Patient Characteristics and Early Functional Outcomes of Combined Arthroscopic Labral Refixation and Periacetabular Osteotomy for Symptomatic Acetabular Dysplasia

Abstract

Background: Symptomatic labral tears are common in patients with acetabular dysplasia; however, optimal treatment of the labrum remains controversial. Purpose: To present patient characteristics and early functional outcomes associated with combined arthroscopic labral refixation and Bernese periacetabular osteotomy (PAO) for symptomatic acetabular dysplasia with a displaced labral tear from the acetabular rim. Study Design: Cohort study; Level of evidence, 3. Methods: Patients undergoing PAO from a single-center prospective hip preservation registry were eligible (N = 73 patients; mean clinical follow-up, 23 months). Indications for combined arthroscopic labral refixation included symptomatic labral injury and MRI findings suggestive of labral detachment from the acetabular rim indicating a repairable tear. The study group consisted of patients undergoing combined arthroscopic labral refixation and PAO (scope/PAO group: n = 21 patients). Patients undergoing PAO alone (PAO group: n = 52 patients) were included as a comparison. Demographic characteristics, pre- and postoperative radiographic findings, and hip-specific functional outcome scores were recorded. Results: The scope/PAO group was older relative to PAO alone (27 vs 23 years; P = .047). Preoperative computed tomography showed increased acetabular version at the 3-o’clock position in the scope/PAO group relative to PAO alone (median [quartile 1, quartile 3]: 24° [20°, 25°] vs 19° [14°, 24°]; P = .026). PAO operative time, achievement of radiographic correction, or postoperative complications did not differ between groups. Improvements by minimum important change for modified Harris Hip Score, Hip Outcome Score (HOS)–ADL, HOS-Sport, and International Hip Outcome Tool (iHOT-33) were seen in 90%, 79%, 74%, and 100% of patients, respectively, undergoing scope/PAO at most recent follow-up. There was greater improvement from baseline in the iHOT-33 at most recent follow-up in the scope/PAO versus PAO group after adjusting for age and Tönnis grade (mean change ± SD: 48 ± 22 [scope/PAO] vs 37 ± 24 [PAO]; P = .03). Conclusion: Patients undergoing combined arthroscopic labral refixation and PAO were older and had increased acetabular anteversion versus patients undergoing PAO alone. Combined arthroscopic labral refixation and PAO was safe, did not affect PAO operative time or radiographic correction achievement, and may benefit clinical outcomes in this patient subset.