Systematic Review
The Management of Labral Tears and Femoroacetabular Impingement of the Hip in the Young, Active Patient

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Purpose: The purpose of this systematic review was to determine (1) the quality of the literature assessing outcomes after surgical treatment of labral tears and femoroacetabular impingement (FAI), (2) patient satisfaction after open or arthroscopic intervention, and (3) differences in outcome with open or arthroscopic approaches. Methods: Computerized literature databases were searched to identify relevant articles from January 1980 to May 2008. Studies were eligible for inclusion if they had a level I, II, III, or IV study design and if the patient population had a labral tear and/or FAI as the major diagnosis. Patients with severe pre-existing osteoarthritis or acetabular dysplasia were excluded. Results: Of the 19 articles with reported outcomes after surgery, none used a prospective study design and only 1 met the criteria for level III basis of evidence. Open surgical dislocation with labral debridement and osteoplasty is successful, with a good correlation between patient satisfaction and favorable outcome scores. The studies reviewed support that 65% to 85% of patients will be satisfied with their outcome at a mean of 40 months after surgery. A common finding in all series, however, was an increased incidence of failure among patients with substantial pre-existing osteoarthritis. Arthroscopic treatment of labral tears is also effective, with 67% to 100% of patients being satisfied with their outcomes. Conclusions: The quality of literature reporting outcomes of surgical intervention for labral tears and FAI is limited. Although open surgical dislocation with osteoplasty is the historical gold standard, the scientific data do not show that open techniques have outcomes superior to arthroscopic techniques. Level of Evidence: Level IV, systematic review.

Section snippets

Methods

We searched the Medline, EMBASE, and Cochrane computerized literature databases for articles from January 1980 to May 2008 containing the following terms: FAI, hip, surgical dislocation, arthroscopy, labrum, labral tear, and outcome. All studies from the previously mentioned searches were reviewed. Reference lists from the articles were retrieved to identify any additional studies of interest. Studies were eligible for inclusion if they met the following criteria: (1) they were in English, (2)

Open Surgical Series

A summary of the outcomes after open surgical dislocation for FAI and labral tears is shown in Table 1. The open surgical series collectively assessed outcomes in 197 patients with a mean follow-up of 40 months. A range of 65% to 94% good to excellent outcomes was reported. The failure rate, as defined by a dissatisfied patient and/or conversion to total hip arthroplasty, ranged from 4% to 30%.

Beck et al.25 were the first to report midterm results of open surgical dislocation and osteoplasty

Discussion

Improved attention to careful examination of the hip in combination with advances in magnetic resonance imaging have substantially improved our ability to detect early degenerative changes previously not detected on conventional radiographs.1, 2, 3, 4, 5, 43 In particular, labral tears have been diagnosed with increasing frequency and have been recognized to be 1 of the factors contributing to osteoarthritis of the hip.14, 15, 22 Recent work by Ganz et al.26 identified morphologic abnormalities

Conclusions

The quality of the literature assessing clinical outcomes after open or arthroscopic treatment of FAI and labral pathology is limited. On the basis of the studies published to date, our hypothesis that arthroscopic techniques are as effective as open surgical techniques in achieving satisfactory clinical outcomes in the treatment of FAI and labral pathology was supported. Although open surgical dislocation with osteoplasty is the historical gold standard, the scientific data do not show that

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    The authors report no conflict of interest.

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