Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A..
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A.; Department of Orthopaedic Surgery, University of Nebraska, Omaha, Nebraska, U.S.A.
Arthroscopy. 2024 May;40(5):1475-1487.e1. doi: 10.1016/j.arthro.2023.10.009. Epub 2023 Oct 20.
To investigate whether paralabral cysts identified incidentally on preoperative magnetic resonance imaging/arthrography predict 2-year functional outcomes after arthroscopic acetabular labral repair.
Prospectively collected data for patients undergoing primary hip arthroscopy by a single surgeon from 2014 to 2020 were retrospectively reviewed. Included patients were ≥18 years and completed baseline patient-reported outcome measures (PROMs) with additional follow-up at 3, 6, 12, and 24 months. Exclusion criteria were labral debridement, hip dysplasia, advanced hip osteoarthritis (Tönnis > 1), or previous ipsilateral hip surgery. Patients were stratified based on the presence of paralabral cysts identified on magnetic resonance imaging/arthrography. Primary outcomes were International Hip Outcome Tool and modified Harris Hip Score. Secondary outcomes included other PROMs and the visual analog pain scale. Outcomes were compared between cohorts using linear mixed-effects models and Fisher's exact tests. Sensitivity analyses accounted for preoperative PROMs, nonlinear improvement trajectories, and relevant baseline characteristics.
Of the 182 included hips (47.8% female; mean ± standard deviation age, 36.9 ± 11.4), 30 (16.4%) had paralabral cysts. During the 2-year study period, there were no significant differences between patients with and without paralabral cysts in terms of International Hip Outcome Tool scores (weighted difference = 1.60; 95% confidence interval [CI], -5.09, 8.28; P = .64), modified Harris Hip Scores (weighted difference = 0.56; 95% CI, -4.16, 5.28; P = .82), or any secondary outcomes (except for HOS-Sports Subscale at 3 months [mean difference = -11.85; 95% CI, -22.85, -0.84; P = .035]). Furthermore, there were no significant differences in clinically meaningful outcomes (P > .05 for all), revision rates (P > .99), or conversion to total hip arthroplasty between cohorts (P > .99). These results held across all sensitivity analyses.
Although preoperative paralabral cysts were associated with worse cam impingement and more severe chondral damage observed intraoperatively, they did not predict 2-year functional outcomes or clinically meaningful improvements, suggesting that incidentally discovered paralabral cysts are not a contraindication for arthroscopic labral repair.
Level III, retrospective cohort study.
探讨术前磁共振成像/关节造影偶然发现的盂唇周围囊肿是否预测关节镜髋臼盂唇修复后 2 年的功能结果。
回顾性分析了 2014 年至 2020 年由一位外科医生进行的原发性髋关节镜检查的患者前瞻性收集的数据。纳入标准为年龄≥18 岁，完成基线患者报告的结果测量（PROM），并在 3、6、12 和 24 个月时进行了额外的随访。排除标准为盂唇清创术、髋关节发育不良、晚期髋关节骨关节炎（Tönnis > 1）或同侧髋关节手术史。根据磁共振成像/关节造影术偶然发现的盂唇周围囊肿对患者进行分层。主要结局为国际髋关节结果工具和改良 Harris 髋关节评分。次要结局包括其他 PROM 和视觉模拟疼痛量表。使用线性混合效应模型和 Fisher 精确检验比较两组之间的结果。敏感性分析考虑了术前 PROM、非线性改善轨迹和相关基线特征。
在 182 个纳入的髋关节中（47.8%为女性；平均年龄±标准差为 36.9±11.4），有 30 个（16.4%）存在盂唇周围囊肿。在 2 年的研究期间，有无盂唇周围囊肿的患者在国际髋关节结果工具评分方面没有显著差异（加权差异=1.60；95%置信区间[CI]，-5.09，8.28；P=.64）、改良 Harris 髋关节评分（加权差异=0.56；95%CI，-4.16，5.28；P=.82）或任何次要结局（除了 3 个月的 HOS-Sports 亚量表[平均差异=-11.85；95%CI，-22.85，-0.84；P=.035]）。此外，两组之间在临床有意义的结果（所有 P>.05）、翻修率（P>.99）或转为全髋关节置换术方面均无显著差异（P>.99）。这些结果在所有敏感性分析中均成立。
尽管术前盂唇周围囊肿与术中观察到的凸轮撞击和更严重的软骨损伤有关，但它们并不能预测 2 年的功能结果或临床有意义的改善，这表明偶然发现的盂唇周围囊肿并不是关节镜盂唇修复的禁忌症。
三级，回顾性队列研究。
