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Association between intraoperative labral tear size and short-term patient-reported outcomes following concomitant
Holden Archer1, Aaron Shi1, Yin Xi1
1University of Texas Southwestern Medical Center, Dallas, TX, USA.
Background:
Hip dysplasia (HD) is a known risk factor for early morbidity in the young adult hip. HD causes a variety of pathologic changes to the hip through an asymmetrical distribution of forces. Periacetabular osteotomy (PAO) is becoming increasingly recognized as a treatment. Labral tears occur frequently in the setting of HD and there still remain questions regarding the best treatment practices for labral pathology. We sought to determine whether intraoperative labral tear size was associated with short-term patient-reported outcomes following concomitant hip arthroscopy and PAO.
Methods:
Seventy-one hips that underwent PAO with concomitant hip arthroscopy at our tertiary care hip center from February 2017 to June 2021 who had PROM follow-up time of more than one year were investigated (88.7% women and 11.3% men with mean patient age of 29.5 years). Labral tear sizes were recorded intraoperatively and sorted into three groups: < 5 mm, 5 - 10 mm, and > 10 mm. HOOS scores were collected pre- and postoperatively and were compared across the three labral tear size groups. The association between labral tear size and postoperative HOOS was evaluated while accounting for preoperative HOOS, age, sex, and BMI. The mean follow-up time was 1.57 years ± 250 days.
Results:
Across all patients, the mean preoperative HOOS was 66.9 ± 14.5, and the mean postoperative HOOS was 77.8 ± 16.3. Statistically significant improvement was observed in the <5 mm and 5-10 mm groups (p<0.001) but not in the >10 mm group (p=0.310). Mean postoperative HOOS values in the <5 mm, 5-10mm, and >10 mm labral tear groups were 84.3 ± 13.7, 76.9 ± 16.6, and 69.2 ± 16.1, respectively. Larger labral tear size was associated with worse postoperative HOOS (p=0.004).
Conclusion:
Among patients undergoing concomitant hip arthroscopy and PAO, larger intraoperative labral tear size was associated with worse short-term postoperative HOOS. However, larger labral tears were also associated with older age and worse markers of intra-articular disease, suggesting that tear size may reflect more advanced disease rather than independently determine outcome.