Arthroscopic surgery for femoroacetabular impingement has limited effect in patients with Tönnis grade-2 at 4-year follow-up

ABSTRACT We aimed to compare clinical and radiologic outcomes in patients with cam-type femoroacetabular impingement (FAI), with and without a partial ligamentum teres (LT) tear, who underwent hip arthroscopy (HA) with ≥10 years of follow-up. Among the patients who underwent HA for a cam-type FAI diagnosis with a labral tear, 28 patients (28 hips) with a partial LT tear and 87 patients (99 hips) with an intact LT were assigned to Groups A and B, respectively. All patients underwent partial labral debridement and femoroplasty. Debridement and thermal shrinkage were performed for LT tears. The grade of chondral damage was measured intraoperatively. Clinical items were assessed preoperatively and at the last follow-up. Patients’ satisfaction with the surgery and changes in postoperative sports ability in those who had previously been active in sports were assessed at the last follow-up. The Tönnis grade was assessed preoperatively and at the last follow-up for radiologic evaluation. Chondral damage to the acetabular and femoral head detected intraoperatively was significantly different between the groups (P = 0.005 and P < 0.001). At the last follow-up, Group A patients experienced more difficulty performing sports activities than Group B patients (P = 0.056), and significantly, more Group A patients had stopped exercising despite their active participation in sports preoperatively (P = 0.002). Regarding the Tönnis grade, significant differences were found only at the final follow-up (P = 0.020). Patients with partial LT tear showed a higher grade of chondral damage, experienced decreased exercise capacity and had significantly worsened Tönnis grades, suggesting hip osteoarthritis progression compared to those with an intact LT.

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Subchondral drilling for chondral flaps reduces the risk of total hip arthroplasty in femoroacetabular impingement surgery at minimum five years follow-up

Hip International ◽

10.1177/1120700018781807 ◽

2018 ◽

Vol 29 (2) ◽

pp. 191-197 ◽

Cited By ~ 2

Author(s):

Pascal C Haefeli ◽

Moritz Tannast ◽

Martin Beck ◽

Klaus A Siebenrock ◽

Lorenz Büchler

Keyword(s):

Los Angeles ◽

Total Hip Arthroplasty ◽

Femoroacetabular Impingement ◽

Hip Arthroplasty ◽

Hip Dislocation ◽

Harris Hip Score ◽

Control Group ◽

Total Hip ◽

Tönnis Grade

Introduction: The best treatment of acetabular chondral flaps during surgery for femoroacetabular impingement (FAI) is unknown. We asked if subchondral drilling improves clinical and radiographic outcome and if there are factors predicting failure. Methods: We treated 79 patients with symptomatic FAI and acetabular chondral flaps with surgical hip dislocation between January 2000 and December 2007. Exclusion of all patients with previous hip pathology or trauma resulted in 62 patients (80 hips). The chondral flap was slightly debrided in 43 patients/51 hips (control group). In 28 patients/29 hips (study group), additional osseous drilling was performed. 4 patients (5 hips, 6%) were lost to follow-up. Mean follow-up was 9 years (5–13 years). The groups did not differ in demographic data, radiographic parameters or follow-up. Clinical outcome was assessed with the Merle d’Aubigné score, modified Harris Hip Score and University of California Los Angeles activity score and progression of osteoarthritis with the Tönnis grade. Results: No patient underwent conversion to total hip arthroplasty (THA) in the drilling group compared to 7 patients (8 hips, 16%) in the control group ( p = 0.005); in the remaining hips, clinical scores and progression of Tönnis grade did not differ. Increased acetabular coverage, age and body mass index were univariate predictive factors for conversion to THA. No drilling was as an independent predictive factor for conversion to THA (hazard ratio 58.07, p = 0.009). Conclusion: Subchondral drilling under acetabular chondral flaps during surgical treatment of FAI is an effective procedure to reduce the rate of conversion to THA.

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Outcomes of Hip Arthroscopic Surgery in Patients With Tönnis Grade 1 Osteoarthritis at a Minimum 5-Year Follow-up: A Matched-Pair Comparison With a Tönnis Grade 0 Control Group

The American Journal of Sports Medicine ◽

10.1177/0363546517706957 ◽

2017 ◽

Vol 45 (10) ◽

pp. 2294-2302 ◽

Cited By ~ 28

Author(s):

Benjamin G. Domb ◽

Edwin O. Chaharbakhshi ◽

Danil Rybalko ◽

Mary R. Close ◽

Jody Litrenta ◽

...

Keyword(s):

Arthroscopic Surgery ◽

Arthroscopic Treatment ◽

Matched Pair ◽

Harris Hip Score ◽

Control Group ◽

Pair Comparison ◽

Labral Tears ◽

Vas Scores ◽

Tönnis Grade

Background: Studies on midterm outcomes of the arthroscopic treatment of femoroacetabular impingement (FAI) and labral tears with mild osteoarthritis (OA) are limited. Purpose: To evaluate outcomes of the arthroscopic treatment of FAI and labral tears in patients with mild preoperative OA (Tönnis grade 1) at a minimum 5-year follow-up, and to perform a matched-pair comparison to a control group with Tönnis grade 0. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected on patients who underwent hip arthroscopic surgery between February 2008 and April 2011. Inclusion criteria were arthroscopic treatment for FAI and labral tears and having preoperative patient-reported outcome (PRO) scores, including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Hip Outcome Score–Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) scores for pain. Exclusion criteria were workers’ compensation claims, preoperative Tönnis grade ≥2, and previous hip conditions (ipsilateral surgery, slipped capital femoral epiphysis, avascular necrosis, and dysplasia). Patients with minimum 5-year outcomes were eligible for matching on a 1:1 ratio (Tönnis grade 0 vs 1) based on age ±5 years, body mass index ±5 kg/m2, sex, labral treatment, and capsular treatment. Results: Of 356 eligible hips, 292 hips had minimum 5-year outcomes (82%). Eighty-five hips with Tönnis grade 1 were evaluated. At 5-year follow-up, patients with Tönnis grade 1 had significant improvements in all PRO and VAS scores ( P < .0001). The overall satisfaction score was 8.2. The survivorship rate with respect to conversion to total hip arthroplasty for the Tönnis grade 1 group was 69.4% at 5 years, while in the Tönnis grade 0 group, it was 88.4% ( P = .0002). Sixty-two hips with Tönnis grade 0 were matched to 62 hips with Tönnis grade 1. Both groups demonstrated improvements in all PRO and VAS scores from preoperatively to postoperatively ( P < .0001). No significant differences existed between preoperative or postoperative scores or survivorship between the groups. Conclusion: The arthroscopic treatment of FAI and labral tears in patients with Tönnis grade 1 had good results at 5-year follow-up. After controlling for other variables using a matched-pair comparison, patients with Tönnis grade 1 had similar, durable improvements to those with Tönnis grade 0. While strict surgical indications and appropriate expectations are recommended for patients with mild OA, Tönnis grade 1 alone should not be considered a contraindication to hip arthroscopic surgery.

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Multicenter Analysis of Midterm Clinical Outcomes of Arthroscopic Labral Repair in the Hip: Minimum 5-Year Follow-up

The American Journal of Sports Medicine ◽

10.1177/0363546517734180 ◽

2017 ◽

Vol 46 (2) ◽

pp. 280-287 ◽

Cited By ~ 18

Author(s):

Mario Hevesi ◽

Aaron J. Krych ◽

Nick R. Johnson ◽

John M. Redmond ◽

David E. Hartigan ◽

...

Keyword(s):

Clinical Outcomes ◽

Periacetabular Osteotomy ◽

Arthroscopic Surgery ◽

Hip Surgery ◽

Labral Repair ◽

Harris Hip Score ◽

Level Of Evidence ◽

Multicenter Analysis ◽

Tönnis Grade

Background: The technique of hip arthroscopic surgery is advancing and becoming more commonly performed. However, most current reported results are limited to short-term follow-up, and therefore, the durability of the procedure is largely unknown. Purpose: To perform a multicenter analysis of mid-term clinical outcomes of arthroscopic hip labral repair and determine the risk factors for patient outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Prospectively collected data of primary hip arthroscopic labral repair performed at 4 high-volume centers between 2008 and 2011 were reviewed retrospectively. Patients were assessed preoperatively and postoperatively with the visual analog scale (VAS), modified Harris Hip Score (mHHS), and Hip Outcome Score–Sports-Specific Subscale (HOS-SSS) at a minimum of 5 years’ follow-up. Factors including age, body mass index (BMI), Tönnis grade, and cartilage grade were analyzed in relation to outcome scores, and revision rates were determined. Failure was defined as subsequent ipsilateral hip surgery, including revision arthroscopic surgery and open hip surgery. Results: A total of 303 patients (101 male, 202 female) with a mean age of 32.0 years (range, 10.7-58.9 years) were followed for a mean of 5.7 years (range, 5.0-7.9 years). Patients achieved mean improvements in VAS of 3.5 points, mHHS of 20.1 points, and HOS-SSS of 29.3 points. Thirty-seven patients (12.2%) underwent revision arthroscopic surgery, and 12 (4.0%) underwent periacetabular osteotomy, resurfacing, or total hip arthroplasty during the study period. Patients with a BMI >30 kg/m2 had a mean mHHS score 9.5 points lower and a mean HOS-SSS score 15.9 points lower than those with a BMI ≤30 kg/m2 ( P < .01). Patients aged >35 years at surgery had a mean mHHS score 4.5 points lower and a HOS-SSS score 6.7 points lower than those aged ≤35 years ( P = .03). Patients with Tönnis grade 2 radiographs demonstrated a 12.5-point worse mHHS score ( P = .02) and a 23.0-point worse HOS-SSS score ( P < .01) when compared with patients with Tönnis grade 0. Conclusion: Patients demonstrated significant improvements in VAS, mHHS, and HOS-SSS scores after arthroscopic labral repair. However, those with Tönnis grade 2 changes preoperatively, BMI >30 kg/m2, and age >35 years at the time of surgery demonstrated significantly decreased mHHS and HOS-SSS scores at final follow-up.

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Use of Biologics as an Adjunct Therapy to Arthroscopic Surgery for the Treatment of Femoroacetabular Impingement: A Systematic Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119890673 ◽

2019 ◽

Vol 7 (12) ◽

pp. 232596711989067

Author(s):

Patrick G. Robinson ◽

Iain R. Murray ◽

Julian Maempel ◽

Conor S. Rankin ◽

David Hamilton ◽

...

Keyword(s):

Systematic Review ◽

Femoroacetabular Impingement ◽

Hip Arthroscopy ◽

Platelet Rich Plasma ◽

Arthroscopic Surgery ◽

Acid Growth ◽

Level Of Evidence ◽

Associated Lesions ◽

Chondrocyte Implantation

Background: There has been a recent increase in the use of biologics in hip arthroscopy to assist in the management of femoroacetabular impingement (FAI). Purpose: To analyze the current use of biologics for the treatment of FAI and its associated lesions. Study Design: Systematic review; Level of evidence, 4. Methods: A search of the PubMed, Medline, and EMBASE databases was performed in March 2019 with use of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The criterion for inclusion was observational, published research articles studying the therapeutic use of biologics as an adjuvant therapy during arthroscopic surgery for FAI; treatments included bone marrow aspirate concentrate, mesenchymal stem cells (MSCs), platelet-rich plasma (PRP), hyaluronic acid, growth factors, and autologous chondrocyte implantation (ACI) or autologous matrix-induced chondrogenesis (AMIC). Results: There were 9 studies that met the inclusion criteria, and a total of 674 patients were included across all studies. FAI was studied in all articles. Further, 7 studies (78%) also analyzed chondral injuries, and 3 studies also analyzed labral tears (33%). ACI or AMIC was used in 56% of studies and showed superior functional outcomes at short- and midterm follow-up versus debridement or microfracture. PRP did not improve the outcome of labral repairs at short-term follow-up. Conclusion: The current literature regarding biologic adjuncts in hip arthroscopy is varied in quality, with only one level 1 study. The use of ACI/AMIC for medium-sized chondral lesions showed promising results in individual studies; however, these were of lower quality. To enable comparisons among future studies, investigators must ensure accuracy in the reporting of biologic preparations and formulations used and homogeneity in the type and severity of lesion treated.

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Do Patients With Borderline Dysplasia Have Inferior Outcomes After Hip Arthroscopic Surgery for Femoroacetabular Impingement Compared With Patients With Normal Acetabular Coverage?

The American Journal of Sports Medicine ◽

10.1177/0363546517702855 ◽

2017 ◽

Vol 45 (9) ◽

pp. 2116-2124 ◽

Cited By ~ 31

Author(s):

Gregory L. Cvetanovich ◽

David M. Levy ◽

Alexander E. Weber ◽

Benjamin D. Kuhns ◽

Richard C. Mather ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Arthroscopic Surgery ◽

Harris Hip Score ◽

Secondary Outcome ◽

Acetabular Coverage ◽

Female Patients ◽

Capsular Plication ◽

Outcome Scores ◽

The Mean

Background: The literature contains conflicting reports regarding whether outcomes of hip arthroscopic surgery for patients with borderline dysplasia are inferior to outcomes in patients with normal acetabular coverage. Purpose: To assess differences in the outcomes of hip arthroscopic surgery for femoroacetabular impingement (FAI) in groups of patients with borderline dysplasia and normal coverage. Study Design: Cohort study; Level of evidence, 3. Methods: A registry of consecutive patients who had undergone primary hip arthroscopic surgery with capsular plication for FAI between January 2012 and January 2014 were divided based on the preoperative lateral center-edge angle (LCEA) into 2 distinct groups: (1) borderline dysplasia (LCEA 18°-25°) and (2) normal acetabular coverage (LCEA 25.1°-40°). There were 36 patients in the borderline dysplastic group and 312 patients in the normal coverage group. The primary outcome measure was the Hip Outcome Score–Activities of Daily Living (HOS-ADL) at a minimum of 2 years postoperatively. Secondary outcome measures included the HOS-Sports and modified Harris Hip Score (mHHS). Results: The mean preoperative LCEA differed significantly between groups (23.4° ± 1.5° for borderline dysplastic, 32.5° ± 3.8° for normal coverage; P < .001). The borderline dysplastic group had a higher percentage of female patients than the normal coverage group (27/36 [75%] vs 177/312 [57%], respectively; P = .048). There were no differences in other preoperative demographics and radiographic parameters. At a minimum 2 years after hip arthroscopic surgery (mean follow-up, 2.6 ± 0.6 years), both groups demonstrated significant improvements in all patient-reported outcome scores ( P < .001 in all cases). There were no significant differences between the borderline dysplastic and normal coverage groups in final outcome scores, score improvements, or percentage of patients experiencing clinically significant improvements. One patient in the borderline dysplastic group (3%) underwent revision hip arthroscopic surgery, and none underwent total hip arthroplasty during the follow-up period. There were no differences between the borderline dysplastic and normal coverage groups with regard to subsequent surgery. Female patients in the borderline dysplastic group had greater improvements in the mean HOS-ADL (25.9 ± 16.3 vs 10.8 ± 18.5, respectively; P = .05) and mHHS (27.9 ± 12.9 vs 8.1 ± 19.0, respectively; P = .005) compared with male patients in the borderline dysplastic group, but male and female patients did not differ in outcomes for the normal coverage group. Conclusion: Patients who underwent hip arthroscopic surgery for FAI with capsular plication experienced significant clinical improvements with low rates of subsequent surgery, regardless of whether their acetabulum had borderline dysplasia or normal coverage.

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Outcomes of Hip Arthroscopic Surgery in Patients With Tönnis Grade 1 Osteoarthritis With a Minimum 2-Year Follow-up

The American Journal of Sports Medicine ◽

10.1177/0363546516638087 ◽

2016 ◽

Vol 44 (7) ◽

pp. 1781-1788 ◽

Cited By ~ 17

Author(s):

Sivashankar Chandrasekaran ◽

Chengcheng Gui ◽

Nader Darwish ◽

Parth Lodhia ◽

Carlos Suarez-Ahedo ◽

...

Keyword(s):

Patient Satisfaction ◽

Arthroscopic Surgery ◽

Matched Pair ◽

Harris Hip Score ◽

Pain Patient ◽

Vas Score ◽

Outcome Score ◽

Significant Difference ◽

Tönnis Grade

Background: There are limited studies on the effect of mild osteoarthritis (OA) on outcomes of hip arthroscopic surgery. Purpose: To conduct a matched-pair analysis with a minimum 2-year follow-up to evaluate outcomes after hip arthroscopic surgery in patients with Tönnis grade 1 OA. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected on patients who underwent hip arthroscopic surgery between April 2008 and December 2012. Patients were excluded if they had previous hip conditions. The remaining patients were divided into either Tönnis 0 or 1 grade OA groups and were matched in a 1-to-1 ratio according to age within 5 years, sex, body mass index category, labral treatment, and capsular treatment. Four patient-reported outcome (PRO) scores, as well as the visual analog scale (VAS) score for pain, patient satisfaction, and rates of revision arthroscopic surgery and conversion to total hip arthroplasty (THA), were recorded. Results: A total of 1412 hip arthroscopic procedures were performed during the study period, of which 1036 met the inclusion criteria and 892 (86.1%) had 2-year follow-up. There were 738 and 154 patients with Tönnis grade 0 and 1, respectively; 93 patients were matched in each group. The Tönnis grade 0 group had a mean follow up of 28.7 months (range, 23.5-67.9 months), and the Tönnis grade 1 group had a mean follow up of 31.5 months (range, 23.6-63.5 months). Both groups demonstrated a significant improvement in all PROs and the VAS at a minimum 2-year follow-up. For the Tönnis grade 0 group, the improvements (in points) in the PROs were as follows: modified Harris Hip Score (mHHS), 15.51; Nonarthritic Hip Score (NAHS), 20.65; Hip Outcome Score–Activities of Daily Living (HOS-ADL), 16.83; and Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), 20.91. The VAS score for the Tönnis grade 0 group decreased by 2.82 points. For the Tönnis grade 1 group, the improvements (in points) in the PROs were as follows: mHHS, 19.52; NAHS, 20.96; HOS-ADL, 18.20; and HOS-SSS, 21.61. The VAS score for the Tönnis grade 1 group decreased by 2.84 points. No significant difference was found between the mean change in PROs, VAS, or patient satisfaction between the groups ( P > .05). There was no significant difference in subsequent rates for revision arthroscopic surgery or conversion to THA between the groups ( P = .3 and .6, respectively). The rates for revision arthroscopic surgery and conversion to THA were 9.68% and 9.68%, respectively, in the Tönnis grade 0 group and 5.38% and 11.83%, respectively, in the Tönnis grade 1 group. Conclusion: At 2-year follow-up, patients with Tönnis grade 1 OA had improved outcomes after hip arthroscopic surgery, with no significant difference compared with a matched control group of patients with Tönnis grade 0 OA. However, further studies are underway to determine if the results of the Tönnis grade 1 cohort will deteriorate over longer term follow-up.

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Hip Arthroscopic Surgery for Femoroacetabular Impingement With Capsular Management: Factors Associated With Achieving Clinically Significant Outcomes

The American Journal of Sports Medicine ◽

10.1177/0363546517739824 ◽

2017 ◽

Vol 46 (2) ◽

pp. 288-296 ◽

Cited By ~ 51

Author(s):

Gregory L. Cvetanovich ◽

Alexander E. Weber ◽

Benjamin D. Kuhns ◽

Jennifer Alter ◽

Joshua D. Harris ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Patient Reported Outcomes ◽

Arthroscopic Surgery ◽

Joint Space ◽

Factors Associated ◽

Younger Age ◽

Patient Reported ◽

Clinically Meaningful Outcomes ◽

Clinically Significant

Background: There has been increasing interest in defining clinically meaningful outcomes in patient reported outcomes following orthopaedic surgery. Little is known about the factors associated with clinically meaningful outcomes after hip arthroscopy for femoroacetabular impingement. Study Design: Case-control study; Level of evidence, 3. Purpose: To report on a large, prospectively collected consecutive series of patients who underwent comprehensive arthroscopic treatment of femoroacetabular impingement (FAI) and capsular management with greater than 2-year follow-up. The objectives were to determine (1) what percentage of patients achieve clinically significant outcomes after hip arthroscopic surgery for FAI as determined by the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) and (2) what factors are associated with achieving the MCID and PASS. Methods: Data from an institutional repository of consecutive patients undergoing primary hip arthroscopic surgery with routine capsular closure for FAI that had failed nonsurgical management between January 2012 and January 2014 were prospectively collected and analyzed. Of 474 patients during the enrollment period, 386 (81.4%) patients were available for a minimum 2-year follow-up. Demographics, radiographic measurements, intraoperative characteristics, and patient-reported outcome scores were collected. The primary outcome measure was achieving published thresholds for the MCID and PASS for the Hip Outcome Score (HOS)–Activities of Daily Living (ADL) in patients with FAI. The HOS–Sport-Specific Subscale (SSS), complications, and reoperations were secondary outcome measures. Multivariate regression analyses were conducted to identify factors associated with achieving the MCID and PASS. Results: At a minimum of 2-year follow-up, the patients had statistically significant improvements in all patient-reported outcomes (HOS-ADL, HOS-SSS, and modified Harris Hip Score [mHHS]; P < .001 for all), with a 1.2% rate of revision hip arthroscopic surgery and 1.7% rate of conversion to total hip arthroplasty. The MCID was achieved by 78.8% of patients for the HOS-ADL, and the PASS was achieved by 62.5% for the HOS-ADL. Younger age ( P = .008), Tönnis grade 0 ( P = .022), and lower preoperative HOS-ADL score ( P < .001) were associated with successfully achieving the MCID for the HOS-ADL. Younger age ( P < .001), larger medial joint space width ( P = .028), and higher preoperative HOS-ADL score ( P < .001) were associated with achieving the PASS for the HOS-ADL. Younger age ( P < .001), lower body mass index ( P = .006), non–workers’ compensation status ( P = .020), and lower preoperative HOS-SSS score ( P < .001) were associated with achieving the MCID for the HOS-SSS. Younger age ( P = .001), Tönnis grade 0 ( P = .014), running ( P = .008), and higher preoperative HOS-SSS score ( P < .001) were associated with achieving the PASS for the HOS-SSS. Overall, 49.4% of patients achieved all 4 clinically significant outcomes: both the MCID and PASS for the HOS-ADL and HOS-SSS. Conclusion: The majority of patients undergoing hip arthroscopic surgery with routine capsular closure for FAI experienced clinically significant outcomes that met the MCID or PASS criteria, with low rates of revision and conversion to total hip arthroplasty. Factors associated with these successful outcomes on multivariate analyses included younger age with a normal joint space. Patients with lower preoperative HOS scores were more likely to achieve the MCID, whereas patients with higher preoperative HOS scores were more likely to achieve the PASS.

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Labral Healing

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00041 ◽

2017 ◽

Vol 5 (1_suppl) ◽

pp. 2325967117S0004

Author(s):

Agustín Catan ◽

Tomas Vilaseca ◽

Damián Arroquy ◽

Martín Carboni ◽

Jorge Eduardo Guiñazú ◽

...

Keyword(s):

Physical Examination ◽

Femoroacetabular Impingement ◽

Selection Criteria ◽

Arthroscopic Surgery ◽

Hip Surgery ◽

Labral Repair ◽

Intraobserver Variability ◽

Intraobserver Agreement ◽

One Year

Objectives: The purpouse of this study was to evaluate MRI images of labral repair after one year, trying to stablish MRI images as a reliable tool for the diagnosis of labral healing. Methods: One hundred and sixty-two patients presenting with femoroacetabular impingement that underwent an arthroscopic surgery were treated between 2012 and 2015. Of these, 124 met the selection criteria and were included in this study. Only patients with 12 months of follow up and labral repair were included. Patients with previous hip surgery were excluded. Coronal, sagittal and axial MRI cuts were evaluated by three independent observers, an arthroscopic hip surgery, a fellow in hip arthroscopic surgery and a musculoeskeletal radiologist. Results: on regard of our statistics 68% of the patients had labral healing images, 16% had no healing signals and 16% unsatisfactory images. Just in the 47% the observers had a 100% of agreement. Interobserver variation was: intraobserver agreement was 94% ( arthroscopic surgeon), 72 % (radiologist), 67 % (fellow). Conclusion: The main finding of this study was that a high inter and intraobserver variability was found when analysing the healing status of hip repaired labrums. Assessment of labrum healing after an arthroscopic repair should not only rely on imaging methods and therefore should be concurrently performed with a comprehensive physical examination.

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