Texas Tech University Health Sciences Center, El Paso, Texas USA.
Washington Orthopaedics and Sports Medicine, Washington, DC, USA.
Am J Sports Med. 2022 Aug;50(10):2622-2628. doi: 10.1177/03635465221109237. Epub 2022 Jul 18.
Increased understanding of the acetabular labrum's role in hip joint biomechanics has led to a greater focus on the conservation and restoration of normal labral anatomic characteristics; however, labral repair is often not possible in the setting of severe intrasubstance damage or deficiency.
To compare 5-year postoperative patient-reported outcomes between hips treated with primary complete arthroscopic labral reconstruction and those treated with primary labral repair.
Cohort study; Level of evidence, 3.
All hips that underwent primary labral repair or reconstruction by the senior surgeon between January 2015 and December 2015 were included. Hips that had undergone a previous intra-articular procedure were excluded. Visual analog scales and patient-reported outcome (PRO) instruments were completed by patients within 1 week before surgery as a baseline measurement, between 22 and 26 months postoperatively for 2-year outcomes, and between 58 and 62 months for 5-year outcomes. PRO scores collected included the modified Harris Hip Score (mHHS), the 12-Item International Hip Outcome Tool, and the visual analog scale for pain and satisfaction. Pain and satisfaction were assessed using visual analog scales.
A total of 68 primary labral repairs and 62 primary complete labral reconstructions were included in the final analysis. Patients in the reconstruction cohort were older (38.3 vs 29.9 years; < .001), had a higher incidence of severe labral tearing (62.90% vs 5.88%; < .001), required a greater number of concomitant procedures ( < .001), and were more likely to have Beck grade III or IV chondral damage (12.94% vs 1.47%; < .001). Both groups demonstrated statistically significant increases in outcome scores at minimum 5-year follow-up. Patients who underwent labral reconstruction had a significantly greater increase in mHHS from the preoperative assessment to latest follow-up compared with patients undergoing labral repair (27.43 vs 17.13; = .04). No statistically significant differences between the 2 cohorts were found in achievement of minimal clinically important difference, Patient Acceptable Symptom State, maximum outcome improvement, and substantial clinical benefit at latest follow-up ( > .05). In total, 2 patients in the repair cohort and 3 patients in the reconstruction cohort required revision arthroscopy ( = .574). Further, 1 patient from each group converted to arthroplasty ( = .947).
The results of this study suggest that primary complete labral reconstruction is a viable surgical option for hips with moderate to severe labral pathology. At minimum 5-year follow-up, labral reconstruction produced similar outcomes to labral repair despite less favorable preoperative patient characteristics in the reconstruction cohort.
对髋臼唇在髋关节生物力学中作用的认识不断提高，促使人们更加关注对正常唇解剖特征的保护和恢复;然而，在严重的实质内损伤或缺陷的情况下，通常不可能进行唇修复。
比较初次全关节镜下唇重建与初次唇修复治疗髋关节的 5 年术后患者报告结果。
队列研究；证据水平，3 级。
纳入由高级外科医生于 2015 年 1 月至 2015 年 12 月期间进行初次唇修复或重建的所有髋关节。排除先前进行过关节内手术的髋关节。患者在术前 1 周内完成视觉模拟量表和患者报告的结果（PRO）量表作为基线测量，术后 22-26 个月进行 2 年随访，术后 58-62 个月进行 5 年随访。收集的 PRO 评分包括改良 Harris 髋关节评分（mHHS）、12 项国际髋关节结果工具和疼痛及满意度的视觉模拟量表。疼痛和满意度通过视觉模拟量表进行评估。
最终分析纳入 68 例初次唇修复和 62 例初次全唇重建。重建组患者年龄更大（38.3 岁比 29.9 岁； <.001），严重唇撕裂发生率更高（62.90%比 5.88%； <.001），需要更多的伴随手术（ <.001），且更可能存在 Beck 分级 III 或 IV 级软骨损伤（12.94%比 1.47%； <.001）。两组在至少 5 年的随访中均表现出统计学意义上的结果评分增加。与行唇修复的患者相比，行唇重建的患者 mHHS 从术前评估到最新随访时的增加有显著差异（27.43 比 17.13； =.04）。两组在达到最小临床重要差异、患者可接受症状状态、最大结果改善和最新随访时的显著临床获益方面无统计学差异（ >.05）。在修复组中有 2 例患者和重建组中有 3 例患者需要行翻修关节镜检查（ =.574）。此外，每组各有 1 例患者转为关节置换术（ =.947）。
本研究结果表明，对于中重度唇病变的髋关节，初次全唇重建是一种可行的手术选择。在至少 5 年的随访中，尽管重建组患者的术前特征较差，但唇重建的结果与唇修复相似。
