Background: Recent advances in the understanding of the anatomy and
function of the acetabular labrum suggest that it is important for normal
joint function. We found no available data regarding whether labral refixation
after treatment of femoro-acetabular impingement affects the clinical and
Methods: We retrospectively reviewed the clinical and radiographic
results of fifty-two patients (sixty hips) with femoro-acetabular impingement
who underwent arthrotomy and surgical dislocation of the hip to allow trimming
of the acetabular rim and femoral osteochondroplasty. In the first twenty-five
hips, the torn labrum was resected (Group 1); in the next thirty-five hips,
the intact portion of the labrum was reattached to the acetabular rim (Group
2). At one and two years postoperatively, the Merle d'Aubigné clinical
score and the Tönnis arthrosis classification system were used to compare
the two groups.
Results: At one year postoperatively, both groups showed a
significant improvement in their clinical scores (mainly pain reduction)
compared with their preoperative values (p = 0.0003 for Group 1 and p <
0.0001 for Group 2). At two years postoperatively, 28% of the hips in Group 1
(labral resection) had an excellent result, 48% had a good result, 20% had a
moderate result, and 4% had a poor result. In contrast, in Group 2 (labral
reattachment), 80% of the hips had an excellent result, 14% had a good result,
and 6% had a moderate result. Comparison of the clinical scores between the
two groups revealed significantly better outcomes for Group 2 at one year (p =
0.0001) and at two years (p = 0.01). Radiographic signs of osteoarthritis were
significantly more prevalent in Group 1 than in Group 2 at one year (p = 0.02)
and at two years (p = 0.009).
Conclusions: Patients treated with labral refixation recovered
earlier and had superior clinical and radiographic results when compared with
patients who had undergone resection of a torn labrum. Although the results
must be considered preliminary, we now recommend refixation of the intact
portion of the labrum after trimming of the acetabular rim during surgical
treatment of femoro-acetabular impingement.
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.