The aim of this work was to report our experience with arthroscopy for the treatment of acetabular labral lesions and identify prognostic factors determining mid- and long-term outcome.

Between August 1991 and December 1997, 12 patients (ten women, two men, mean age 39 years, age range 25-61 years) underwent arthroscopic treatment of an acetabular labrum lesion. All were reviewed at a mean 4 years follow-up (18 months-8 years). Half of the patients (n = 6) had a history of hip surgery: two femoral osteotomies and one acetabular bone block for congenital hip dislocation, two high-energy traumas and one traumatic dislocation. Clinical manifestations including pain (n = 12), a sensation of a snag (n = 10), or blockage (n = 8) had developed over a mean 15 months (2-24 months). Standard x-rays evidenced early signs of degenerative disease in four cases and acetabular dysplasia in four (5° < VCE < 18°), and were normal in four. Arthroscanography was performed in all cases and always evidenced a lesion of the anterior or anterosuperior part of the labrum, generally a fissuration (n = 7). The surgical procedure performed on an orthopedic table with traction on the limb lasted 45 to 75 min for regularization of the degenerated labrum in three patients, resection of the languette in six, the anse de seau in two or the labral notch in one. A short hospitalization (24 to 48 hours) was sufficient with immediate weight bearing with two canes. One patient developed sciatic paresia which regressed in 72 hours with vulvar edema due to excessive peroperative traction.

Besides the labral lesion, the exploration also identified an associated chondral lesion in seven cases (acetabulum in two, femoral head in three, both in two) which had been suspected in six cases from preoperative imaging (osteoarthrosis in four, dysplasia in two) and which affected the final outcome. Four of these patients (osteoarthritis in two and dysplasia in two) worsened clinically and radiographically to the point where a total hip arthroplasty was required in three. Among the three other patients, two had residual pain (osteoarthritis in one and initial x-ray normal in one) with no radiographic deterioration and only one (osteoarthrtis) was totally relieved without any radiographic deterioration at six years follow-up. Among the five patients with no chondral lesions, three (with normal x-rays initially) were pain free at four years follow-up while the two others (dysplasia) had residual pain at two years follow-up with no sign of osteoarthrtis on the latest x-rays.

Lesions of the acetabular labrum are uncommon but can be treated arthroscopically. Resection of the labral lesion is immediately effective but does not prevent long-term degradation of the joint if there is an associated chondral lesion.

Douze patients (10 femmes, 2 hommes) âgés en moyenne de 39 ans (25-61 ans) traités arthroscopiquement d'une lésion du labrum acétabulaire ont été rétrospectivement revus avec un recul moyen de 4 ans (18 mois-8 ans). Les signes cliniques étaient classiques : douleur, sensation d'accrochage et/ou de blocage de la hanche, limitation de la rotation interne. Les radiographies retrouvaient des signes d'arthrose débutante (4 cas), une dysplasie acétabulaire (5°<VCE <18°) (4 cas). La lésion fut toujours retrouvée sur l'arthrographie avec arthroscanner. L'intervention permit la régularisation du labrum dégénéré (n = 3) ou la résection de la languette (n = 6), de l'anse de seau (n = 2), ou de la fente labrale (n = 1). En marge de la lésion labrale, l'exploration retrouva également une lésion chondrale associée dans 7 cas (acetabulum = 2, tête fémorale = 3, mixte = 2) qui conditionna le résultat final. Quatre de ces patients se sont aggravés cliniquement et radiographiquement au point de nécessiter la pose d'une prothèse totale dans 3 cas. Parmi les 3 autres patients ayant des lésions chondrales, 2 présentaient des douleurs résiduelles sans aggravation radiologique et 1 seul est resté totalement soulagé sans dégradation radiographique à 6 ans de recul. Parmi les 5 patients indemnes de lésions chondrales, 3 patients restaient soulagés à plus de 4 ans de recul tandis que les 2 autres présentaient à 2 ans des douleurs résiduelles sans signe d'arthrose sur les clichés récents. Les lésions du labrum acétabulaire sont rares mais sont accessibles au traitement arthroscopique. La résection de la lésion labrale est efficace dans le temps pourvu que cette lésion ne survienne pas dans un contexte dégénératif. En cas de dysplasie, le traitement de la lésion labrale ne doit pas faire oublier la nécessité de corriger le défaut de couverture de l'acetabulum.