고관절 이형성증 환자에서 비구순 파열의 새로운 관절경적 분류

Abstract

Background: Acetabular labral tear is a cause of pain in patients with symptomatic hip dysplasia. However, no structured grading system exists to evaluate labral tears in these patients. Here, we introduced a new grading system of labral tears in acetabular dysplasia. Methods: We retrospectively reviewed the data of 66 patients who underwent hip arthroscopy for symptomatic hip dysplasia in March 2014–February 2018. Labral tears were classified into four groups according to the presence of labrochondral junction (LCJ) disruption, capsulolabral recess (CLR) disruption and labral displacement. We investigated the radiological / clinical baseline characteristics in each grade and recorded concomitant findings, including rupture of the ligamentum teres, articular cartilage damage, and presence of a paralabral cyst. The surgical options selected according to each grade and clinical outcomes were investigated at final follow-up. Results: Labral tears without instability were classified as grade 1 or 2. A grade 1 labral tear was defined as partial delamination or blistering of the labrum with minimal fraying at the LCJ, whereas a labral tear with LCJ disruption was classified as grade 2. Seven hips (10.6%) were classified as grade 1 labral tears and 10 hips (15.2%) were grade 2 tears. Unstable labral tears with CLR disruption followed by LCJ disruption were classified as grade 3 or 4. Thirty hips (45.5%) were defined as grade 3 labral tears without labral displacement, and 19 hips (28.8%) were grade 4 tears with labral displacement. The symptom duration and preoperative Tonnis osteoarthritis grade were correlated with the baseline characteristics of tear grade (P = 0.017 and P < 0.001, respectively), cartilage damage and the presence of a paralabral cyst also correlated with the severity of the tear as a concomitant injury (P < 0.001 and P = 0.001, respectively). In all groups, the clinical score improved after surgical treatment. Conclusions: The labral tears classification in dysplastic hips advocates the natural course of disease progression and will be useful for determining the labral tear degree in hip dysplasia and predicting treatment prognosis.