Date of Award

January 2025

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Andrew E. Jimenez

Abstract

Acetabular labral tears secondary to femoroacetabular impingement (FAI) are a common cause of reduced range of motion, hip and groin pain, stiffness, and impaired function in patients. FAI has been implicated as an important cause of early-onset osteoarthritis; consequently, patients who fail to achieve adequate symptomatic relief from nonoperative management are frequently prescribed hip arthroscopy. One factor gaining increased attention in hip arthroscopy in recent years is the chondrolabral junction (CLJ), or the transition zone between the acetabular cartilage and labrum. Despite focus on surgical preservation of the CLJ, the association between severity of CLJ breakdown and functional outcomes following hip arthroscopy remains unexplored.

The purpose of the current thesis was to assess the impact of CLJ breakdown on patient-reported outcome measures (PROMs) at 24-month follow-up in patients undergoing hip arthroscopy for symptomatic labral tears.

A retrospective review of prospectively-collected data identified patients >18 years with minimum 24-month follow-up who underwent primary hip arthroscopy by a single surgeon for treatment of symptomatic labral tears secondary to FAI. The Beck classification of transition zone cartilage was used to grade CLJ damage; patients with grades 0-2 were classified into the “mild CLJ damage” cohort, and those with grades 3-4 were classified into the “severe CLJ damage” cohort. PROMs were collected at baseline and at 3, 6, 12, and 24 months postoperatively. Linear mixed effects models were used to compare PROMs between cohorts. Rates of achieving clinically meaningful thresholds and subsequent surgery rates were also compared.

Overall, 198 patients met inclusion criteria, with average follow-up of 3.54 ± 1.26 years. Of these, 95 patients with severe CLJ damage (32.6% female, 34.9 ± 10.5 years, and BMI 24.9 ±4.0 kg/m2) were compared to 103 patients with mild CLJ damage (62.1% female, 38.2 ± 11.9 years, and BMI 25.4 ± 4.3 kg/m2). Hip Outcome Score-Activities of Daily Living (HOS-ADL), Non-Arthritic Hip Score (NAHS), and visual analog score (VAS) for pain were inferior in the severe CLJ group at enrollment and all time points thereafter (P < 0.05). However, patients with severe CLJ breakdown exhibited greater improvements in HOS-ADL and NAHS at 24-month follow-up, and achieved clinically meaningful thresholds at equivalent rates to patients with mild CLJ breakdown. Subsequent surgery rates were 6.8% and 12.6% in patients with mild versus severe CLJ damage, respectively (P > 0.05).

In conclusion, this thesis found that severe CLJ breakdown is associated with increased pain and decreased functional level preoperatively and up to 24 months following primary hip arthroscopy. Despite this, patients with severe CLJ breakdown experienced greater improvements in functional outcomes at 24-month follow-up and achieved clinical thresholds at similar rates to patients with mild CLJ damage. Thus, while worse baseline pain and functional levels may indicate severe CLJ breakdown, these patients still benefit substantially from hip arthroscopy.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/14/2027

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