UNASSIGNED: Despite focus on surgical preservation of the chondrolabral junction (CLJ), the transition zone between the acetabular cartilage and labrum, the association between severity of CLJ breakdown and functional outcomes after hip arthroscopy remains unexplored.
UNASSIGNED: To assess the influence of CLJ breakdown on patient-reported outcome measures (PROMs) at a 24-month follow-up after hip arthroscopy for symptomatic labral tears.
UNASSIGNED: Cohort study; Level of evidence, 3.
UNASSIGNED: A retrospective review of prospectively collected data was conducted to identify patients ≥18 years of age with a minimum 24-month follow-up who underwent hip arthroscopy by a single surgeon for the treatment of symptomatic labral tears secondary to femoroacetabular impingement. The Beck classification of transition zone cartilage was used to grade CLJ damage; patients with grades 0 to 2 were stratified into the mild CLJ damage cohort, and those with grades 3 and 4 were stratified into the severe CLJ damage cohort. PROMs were collected at baseline and at 3, 6, 12 months, and annually thereafter postoperatively. Linear mixed-effects models were used to compare PROMs. Rates of achieving clinically meaningful thresholds and subsequent surgery rates were also compared.
UNASSIGNED: In total, 198 patients met the inclusion criteria, with a mean follow-up of 3.54 ± 1.26 years. A total of 95 patients with severe CLJ damage (mean age, 34.9 ± 10.5 years) were compared with 103 patients with mild CLJ damage (mean age, 38.2 ± 11.9 years). Hip Outcome Score-Activities of Daily Living (HOS-ADL), Non-Arthritic Hip Score (NAHS), and visual analog score for pain were inferior in the severe CLJ group at enrollment and all follow-up time points (P≤ .05). However, patients with severe CLJ breakdown exhibited greater improvements in HOS-ADL and NAHS at the 24-month follow-up and achieved clinically meaningful thresholds at equivalent rates to patients with mild CLJ breakdown. Subsequent surgery rates were 6.8% and 12.6% in patients with mild versus severe CLJ damage, respectively (P = .250).
UNASSIGNED: Severe CLJ breakdown is associated with increased pain and decreased functional level preoperatively and up to 24 months after hip arthroscopy. Despite this, patients with severe CLJ breakdown experienced greater improvements in functional outcomes at a 24-month follow-up and achieved clinical thresholds at similar rates to patients with mild CLJ damage. Thus, while worse baseline pain and functional levels may indicate severe CLJ breakdown, these patients still benefit substantially from hip arthroscopy.

UNASSIGNED: Arthroscopic treatment of femoroacetabular impingement (FAI) and symptomatic labral tears confers short- to midterm benefits, yet further long-term evidence is needed. Moreover, despite the physiological and biomechanical significance of the chondrolabral junction (CLJ), the clinical implications of damage to this transition zone remain understudied.
UNASSIGNED: To (1) report minimum 8-year survivorship and patient-reported outcome measures after hip arthroscopy for FAI and (2) characterize associations between outcomes and patient characteristics (age, body mass index, sex), pathological parameters (Tönnis angle, alpha angle, type of FAI, CLJ breakdown), and procedures performed (labral management, FAI treatment, microfracture).
UNASSIGNED: Cohort study; Level of evidence, 3.
UNASSIGNED: This retrospective cohort study included patients who underwent primary hip arthroscopy for symptomatic labral tears secondary to FAI by a single surgeon between 2002 and 2013. All patients were ≥18 years of age with minimum 8-year follow-up and available preoperative radiographs. The primary outcome was conversion to total hip arthroplasty (THA), and secondary outcomes included revision arthroscopy, patient-reported outcome measures, and patient satisfaction. CLJ breakdown was assessed using the Beck classification. Kaplan-Meier estimates and weighted Cox regression were used to estimate 10-year survivorship (no conversion to THA) and identify risk factors associated with THA conversion.
UNASSIGNED: In this study of 174 hips (50.6% female; mean age, 37.8 ± 11.2 years) with mean follow-up of 11.1 ± 2.5 years, the 10-year survivorship rate was 81.6% (95% CI, 75.9%-87.7%). Conversion to THA occurred at a mean 4.7 ± 3.8 years postoperatively. Unadjusted analyses revealed several variables significantly associated with THA conversion, including older age; higher body mass index; higher Tönnis grade; labral debridement; and advanced breakdown of the CLJ, labrum, or articular cartilage. Survivorship at 10 years was inferior in patients exhibiting severe (43.6%; 95% CI, 31.9%-59.7%) versus mild (97.9%; 95% CI, 95.1%-100%) breakdown of the CLJ (P < .001). Multivariable analysis identified worsening CLJ breakdown (weighted hazard ratio per 1-unit increase, 6.41; 95% CI, 3.11-13.24), older age (1.09; 95% CI, 1.04-1.14), and higher Tönnis grade (4.59; 95% CI, 2.13-9.90) as independent negative prognosticators (P < .001 for all).
UNASSIGNED: Although most patients achieved favorable minimum 8-year outcomes, several pre- and intraoperative factors were associated with THA conversion; of these, worse CLJ breakdown, higher Tönnis grade, and older age were the strongest predictors.

To compare the outcomes of arthroscopic labral repair using looped type suture with a matched-pair selective labral debridement with a minimum 2-years follow-up.
We identified 378 patients undergoing primary arthroscopic labral repair using loop-suture and selective labral debridement from January 2, 2018, to December 28, 2020. The labral repair group was matched 1:1 to a selective labral debridement control group by age, sex, body mass index, follow-up period, lateral center-edge angle, Tönnis grade, and preoperative joint space. Before surgery, 3-Tesla radial magnetic resonance imaging with a 3-dimensional double-echo steady-state sequence was obtained following failed nonoperative treatment lasting more than 3 months. Follow-up imaging was conducted at a minimum of 2 years. In both groups, the ratio of positive slices in which a disrupted chondrolabral junction was observed between the 2 o\'clock and 11 o\'clock positions was measured. Patient-reported outcome scores included the Harris Hip Score, visual analog score, Hip Outcome Score Activities of Daily Living Subscale, and Hip Outcome Score of Sport-Specific Subscale.
In total, 76 patients of the repair group were matched to 76 controls with a minimum 2-years follow-up (repair vs control: 2.6 ± 0.4 vs 2.6 ± 0.4 years, P = .775). The repair group experienced a 2-fold improvement (0.6 ± 0.1 to 0.3 ± 0.1, P＜.001). Although the selective debridement group experienced a 3-fold improvement (0.3 ± 0.1 to 0.1 ± 0.1, P＜.001). Significant improvement of the patient-reported outcome was shown in both groups at final follow-up without significant difference between the 2 groups.
The mid-term clinical outcomes are comparable between the labral repair using looped type suture and selective labral debridement group. Although a gap between the labrum and articular cartilage may appear in 3-dimensional double-echo steady-state magnetic resonance imaging results after labral repair, it does not correspond with clinical outcomes.
Level III, retrospective comparative study.

UNASSIGNED: The preservation of the native labral vascularization is assumed to be the potential advantage of acetabular labral augmentation, the effect of which remains unknown.
UNASSIGNED: To identify the vascular distribution within the labral autograft and its effect on the healing process between labral augmentation (AUG) and reconstruction (RECON) in a porcine model.
UNASSIGNED: Controlled laboratory study.
UNASSIGNED: A total of 36 pigs randomly underwent unilateral labral augmentation or reconstruction (AUG group, n = 18; RECON group, n = 18). The pigs were randomly sacrificed at 6, 12, and 24 weeks postoperatively. The labral autografts were harvested for macroscopic evaluation and histologic assessment. The labral autograft was zoned into 2 halves to observe the vascular distribution: the capsular half (zone I) and the articular half (zone II). Each zone was divided into 2 parts: the peripheral part (IA and IIA) and the part attached to the acetabulum (IB and IIB).
UNASSIGNED: At 6 weeks, there existed more vascular ingrowth in zone I, whereas zone IIB appeared nearly avascular in both groups. At 12 weeks, the area with the greatest vascularity was zone II in the RECON group and zone IA in the AUG group. The vascularity was concentrated at zones IA and IIA in both groups at 24 weeks. The labral autografts were hypertrophic with sufficient filling of the labral defect in both groups at 6 weeks. At 12 weeks, an insufficient volume of the articular half was observed in 3 of 6 labral autografts in the RECON group, while all autografts remained well integrated with the chondrolabral junction in the AUG group. At 24 weeks, unsatisfactory merging of the labral autograft with the cartilage at the articular side was found in 2 of 6 labral autografts in the RECON group, which was not observed in the AUG group despite the sufficient volume of autografts labrum in both groups.
UNASSIGNED: Slow vascular ingrowth within the articular half might account for the poor healing of the reconstructed labral autograft. Labral augmentation provides the possibility of better tissue healing because of the preservation of the original chondrolabral junction compared with labral reconstruction.
UNASSIGNED: Labral augmentation might be a feasible alternative to labral reconstruction under the condition of viable labral remnants.

The purpose of this study was to evaluate the histologic features of the caprine labrum, with emphasis on the chondrolabral junction, with the goal of informing the feasibility of the goat as an animal model. The left hip joint of six adolescent Spanish goats (Capra pyrenaica) was harvested and subjected to anatomical and histological assessments. Human acetabular and femoral head samples, collected during total hip arthroplasty, served as comparison samples. The caprine labrum was found to consist of mostly type I collagen with uniform crimp, with an average crimp length of 20.8 µm. Upon histological assessment, acetabular articular chondrocytes were found to express substance-P, especially near or in the chondrolabral junction. And the majority of nonvascular cells expressed α-smooth muscle actin (SMA), with no notable elastin and laminin expression. Human labrum demonstrated similar staining patterns. Overall, the goat hip was found to be homologous to the human hip, demonstrating potential as a useful animal model for future studies. This is the first report of a crimped collagen structure in the labrum. Crimped type I collagen at the chondrolabral junction imparts an extension-recovery property which allows for toleration of stress without permanent deformation, underlying the importance of its preservation during surgery. The high expression of substance-P reflects the degree to which the labrum is innervated. Finally, the expression of α-SMA with contractile characteristics could indicate the potential for chondrocyte (i.e., myochondrocytes) modeling of the extracellular matrix. Statement of Clinical Significance: Establishment of a large animal model and deeper knowledge of the histological composition of the hip joint will enhance our study of the acetabular labrum, including repair techniques. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:1070-1080, 2020.

The importance of the acetabular labrum has been increasingly recognized, playing a critical role in both normal anatomy and abnormal pathology of the hip joint. The labrum increases acetabular surface area and volume, providing a stable and durable articulation. The fibrocartilaginous composition affords a tissue capable of a lifetime of normal function in the absence of significant osseous pathology. In the setting of femoroacetabular impingement (FAI) or dysplasia, bony biomechanics may cause labral injury, which may translate to patient symptoms. Long-term consequences of labral tears may include joint degeneration. Labral preservation surgery emphasizes retention of the form and function of the labrum, prioritizing labral repair (in the presence of reparable tissue) and reconstruction (in the absence of reparable tissue) over debridement. Patient-reported outcomes have consistently demonstrated significantly better results following labral repair versus debridement. In conjunction with correction of osseous abnormalities, labral surgery can improve short-term outcomes and potentially reduce the risk of long-term osteoarthritis.