TY - JOUR
T1 - Surgical Decision Making for Acetabular Labral Tears
T2 - An International Perspective
AU - Herickhoff, Paul Kenneth
AU - Safran, Marc Raymond
N1 - Funding Information:
‡Address correspondence to Marc Raymond Safran, MD, Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, Mail Code 6342, Redwood City, CA 94063, USA (email: msafran@stanford.edu). *Penn State Sports Medicine, Pennsylvania State University, State College, Pennsylvania, USA. †Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA. One or more of the authors has declared the following potential conflict of interest and source of funding: P.K.H. has received educational funding from Linvatec and hospitality payments from Smith & Nephew. M.R.S. has received research funding from Ferring Pharmaceuticals, ISAKOS, and ConMed Linvatec; has received fellowship funding from Smith & Nephew, Ossur, ConMed Linvatec, and Biomet; is a consultant for Medacta and Smith & Nephew; and receives royalties from Stryker, DJ Orthopedics, Smith & Nephew, and Howmedica. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was waived by Stanford University.
Publisher Copyright:
© The Author(s) 2018.
PY - 2018/9/1
Y1 - 2018/9/1
N2 - Background: Studies comparing acetabular labral repair with debridement have generally demonstrated better clinical outcomes with repair. However, it is not clear whether hip arthroscopic surgeons agree on the indications for labral repair and debridement, bringing the generalizability of these (and future) studies into question. Purpose: To investigate surgical decision making for acetabular labral tears, with a specific focus on indications for repair or debridement, by performing an international survey of hip arthroscopic surgeons. Study Design: Cross-sectional study. Methods: A total of 35 hip arthroscopic surgeons from around the world were invited to participate in this survey study. Surgeons selected the factors that they consider when deciding to repair or debride acetabular labral tears. For each variable selected, computerized adaptive logic prompted additional questions to better define how that variable affects decision making. Six deidentified intraoperative videos of a variety of labral tears were included to determine the level of agreement between the experts on which labral tears are repairable. Results: The survey response rate was 86%. A majority (77%) of hip arthroscopic surgeons selected the intraoperative appearance of the labrum as the most important factor affecting their decision making. Specific factors affecting surgical decision making included pattern of the labral tear (73% of surgeons), ossification of the labrum (70%), magnetic resonance imaging findings (70%), patient age (63%), activity level (57%), radiographic findings (53%), calcification of the labrum (50%), and thickness of the labrum (47%). Three intraoperative videos had ≥90% agreement for labral repair, while the other 3 had ≤76% agreement. Conclusion: The intraoperative appearance of the labrum is the most important factor affecting surgical decision making. However, different surgeons viewing the same tear arthroscopically may select different treatments. The indications to repair a torn acetabular labrum are highly variable among hip arthroscopic surgeons.
AB - Background: Studies comparing acetabular labral repair with debridement have generally demonstrated better clinical outcomes with repair. However, it is not clear whether hip arthroscopic surgeons agree on the indications for labral repair and debridement, bringing the generalizability of these (and future) studies into question. Purpose: To investigate surgical decision making for acetabular labral tears, with a specific focus on indications for repair or debridement, by performing an international survey of hip arthroscopic surgeons. Study Design: Cross-sectional study. Methods: A total of 35 hip arthroscopic surgeons from around the world were invited to participate in this survey study. Surgeons selected the factors that they consider when deciding to repair or debride acetabular labral tears. For each variable selected, computerized adaptive logic prompted additional questions to better define how that variable affects decision making. Six deidentified intraoperative videos of a variety of labral tears were included to determine the level of agreement between the experts on which labral tears are repairable. Results: The survey response rate was 86%. A majority (77%) of hip arthroscopic surgeons selected the intraoperative appearance of the labrum as the most important factor affecting their decision making. Specific factors affecting surgical decision making included pattern of the labral tear (73% of surgeons), ossification of the labrum (70%), magnetic resonance imaging findings (70%), patient age (63%), activity level (57%), radiographic findings (53%), calcification of the labrum (50%), and thickness of the labrum (47%). Three intraoperative videos had ≥90% agreement for labral repair, while the other 3 had ≤76% agreement. Conclusion: The intraoperative appearance of the labrum is the most important factor affecting surgical decision making. However, different surgeons viewing the same tear arthroscopically may select different treatments. The indications to repair a torn acetabular labrum are highly variable among hip arthroscopic surgeons.
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U2 - 10.1177/2325967118797324
DO - 10.1177/2325967118797324
M3 - Article
C2 - 30263897
AN - SCOPUS:85054516141
SN - 2325-9671
VL - 6
JO - Orthopaedic Journal of Sports Medicine
JF - Orthopaedic Journal of Sports Medicine
IS - 9
ER -