The femoroacetabular impingement syndrome is a chronic pain condition in young adult patients and is seen as an overuse syndrome in athletes. Very often there is also a co-existing tear of the labrum of the acetabulum, which requires repair.
For many specialists the question of whether to remove the femoroacetabular impingement lesion, or whether treating the acetabular labral tear alone is sufficient, remains a matter of debate.
A new and very interesting study answers this question in part. In this work the researchers used two large groups of patients in whom the femoroacetabular impingement syndrome was present and was, in a high proportion, combined with a tear of the acetabular labrum. In all, 220 patients aged 18-50 with femoroacetabular impingement syndrome and with no signs of arthritis were included, in 10 referral centres in Canada, Finland and Denmark, between October 2012 and November 2017, of whom 214 patients were finally available for the final analysis. In the osteoplasty group (cam or pincer) the lesion was removed under radiographic guidance and the labral tear was repaired. In the 2nd group the joint was simply lavaged with normal saline. In this group, however, the acetabular labrum was also repaired if it was unstable or showed complete separation from the articular cartilage.
The results were assessed on the basis of the hip rating scales (Hip Outcome Score [HOS], International Hip Outcome Tool, 12-Item Short Form Health Survey, EuroQol-5 Dimensions) at 12 and 24 months. Any reoperations were also recorded.
At 12 months there was no difference between the 2 groups. In all, 88.3% of the patients had a tear of the acetabular labrum, of which 60.3% were repaired. As regards the secondary outcomes there were no statistically significant differences between the two groups. At 24 months, however, there were significantly fewer reoperations in the osteoplasty group than in the simple lavage group.
The researchers concluded that both the osteoplasty group and the lavage group, with or without a tear of the acetabular labrum, showed improvement in pain and function at one year. However, the reoperation rate was significantly lower in the osteoplasty group.
Source: “American Journal of Sports Medicine”, January 2021