Labral repair superior to labral debridement for treatment of femoroacetabular impingement .
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(2):220 Arthroscopy. 2013 Jan;29(1):46-53. doi: 10.1016/j.arthro.2012.07.011Exclusive Author Interview
Dr. Aaron Krych discuss Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement.
36 patients (all female) were randomized to determine which treatment, labral repair or labral debridement, was more effective for femoroacetabular impingement. Patients received either labral repair or labral debridement, and were followed-up at a minimum of one year postoperatively. Results suggest that labral repair displayed superiority in improving clinical outcome and propioception of hip function compared to the debridement procedure. Patient subjective outcome was also superior in the labral repair group.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
2/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
Femoroacetabular impingement arises through either a cam impingement or pincer impingement, which are characterized by an irregularly shaped femoral head/neck or positional problems of the acetabulum, respectively. A number of studies have reported outcomes associated with either labral debridement or labral repair, but there has yet to be a prospective randomized study to compare the two procedures.
¿Cuál era la pregunta principal de la investigación?
Which treatment of femoroacetabular impingement - labral debridement or repair - provided superior results in functional and/or subjective outcome when measured at least 1 year after surgery in female patients?
- HOS for activities of daily living were improved from 68.2 to 91.2 in the repair group and from 60.2 to 80.9 in the debridement group. Both these improvements were significant within-group differences, and the postoperative score was significantly greater for the repair group (p<0.05).
- Improvement in HOS-sports was from 47.5 preoperatively to 88.7 postoperatively in the repair group, and 40.6 to 76.3 in the debridement group. Improvement was significantly greater in the repair group (p<0.05).
- 76% of patients in both groups rated their hip function as "severely abnormal" preoperatively. Postoperatively, 72% (n=13) of repair patients reported "normal" function, 22% (4) "near normal", 6% (1) "abnormal" and none reported "severely abnormal" function. In contrast, 28% (5) of debridement patients experienced "normal" function, 50% (9) "nearly normal", 17% (3) "abnormal" and 6% (1) "severely abnormal". The postoperative ratings were significantly better in the repair group (p=0.046).
¿Qué es lo que más debo recordar?
Patients who were treated with labral repair experienced significantly greater improvements in clinical outcome, and a larger percentage of patients had felt that their hip function had been returned to "normal" or "near normal" when compared to patients who received labral debridement.
¿Cómo afectará esto al cuidado de mis pacientes?
These findings favour the use of labral repair over debridement in the treatment of patients with femoroacetabular impingement. However further, larger-scale RCTs should be conducted before the evidence can be considered conclusive.
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