Diagnosis and treatment of labral tear

Patients Undergoing Revision Hip Arthroscopy With Labral Reconstruction or Augmentation Demonstrate Favorable Patient Reported Outcomes: A Systematic Review

PURPOSE

To review current literature evaluating patient-reported outcomes (PROs) and survivorship in patients undergoing revision hip arthroscopy with labral reconstruction or augmentation.

METHODS

A systematic review was performed with the following key words: (revision) AND (hip OR femoroacetabular impingement) AND (arthroscopy OR arthroscopic) AND (reconstruction OR augmentation OR irreparable). PubMed, Cochrane Trials, and Scopus were queried in October 2022 using the criteria established in the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Studies were included if they involved patients undergoing revision hip arthroscopy with labral reconstruction or augmentation and reported preoperative and postoperative PROs at minimum 2-year follow-up. Only original research articles were included. Survivorship was defined as a nonconversion to total hip arthroplasty. Outcomes present in 3 or more studies underwent further statistical analysis with forest plots. Heterogeneity of studies was evaluated using the I2 statistic.

RESULTS

Five studies were reviewed, including 359 revision hip arthroscopies (335 with complete follow-up) with a follow-up that ranged from 2.2 to 5.2 years. Four studies reported on outcomes after revision labral reconstruction and 1 study reported on labral augmentation. Two out of 5 included studies evaluated for statistical significance between preoperative and postoperative outcomes. Three out of 5 studies reported a rate of at least 70% for achieving minimal clinically important difference in at least 1 PRO. At minimum 2-year follow-up, survivorship ranged from 93.5% to 100%.

CONCLUSIONS

Patients that underwent revision hip arthroscopy with labral reconstruction or augmentation demonstrated improvement in PROs with mixed rates of achieving clinical benefit and rates of survivorship at minimum 2-year follow-up ranging from 93.5% to 100%.

LEVEL OF EVIDENCE

Level IV, systematic review of level III to IV studies.

Comparison of 3T MR arthrography and 3T MRI in intra-articular hip pathology: a cost-analysis

BACKGROUND

MR arthrography (MRA) has previously been the radiological gold standard for investigating labral and chondral lesions of the hip joint. In recent years, 3T MRI has demonstrated comparable accuracy, being adopted as the first-line imaging investigation in many institutions.

AIMS

We compare the associated increased cost and radiation dose of the fluoroscopic component of the MRA compared to MRI.

METHODS

In this retrospective review over 2 years, 120 patients (mean age 27.3 years ± 13.2, range 8-67) underwent 3T MRA or non-contrast 3T MRI. Three musculoskeletal radiologists reported the data independently. Primary objectives included cost-comparison between each and radiation dose of the fluoroscopic component of the MRA. Secondary objectives included comparing detection of pathology involving the acetabular labrum, femoral cartilage, and acetabular cartilage.

RESULTS

Then, 58 (48%) underwent 3T MRA and 62 (52%) patients underwent 3T MRI. The added cost of the fluoroscopic injection prior to MRA was €116.31/patient, equating to €7211.22 savings/year. MRA was associated with a small radiation dose of 0.003 mSv.

CONCLUSIONS

Transitioning from 3T MRA to 3T MRI in the investigation of intra-articular hip pathology increases cost savings and reduces radiation dose.

No Difference in Most Reported Outcome Measures for Allograft Versus Autograft for Hip Labral Reconstruction: A Systematic Review of Comparative Studies

PURPOSE

To systematically review studies comparing outcomes of allograft versus autograft for hip labral reconstruction.

METHODS

A systematic review following guidelines established by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) was performed in 3 databases using the terms "labrum," "hip," "acetabulum," "reconstruction," "augmentation," "allograft," and "autograft." Data on study characteristics, patient demographic characteristics, follow-up time, patient-reported outcomes (PROs), rates of revision surgery, and rates of conversion to total hip arthroplasty (THA) were collected.

RESULTS

Three studies were included, with Methodological Index for Non-randomized Studies (MINORS) scores ranging from 17 to 23. Among 92 patients receiving allografts, the mean ages ranged from 30.6 to 34.8 years; mean follow-up times, from 34.6 to 66.1 months; revision rates, from 0% to 23.6%; and conversion-to-THA rates, from 0% to 20%. Among 185 patients receiving autografts, the mean ages ranged from 34.6 to 35.9 years; mean follow-up times, from 32.7 to 80.8 months; revision rates, from 0% to 7.3%; and conversion-to-THA rates, from 0% to 6.7%. One study reported significantly higher revision rates in the allograft group. All studies reported no statistically significant differences in postoperative PROs, and all postoperative PROs significantly improved compared with preoperative PROs. Rates of achievement of the minimal clinically important difference and patient acceptable symptomatic state, reported by 1 study, were statistically similar between the 2 groups and ranged from 55.6% to 100% for the allograft group and from 53.8% to 84.6% for the autograft group.

CONCLUSIONS

There were no significant differences between allograft and autograft patients in terms of postoperative PROs; however, all PRO measures were slightly higher in allograft patients. Both revision and conversion-to-THA rates were higher in allograft patients in 2 studies, with the level of significance being reached in terms of revision in 1 study. The third study reported zero revisions and conversions to THA in allograft and autograft patients.

LEVEL OF EVIDENCE

Level III, systematic review of Level II and III studies.

A comprehensive review of hip arthroscopy techniques and outcomes

Transforming the orthopedic landscape, hip arthroscopy pioneers a minimally invasive surgical approach for diagnosing and addressing hip pathologies. With its origins dating back to Burman's 1931 cadaveric study, this groundbreaking technique gained clinical relevance in 1939 through Takagi's report. However, the 1980s marked the actual emergence of hip arthroscopy for treating a wide range of hip disorders. Now, a staple in modern orthopedics, hip arthroscopy empowers patients with previously undiagnosed and untreated hip conditions, enabling them to obtain relief and reclaim their lives. By employing a compact camera and specialized tools, surgeons expertly navigate the hip joint, performing procedures from excising loose bodies and mending labral tears to addressing femoroacetabular impingement and tackling other intricate issues. This innovative approach has dramatically elevated patients' quality of life, allowing them to embrace targeted treatments and resume daily activities without resorting to lifestyle alterations.

The correlation between hip alpha angle and acetabular labral tear location and size: A cross-sectional study

BACKGROUND

Explore the correlation between hip morphology and labral tear location/size.

METHODS

This retrospective study analyzed patients with hip pain who received magnetic resonance (MR) arthrography at our institution, between January 2017 and December 2020. Imaging analysis includes labral tear location and size, and hip morphology measurement with alpha angle, lateral center-edge (CE) angle, anterior CE angle, and femoral neck version. The correlation between hip morphology angles and labral tear location/size was evaluated using multiple regression, followed by stratification analysis with Chi-square test to investigate interactions between the variables.

RESULTS

A total of 103 patients (105 hips) with hip pain who received MR arthrography (mean age, 50 years ± 15 [SD]) were included, with mean alpha angle of 57.7° ± 9.9° [SD], mean lateral CE angle of 32.6° ± 6.8° [SD], mean anterior CE angle of 58.2° ± 8.1° [SD], mean femoral neck version of 17.1° ± 8.2° [SD]. Large alpha angle (>57°) and older age were both correlated with superior and posterosuperior labral tear incidence ( p < 0.05) and larger tear size ( p < 0.05). Furthermore, alpha angle is significantly correlated with superior labral tear incidence in young-age subgroup (age <45 years) ( p < 0.05), also significantly correlated with posterosuperior labral tear incidence and larger tear size in middle-age subgroup (45 ≤ age ≤ 60 years) ( p < 0.05).

CONCLUSION

A large alpha angle (>57°) is significantly correlated with increased incidence of superior and posterosuperior labral tear, and larger tear size in patients with hip pain, and the relationships depend on age.

The Evaluation of the Balance Test and MuscleLab Test for the Early Detection of Femoroacetabular Impingement

Femoroacetabular impingement (FAI) is a common source of hip pain affecting a wide range of subjects. In this work, we assessed two tests, namely the balance test and the MuscleLab test, in comparison with the flexion-abduction-external rotation (FABER) and flexion-adduction-internal rotation (FADIR) tests, in order to evaluate the functionality of the neural-musculoskeletal system of the subjects affected by FAI based on the measurement of biomechanical parameters. Our goal was to investigate the early detection of an altered hip joint and to monitor pathology progression over time. A total of 52 subjects, 29 females and 23 males, with an average age of 42 ± 13 years presenting hip impingement diagnosed using X-ray, were enrolled. Twenty-eight patients without signs of hip impingements were used as the control group. The balance test, which evaluates the capacity of a person to keep the orthostatic position against terrestrial gravity, and the MuscleLab test, which measures the force and power generated by active muscles during a movement, as well as FABER and FADIR tests, were performed in each subject. The balance and MuscleLab tests presented 100% sensitivity and higher sensitivity in FAI diagnosis, with 72.9% and 70.4%, respectively, in comparison with those obtained using FABER and FADIR tests, with 59.6% and 67.3%, respectively. The evaluation of the neural-musculoskeletal system using the balance and MuscleLab tests can help in the early detection of the severity of hip impingements and the assessment of non-operative treatments used over time.

Care for the patient with hip pain

ABSTRACT

Hip pain is a common and sometimes disabling condition that affects adults in the primary care setting. The NP must understand the assessment, diagnosis, and treatment options for patients with hip pain. Proper care of these patients often involves conservative medical management and coordination with physical therapy.

Acetabular Cartilage Lesions Predict Inferior Mid-Term Outcomes for Arthroscopic Labral Repair and Treatment of Femoroacetabular Impingement Syndrome

PURPOSE

To analyze the effect of acetabular chondrosis at a minimum of 2 years following hip arthroscopy in patients undergoing labral repair and treatment of femoroacetabular impingement.

METHODS

From 2014 to 2017, patients undergoing arthroscopic labral repair were prospectively enrolled in a multicenter hip arthroscopy registry. The registry was retrospectively queried for primary labral repair patients with complete 2-year outcomes and a Tonnis grade of less than 2. Patients were grouped according to severity of articular cartilage damage noted intraoperatively using the Beck classification system: none, low-grade (Grade 1 or 2), or high-grade (Grade 3 or 4) damage. A Kruskal-Wallis test and post hoc Dunn's test with Holm correction compared 2-year postoperative outcome scores of the iHOT-12 scale between groups. The proportion of patients in each cohort who achieved the clinically significant thresholds of the minimum clinically important difference (MCID), patient-acceptable symptom scale, and substantial clinical benefit (SCB) were analyzed. Multivariate logistic regression models identified predictors of achieving clinical thresholds while controlling for demographic variation.

RESULTS

422 patients met inclusion criteria, from which 347 completed 2-year outcomes. All groups experienced improvement in iHOT-12 scores from baseline to follow-up (P < .001). iHOT-12 scores at follow-up were inferior for Low-Grade Damage and High-Grade Damage Groups relative to the No Damage Group (P = .04; P = .03). When accounting for age, body mass index, gender, and preoperative iHOT-12 scores in logistic regression models, the presence of high-grade lesions was a negative predictor for achieving SCB (OR [95% CI], 0.54 [0.29-0.96]) and low-grade lesions a negative predictor for achieving MCID (0.50 [0.27-0.92]. Among patients with high-grade lesions, there was no significant difference in 2-year iHOT-12 scores between those undergoing chondroplasty (n = 50) and those undergoing microfracture (n = 14) (P = .14).

CONCLUSIONS

Acetabular cartilage damage portends inferior patient-reported outcomes 2 years after primary labral repair and treatment of femoroacetabular impingement. The presence of cartilage lesions was a negative predictor of individual achievement of several clinical thresholds.

LEVEL OF EVIDENCE

III, Retrospective comparative cohort.

Symptom duration predicts inferior mid-term outcomes following hip arthroscopy

INTRODUCTION

Studies have demonstrated a negative relationship between the length of time with symptoms and patient-reported outcome measures in primary hip arthroscopy. Our aim was to expand the generalizability of this finding with a multi-center cohort.

METHODS

A multi-center hip arthroscopy registry was queried for patients undergoing primary hip arthroscopy from 2014 to 2017. Patients were stratified according to whether pre-operative symptom duration exceeded two years or did not exceed two years. A Wilcoxon rank sum test was performed for differences in two year post-operative outcome scores. Logistic regression models analyzed the influence of symptom duration on achieving clinically meaningful thresholds (minimum clinically important difference, patient-acceptable symptom state, substantial clinical benefit) when controlling for baseline scores, age, BMI, and sex.

RESULTS

Seven hundred forty-four patients met the inclusion criteria, from which 620 had complete outcomes information. The mean ± SD 2-year iHOT-12 scores of patients with symptom duration greater than two years (69 ± 26) were significantly lower than patients with symptom duration less than two years (77 ± 23) (Dunn test, p < 0.001). Chronic duration of pain was a negative predictor of achieving iHOT-12 MCID (0.47 [0.31-0.72]), PASS (0.53 [0.37-0.76]), and SCB (0.67 [0.47-0.94]).

CONCLUSION

When controlling for differences in baseline demographic factors and pre-operative iHOT-12 scores, patients with chronic pain report poorer functional outcomes at mid-term follow-up. These results suggest that chronic pain predicts inferior outcomes from primary hip arthroscopy and that surgical intervention at earlier time points may be beneficial in achieving better outcomes.

Labral Degeneration Predicts Inferior Mid-Term Outcomes in Hip Labral Repair: A Multicenter Comparative Analysis

PURPOSE

To analyze and compare the mid-term outcomes of hip arthroscopy for patients with and without labral degeneration from multiple orthopaedic centers. The purpose of this research is to develop an understanding of the impacts of labral degeneration on patient outcomes following arthroscopic treatment of labral tears.

METHODS

A prospective multicenter hip arthroscopy registry was queried for primary surgeries from January 2014 to October 2017 with completed 2-year International Hip Outcome Tool-12 (iHOT-12) reports. Patients were placed into cohorts based on the presence or absence of labral degeneration noted intraoperatively during hip arthroscopy. Degeneration was defined as yellowing, ossification, or calcification present in at least 50% of the labrum. Differences in baseline variation between groups were assessed with a Wilcoxon rank-sum test or χ² test. Two-year outcomes were assessed with iHOT-12. Multivariate logistic regression models were fitted while controlling for age, body mass index, sex, and preoperative iHOT-12 scores to identify significant predictors of achieving the clinically significant thresholds of minimal clinically important difference, substantial clinical benefit, and patient-acceptable symptom scale.

RESULTS

In total, 735 patients met inclusion criteria, of whom 613 had complete outcomes information. Relative to the control group, the labral degeneration group was significantly older (mean age 44 ± 11 years vs 33 ± 12 years; P < .01). Both groups experienced statistically significant improvement in iHOT-12 scores from baseline to final follow-up (P < .001); however, patients with labral degeneration reported inferior 2-year iHOT-12 scores when compared with patients without degeneration (P < .001). In the logistic regression models, labral degeneration was a significant negative predictor of achieving iHOT-12 minimal clinically important difference (odds ratio [OR] 0.47; 95% confidence interval [95% CI] 0.28-0.79), patient acceptable symptom state (OR 0.50; 95 CI 0.32-0.77), and substantial clinical benefit (OR 0.58; 95% CI 0.37-0.89).

CONCLUSIONS

The results of our study conclude that patients with nondegenerative labral tissue at the time of repair have superior patient-reported outcomes at mid-term follow-up. The presence of labral degeneration was a negative predictor of achieving clinically significant thresholds after controlling for patient age, body mass index, sex, and baseline iHOT-12 scores.

LEVEL OF EVIDENCE

III, retrospective comparative prognostic trial.

Caring for adults with hip pain

This article discusses the pathophysiology, assessment techniques, and management of hip pain in adults and the role of nurses in caring for patients with hip pain.

Patterns of labral tears and cartilage injury are different in femoroacetabular impingement and dysplasia

The aim of this study was to assess injury patterns and risk factors of the acetabular labrum and associated cartilage in patients with femoroacetabular impingement (FAI) versus dysplasia. We retrospectively reviewed 137 patients diagnosed with labral tears and FAI or dysplasia (74 or 63 cases, respectively) through an arthroscopic procedure. Labral and concomitant cartilage injuries were evaluated. Demographics and radiological variables [lateral center-edge angle (LCEA), anterior center-edge angle, acetabular index (AI), acetabular version and alpha angle] were evaluated as risk factors for labral and cartilage injuries. Detachment of acetabular cartilage with intact labro-cartilaginous junction was the most common in dysplasia, whereas cartilage delamination from the labro-cartilaginous junction was more common in FAI (P < 0.001). A higher body mass index was significantly associated with delamination injury in FAI (odds ratio 1.226; 95% CI 1.043–1.441; P = 0.013). A significant correlation was evident between detachment injury and a larger AI in dysplasia (odds ratio 1.127; 95% CI 1.000–1.270; P = 0.049). In addition, symptom duration was positively correlated with the extent of labral tearing in FAI (P = 0.013), whereas the smaller LCEA was correlated with the larger extent of labral tearing in dysplasia (P = 0.044). FAI and dysplasia patients exhibited different labral and cartilage injury patterns. Increased body mass index was correlated with delamination injury in FAI, whereas an increased AI was associated with detachment injury in dysplasia. Greater tearing was associated with a longer symptom duration in FAI, and a decreased LCEA was a risk factor for the extent of tearing in dysplasia.

Level of evidence

Level III. Case–control study.

Can Non-Contrast 3T MRI scans predict the type of labral procedure in hip arthroscopy?

PURPOSE

The study proposed a simple classification system that aimed at predicting the labral procedure during hip arthroscopy using images from unenhanced 3T MRI scans.

PATENTS AND METHODS

Forty patients undergoing hip arthroscopy had their MRI scans reviewed pre-operatively by one of two senior radiologists and classified into: type 1: stable labrum with intra-substance degeneration (no labral repair required), type 2: unstable labrum, no intra-substance degeneration (labral repair required), or type 3: unstable labrum with intra-substance degeneration (Labral repair not feasible). Hip arthroscopy is carried out by one of two surgeons and classified accordingly while blinded to the radiologists' assessment.

RESULTS

The pre-operative radiological classification managed to predict the labral procedure in 29 cases out of 40 (72.5%). The gamma value was 0.83, and the kappa value was 0.46 denoting moderate agreement. The inter-class correlation coefficient was 0.52 indicating moderate reliability.

CONCLUSION

The proposed classification showed a moderate agreement between the radiological findings and arthroscopic findings. As we cannot accurately correlate the MRI findings with the type of surgical management, the surgeon should be prepared for all scenarios of labral procedures.

LEVEL OF EVIDENCE

Level IV (case series).

Hip Labral Reconstruction with Capsular Autograft Augmentation

Multiple treatment options are available for patients presenting with a torn or deficient acetabular labrum. Biomechanical studies have demonstrated that the acetabular labrum may play a role in decreasing the risk of osteoarthritis and in maintaining long-term hip kinematics and stability. As such, repair or reconstruction of the labrum is often preferred over resection or debridement. In instances of a hypoplastic labrum, labral reconstruction or augmentation may be necessary even in a primary setting. Although reconstruction is a technique that should be in any hip arthroscopist's toolkit, allografts can be expensive and may not always be available when needed. In this Technical Note, we describe a labral augmentation with capsular autograft that diminishes donor-site morbidity associated with fascia lata autografts. This technique enables incorporation of healthy capsular tissue that allows for the recreation of the suction seal while avoiding some of the technically challenging aspects and costs of the conventional allograft labral reconstruction.

Acetabular margin changes in feline hip joints - Implications for radiologic diagnosis and development of osteoarthritis

The development and early morphological features of feline hip osteoarthritis (OA) are largely unknown. Tears in the acetabular labrum and at the chondrolabral transition zone are suggested to be important in the pathogenesis of human hip OA, but in cats such lesions have not been described. We investigated associations between computed tomography (CT)-detected joint changes and microscopic articular cartilage lesions, the distribution of detected changes, and histologically evaluated the acetabular margin (AM) in hip joints from 20 cats. Histologic evaluation was undertaken on at least one joint from each cat. CT-detected joint changes and articular cartilage lesions were graded and the histological appearance of CT-detected osteophytes evaluated. The majority of CT-detected lesions and cartilage lesions were mild. Whole-joint CT scores and AM osteophyte CT scores showed moderate to strong correlation with cartilage scores. The odds were higher for presence of CT-detected osteophytes in craniodorsal, cranial, cranioventral, ventral and dorsal AM regions. Peripheral acetabular regions showed higher cartilage lesion grades than central regions. Tears, seen as fissures/clefts, in labral and perilabral tissues were common. CT-detected AM osteophytes morphologically presented as pointed sclerotic bone, spur-shaped bone or rounded chondro-osteophytes. The results suggest that CT is a valuable tool for diagnosing early feline hip OA. CT-detected osteophytes showed variable histologic morphologies, which may implicate different disease mechanisms and/or disease stages. Tears in the AM could represent an early event in feline hip OA and this warrants further investigation.

Surgical Treatment of Labral Tears: Debridement, Repair, and Reconstruction

Advances in hip preservation surgery have to lead to increased utilization of hip arthroscopy. With this, there has also been a growth in the understanding of various hip conditions, therefore, leading to an increase in hip conditions amenable to arthroscopic intervention. The acetabular hip labrum has been at the forefront of arthroscopic advances in the hip. The labrum is important for hip stability, provision of the suction seal, and joint proprioception. Given the labrum's central role in hip biomechanics, there is increasing emphasis on labral preservation in the form of debridement and repair. In revision settings, advanced techniques such as labral augmentation and reconstruction may play a role in the management of labral pathology. Appropriate management of the hip labrum at the time of surgery can be an important mediator of the outcome. As such, an understanding of the evolving evidence base and surgical indications and techniques are integral to the treatment and management of labral pathology.

All-suture anchors in arthroscopic acetabular labral repair: our experience

Background:

Over the past years, the role of the acetabular labrum in hip joint biomechanics and its relations with joint health has been of particular interest. There is a good clinical improvement of patients in whom the acetabular labrum is preserved during arthroscopic hip surgery. The purpose of this study is to report the results of arthroscopic repair of labral tears at a medium term follow up.

Materials and methods:

We performed a retrospective review of all cases that underwent hip arthroscopy at our Institution from January 2013 until December 2018. There were 24 patients, 13 males and 11 females, and their mean age at the time of surgery was 29, 42 years (range, 19 to 43 years). All patients were treated by the same surgeon with an extracapsular OUT-IN approach. Suture was performed using a non-absorbable suture anchor all-suture. Clinical assessment was performed at December 2019 using a modified Harris hip score (mHHS), hip outcomes score activities of daily living (HOS ADL), hip outcomes score activities of sport scale (HOS SS). All patients with acetabular labrum injury had femoro-acetabular impingement.

Results:

The mean overall values in the preoperative period were 67.21 ± 10.31 for mHHS, 70.04 ± 12.11 for HOS-ADL and 60.06 ± 14.58 for HOS –SS. The results obtained in the re-evaluations of patients in December 2019 with a mean follow-up of 38, 3 months (minimum 1 year) are on average 82.17 ± 11.36 for mHHS, 83.00 ± 12.80 for HOS-ADL and 76.09 ± 18.52 for HOS-SS.

Conclusions:

The progress of knowledge and the advancement of diagnostic and therapeutic skills has led to a greater awareness of the importance of treating acetabular labrum tears. Arthroscopic treatment with suture appear to be a good option for these patients and we had encouraging results in our center. (www.actabiomedica.it)

Arthroscopic labral debridement versus labral repair for patients with femoroacetabular impingement: A meta-analysis

OBJECTIVE

Femoroacetabular impingement (FAI) is a common cause of hip pain and even tearing of the acetabular labrum in young adults and athletes. Either arthroscopic labral debridement (LD) or labral repair (LR) technique for FAI patients is needed to choose. We conducted this systematic review and meta-analysis to compare the clinical outcomes of arthroscopic LD versus LR intervention.

METHODS

The five studies were acquired from PubMed, Medline, Embase, and Cochrane Library. The data were extracted by two of the coauthors independently and were analyzed by RevMan5.3. Mean differences (MDs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration's Risk of Bias Tool and Newcastle-Ottawa Scale were used to assess risk of bias.

RESULTS

Four observational studies and one prospective randomized study were assessed. The methodological quality of the trials indicated a low to moderate risk of bias. The pooled results of Non-Arthritic Hip Score (NAHS), failure rate of surgeries and complications showed that the differences were not statistically significant between the two interventions. The difference of modified Harris Hip Score (mHHS), the Visual Analogue Scale (VAS) score and satisfaction rate was statistically significant between LD and LR intervention, and LR treatment was more effective. Sensitivity analysis proved the stability of the pooled results and there were too less included articles to verify the publication bias.

CONCLUSIONS

Hip arthroscopy with either LR or LD is an effective treatment for symptomatic FAI. The difference of mHHS, VAS score, and satisfaction rate was statistically significant between LD and LR intervention, and arthroscopic LR could re-create suction-seal effect, potentially reduce microinstability, which demonstrated a trend toward better clinical efficacy and comparable safety compared with LD. The arthroscopic LR technique is recommended as the optical choice for acetabular labrum tear with FAI.