Iatrogenic labral punctures did not affect clinical result of hip arthroscopy
Iatrogenic labral punctures had no effect on the 1- and 2-year clinical results of hip arthroscopy, according to case-control study results.
John S. Badylak, MD, and James S. Keene, MD, identified 50 patients with iatrogenic labral punctures (ILPs) from a database of 250 hip arthroscopy patients. The senior surgeon performed all of the arthroscopies. The researchers compared the results of these 50 patients with a matched group of 50 patients who did not have an ILP. They evaluated all of the hips with Byrd’s 100-point modified Harris hip score before the operation and at 3, 6, 12 and 24 months postoperatively.
In the ILP group, mean patient age was 40 years; for the comparison group it was 36 years. The average preoperative score was 36 points. Mean joint distraction was 13 mm in the ILP group and 15 mm in the NLP group. The researchers saw a positive Byrd’s sign in both the puncture (84%) and non-puncture (42%) groups.
There were no significant differences between the groups at all follow-up intervals. At 6 months postoperatively, the ILP group averaged 85 points and the comparison group averaged 88 points. At 12 months, the average score was 88 for the ILP and 90 for the comparison group, and at 24 months, it was 88 for the ILP group and 89 for the group.
The authors performed a well thought out, well controlled, case-control study. The data presented in this paper is timely given the increased numbers of hip arthroscopic procedures being performed in the United States.
However, it is important to note that almost all of the patients in this study underwent hip arthroscopy with labral debridement/excision of labral tears. Although historically, this has been the treatment of choice for most labral tears, new data in the last several years, particularly by Chris Larson, MD, has shown that arthroscopic labral debridement yields inferior clinical results to arthroscopic labral repair/refixation.
The importance of the labral seal on the femoral head has been delineated and reinforces the need to repair the labrum to the acetabular rim. So, although iatrogenic labral punctures may not affect the clinical outcome at 2 years in the setting of labral debridement, there may in fact be a clinically significant difference when compared in the setting of labral repair or at longer term follow-up with labral debridement. The treating hip arthroscopist should be careful not to generalize the results of this study to the labral repair population.
These iatrogenic labral punctures do occur, but one should give thought to repairing these punctures if they disrupt the labral seal on dynamic examination intraoperatively.
— John E. McDonald Jr., MD
The Steadman Philippon Research Institute
Vail, Colorado
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