for a short version of the International Hip Outcome Tool (iHOT-12). The iHOT-12 showed excellent agreement with the long version (iHOT-33). It captured 95.9% (95% confidence interval, 95.0% to 96.8%) of the variation of the iHOT-33 and showed equivalent sensitivity to change with a standardized effect size of 0.98 (95% confidence interval, 0.67 to 1.28).
CONCLUSIONS: A short version of the International Hip Outcome Tool (iHOT-12) has been developed. It has very similar characteristics to the original rigorously validated 33-item questionnaire, losing very little information despite being only one-third the length. It is valid, reliable, and responsive to change. We suggest that it be used for initial assessment and postoperative follow-up in routine clinical practice.

Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
PMID 22542434
A Kassarjian, L Cerezal, E Llopis
[MR arthrography of the hip with emphasis on femoroacetabular impingement].
Radiologia. 2009 Jan-Feb;51(1):17-29; quiz 119. doi: 10.1016/S0033-8338(09)70402-3.
Abstract/Text Hip pain is a common complaint in patients of all ages. Recent advances in imaging and treatment are changing the approach to the evaluation and management of hip pain. Abnormal femoral and acetabular morphology and lesions of the acetabular labrum and cartilage are increasingly recognized as crucial in the development of degenerative changes. In addition, femoroacetabular impingement is increasingly recognized as an etiologic factor in hip pain. This article discusses techniques for MR arthrography of the hip, normal anatomy at hip MR arthrography, common intra-articular pathologies in patients with hip pain, and imaging findings of femoroacetabular impingement.

PMID 19303477
Elizabeth A Bardowski, J W Thomas Byrd
Ultrasound-Guided Intra-Articular Injection of the Hip: The Nashville Sound.
Arthrosc Tech. 2019 Apr;8(4):e383-e388. doi: 10.1016/j.eats.2018.11.016. Epub 2019 Mar 11.
Abstract/Text Ultrasound-guided intra-articular injection has become a mainstay in the diagnosis and treatment of a variety of hip disorders. It is the single greatest adjunct to history and examination in the clinical assessment of hip problems and has substantial therapeutic value in the conservative management of symptomatic disorders, especially when used in conjunction with supervised physical therapy.

PMID 31080722
Marc Philippon, Mara Schenker, Karen Briggs, David Kuppersmith
Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression.
Knee Surg Sports Traumatol Arthrosc. 2007 Jul;15(7):908-14. doi: 10.1007/s00167-007-0332-x. Epub 2007 May 4.
Abstract/Text Femoroacetabular impingement (FAI) occurs when an osseous abnormality of the proximal femur (cam) or acetabulum (pincer) triggers damage to the acetabular labrum and articular cartilage in the hip. Although the precise etiology of FAI is not well understood, both types of FAI are common in athletes presenting with hip pain, loss of range-of-motion, and disability in athletics. An open surgical approach to decompressing FAI has shown good clinical outcomes; however, this highly invasive approach inherently may delay or preclude a high level athlete's return to play. The purpose of this study was to define associated pathologies and determine if an arthroscopic approach to treating FAI can allow professional athletes to return to high-level sport. Hip arthroscopy for the treatment of FAI allows professional athletes to return to professional sport. Between October 2000 and September 2005, 45 professional athletes underwent hip arthroscopy for the decompression of FAI. Operative and return-to-play data were obtained from patient records. Average time to follow-up was 1.6 years (range: 6 months to 5.5 years). Forty two (93%) athletes returned to professional competition following arthroscopic decompression of FAI. Three athletes did not return to play; however, all had diffuse osteoarthritis at the time of arthroscopy. Thirty-five athletes (78%) remain active in professional sport at an average follow-up of 1.6 years. Arthroscopic treatment of FAI allows professional athletes to return to professional sport.

PMID 17479250
Marc R Safran
Advances in hip arthroscopy.
Sports Med Arthrosc. 2010 Jun;18(2):55. doi: 10.1097/JSA.0b013e3181e13196.
Abstract/Text
PMID 20473122
Marc J Philippon, Karen K Briggs, Connor J Hay, David A Kuppersmith, Christopher B Dewing, Michael J Huang
Arthroscopic labral reconstruction in the hip using iliotibial band autograft: technique and early outcomes.
Arthroscopy. 2010 Jun;26(6):750-6. doi: 10.1016/j.arthro.2009.10.016. Epub 2010 Apr 3.
Abstract/Text PURPOSE: The purpose of this study was to investigate the indications for and outcomes of arthroscopic labral reconstruction in the hip by use of iliotibial band (ITB) autograft.
METHODS: Between August 2005 and May 2008, the senior author (M.J.P.) performed 95 arthroscopic labral reconstructions using an ITB autograft in patients with advanced labral degeneration or deficiency. There were 47 patients who had undergone surgery at a minimum of 1 year previously and met the inclusion criteria. The modified Harris Hip Score (MHHS) and patient satisfaction were used to measure outcomes postoperatively. The labral autograft was harvested from the ITB through a separate incision. The graft was sutured to the intact labral remnant in the region of labral deficiency, re-establishing the suction seal of the hip joint.
RESULTS: There were 32 men and 15 women. The mean age at the time of surgery was 37 years (range, 18 to 55 years). The mean time from the onset of symptoms to labral reconstruction was 36 months (range, 1 month to 12 years). Subsequent total hip arthroplasty was performed in 4 patients (9%). Follow-up was obtained in 37 of the remaining 43 patients. The mean time to follow-up was 18 months (range, 12 to 32 months). The mean MHHS improved from 62 (range, 35 to 92) preoperatively to 85 (range, 53 to 100) postoperatively (P = .001). Median patient satisfaction was 8 out of 10 (range, 1 to 10). Patients who were treated within 1 year of injury had higher MHHSs than patients who waited longer than 1 year (93 v 81, P = .03). The independent predictor of patient satisfaction with outcome after labral reconstruction was age.
CONCLUSIONS: This study showed that patients who have labral deficiency or advanced labral degeneration had good outcomes and high patient satisfaction after arthroscopic intervention with acetabular labral reconstruction. Lower satisfaction was associated with joint space narrowing and increased age. Patients who waited longer than 1 year from the time of injury to surgery had lower function at follow-up than those treated in the first year.
LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Copyright (c) 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
PMID 20511032
E Schilders, A Dimitrakopoulou, Q Bismil, P Marchant, C Cooke
Arthroscopic treatment of labral tears in femoroacetabular impingement: a comparative study of refixation and resection with a minimum two-year follow-up.
J Bone Joint Surg Br. 2011 Aug;93(8):1027-32. doi: 10.1302/0301-620X.93B8.26065.
Abstract/Text Labral tears are commonly associated with femoroacetabular impingement. We reviewed 151 patients (156 hips) with femoroacetabular impingement and labral tears who had been treated arthroscopically. These were subdivided into those who had undergone a labral repair (group 1) and those who had undergone resection of the labrum (group 2). In order to ensure the groups were suitably matched for comparison of treatment effects, patients with advanced degenerative changes (Tönnis grade > 2, lateral sourcil height < 2 mm and Outerbridge grade 4 changes in the weight-bearing area of the femoral head) were excluded, leaving 96 patients (101 hips) in the study. At a mean follow-up of 2.44 years (2 to 4), the mean modified Harris hip score in the labral repair group (group 1, 69 hips) improved from 60.2 (24 to 85) pre-operatively to 93.6 (55 to 100), and in the labral resection group (group 2, 32 hips) from 62.8 (29 to 96) pre-operatively to 88.8 (35 to 100). The mean modified Harris hip score in the labral repair group was 7.3 points greater than in the resection group (p = 0.036, 95% confidence interval 0.51 to 14.09). Labral detachments were found more frequently in the labral repair group and labral flap tears in the resection group. No patient in our study group required a subsequent hip replacement during the period of follow-up. This study shows that patients without advanced degenerative changes in the hip can achieve significant improvement in their symptoms after arthroscopic treatment of femoroacetabular impingement. Where appropriate, labral repair provides a superior result to labral resection.

PMID 21768624
Christopher M Larson, M Russell Giveans
Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement.
Arthroscopy. 2009 Apr;25(4):369-76. doi: 10.1016/j.arthro.2008.12.014. Epub 2009 Mar 5.
Abstract/Text PURPOSE: The purpose of this study was to compare the outcomes of arthroscopic labral debridement with those of labral refixation.
METHODS: We reviewed patients who underwent labral debridement during a period before the development of labral repair techniques. Patients with labral tears deemed repairable with our current arthroscopic technique were compared with patients who underwent labral refixation with a minimum 1 of year of follow-up. To better match the 2 groups, only patients with labral pathology caused by pincer-type or combined pincer- and cam-type femoroacetabular impingement were included. In the first 36 hips the labrum was debrided (group 1); in the next 39 hips the labrum underwent refixation (group 2). Outcomes were measured preoperatively and postoperatively with the modified Harris Hip Score (HHS), Short Form 12, and visual analog scale for pain. Preoperative and postoperative radiographs were obtained to evaluate bony resection (alpha angle) and osteoarthritis (Tönnis grade).
RESULTS: The mean age was 31 years in group 1, with a mean follow-up of 21.4 months, and 27 years in group 2, with a mean follow-up of 16.5 months. Preoperative subjective outcomes scores were not significantly different between groups. At the 1-year follow-up visit, subjective outcomes were significantly improved (P < .01) in both groups. HHSs were significantly better for the refixation group (94.3) compared with the debridement group (88.9) at 1 year (P = .029). At most recent follow-up, good to excellent results were noted in 66.7% of hips in the debridement group compared with 89.7% of hips in the refixation group (P < .01).
CONCLUSIONS: Although other variables could have influenced these outcomes, these preliminary results indicate that labral refixation resulted in better HHS outcomes and a greater percentage of good to excellent results compared with the results of labral debridement in an earlier cohort.
LEVEL OF EVIDENCE: Level III, retrospective comparative study.

PMID 19341923
Christopher M Larson, M Russell Giveans, Rebecca M Stone
Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: mean 3.5-year follow-up.
Am J Sports Med. 2012 May;40(5):1015-21. doi: 10.1177/0363546511434578. Epub 2012 Feb 3.
Abstract/Text BACKGROUND: The acetabular labrum provides a sealing function and a degree of hip joint stability. Limited, short-term follow-up studies suggest that labral refixation/preservation leads to superior outcomes compared with labral debridement/excision.
PURPOSE: To compare the results of labral refixation versus focal labral excision/debridement in a cohort of patients who underwent arthroscopic correction of femoroacetabular impingement (FAI).
STUDY DESIGN: Cohort study; Level of evidence, 3.
METHODS: We reported on patients who underwent labral debridement/focal labral excision during a period before the development of labral repair techniques. Patients with labral tears thought to be repairable with our current arthroscopic technique were compared with a cohort of patients who underwent labral refixation. To better match the 2 groups, only patients with labral pincer- or combined-type FAI were included. In the first 44 hips, the labrum was focally excised/debrided (group 1); in the next 50 hips, the labrum was refixed (group 2). Outcomes were measured with the modified Harris Hip Score (HHS), Short Form 12 (SF-12), and a visual analog scale (VAS) for pain preoperatively and postoperatively. Preoperative and postoperative radiographs were obtained to evaluate bony resection.
RESULTS: The mean age was 32 years in group 1 and 28 years in group 2 with a mean follow-up of 42 months (range, 24-72 months). Preoperative mean subjective outcome scores were not significantly different between groups. At a mean 3.5 years' follow-up, subjective outcomes were significantly improved (P < .01) for both groups compared with preoperative scores. The HHS (P = .001), SF-12 (P = .041), and VAS pain scores (P = .004) were all significantly better for the refixation group compared with the debridement group at the most recent follow-up. At a mean 3.5 years' follow-up, good to excellent results were noted in 68% of the focal excision/debridement group and 92% of the refixation group (P = .004).
CONCLUSION: Although other factors may have influenced these results, labral refixation compared with an earlier cohort of focal labral excision/debridement resulted in better HHS, SF-12, and VAS pain outcomes and a greater percentage of good to excellent results at a mean 3.5-year follow-up.

PMID 22307078

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