Repair Vs Debridement

I just came across this website today
http://www.orthosupersite.com/view.asp?rid=32004
Differences seen between repair vs. labral debridement for hip impingement at 1 year
Researchers saw a significant increase in radiographic degenerative changes in the debridement group.
By Gina Brockenbrough1st on the web (October 13, 2008)
October 2008
WASHINGTON — Research indicates that although there is no significant difference in the early clinical outcomes between arthroscopic labral debridement and labral repair for the treatment of femoroacetabular impingement, significant changes were seen between two treatment groups at 1-year-plus follow-up.
In a consecutive series of patients who underwent arthroscopic management for femoroacetabular impingement (FAI), Christopher M. Larson, MD, and colleagues compared the results of those who underwent labral refixation to those who underwent a labral debridement prior to performing any repairs.
The investigators discovered no significant differences between the groups regarding Harris Hip Scores, Visual Analog Scale (VAS) scores for pain, SF-12 scores and alpha angles on both anterior-posterior and lateral views with a minimum follow-up of 1 year. The analysis also revealed no significant differences in these outcomes among patients who had debridement, excisions with rim trimming or repair at that time.
Degenerative changes
However, “With further follow-up at 1 year and [beyond], there is a statistically significant increase in radiographic degenerative changes in the debridement group and statistically improved Harris Hip scoring in the labral group,” Larson recently told Orthopedics Today.
However, he noted that 5- to 10-year follow-up is needed to fully compare the outcomes and said that follow-up radiographs may detect changes earlier than clinical scores.
“It is a consecutive series, and management with this technique is evolving,” Larson said. “And if a difference does show up with time, the question will remain whether this relates to labral preservation or improved technique in managing impingement.”
Larson presented the study during the 27th Annual Meeting of the Arthroscopy Association of North America.
The investigators studied 80 hips; the labral debridement group included 37 consecutive hips that the researchers studied before performing repairs.
“All of these cases were reviewed and were felt to be repairable by current techniques,” Larson said. Patients in this group had a mean age of 31 years and a mean follow-up of 14 months.
The labral refixation group had a mean age of 27 years and a mean follow-up of 8 months. In both groups, most patients had minimal or no degenerative changes.
Procedures
Patients with pincer impingement underwent a labral debridement, rim trimming and labral refixation with two to six suture anchors. Those with cam impingement had a capsulotomy and a proximal femoral osteochondroplasty.
Surgeons performed 29 femoral osteochondroplasties in the debridement group. Eighteen patients in the group underwent labral debridement without rim trimming and 19 had rim trimming with labral excision. In the refixation group, 36 patients also had a femoral osteochondroplasty and 40 patients underwent rim trimming.
Larson noted that the groups showed good and excellent results postoperatively and that the study investigated labral tears without significant degenerative changes.
“There are finite element models that have suggested that the labrum has a ceiling function,” he said. “In the absence of this sealing, strains within the cartilage matrix increase, which may increase those degenerative changes over time.”
For more information:
Christopher M. Larson, MD, can be reached at Minnesota Sports Medicine, 775 Prairie Center Drive, Suite 250, Eden Prairie, MN 55344; 952-944-2519; e-mail: Christopher_larson@med.unc.edu. He receives research or institutional support from Biomet, Omeros Corp., Arthrex Inc. and Zimmer and miscellaneous funding from Smith & Nephew.
Reference:
Larson CM, Giveans M. Arthroscopic treatment of femoroacetabular impingement: Early outcomes evaluation of labral refixation/repair vs. debridement. Paper #SS-04. Presented at the 27th Annual Meeting of the Arthroscopy Association of North America. April 24-27, 2008. Washington.


This got me thinking about a few things. My first thought was "hmmm, I wonder what my hips look like now, radiographically, at almost 16 months and 12 months postop"? Being that I had to postpone my postop x-rays due to my current "situation", I will not know for some time.

It also got me thinking about how accurate the study could be. I don't know any type of detail, I only have read what I posted here, so I may be totally off base, but here it goes:
In the debridement group, the labrum was probably more damaged than in the repair group, meaning that they had either been dealing with the FAI and labral tear for a longer period of time, or had a more severe injury. The repair group had to have a labrum that was in essence "repairable", i.e. not as "far gone" as the debridement group. It would make sense that the group that had more damage would show more degeneration in a shorter amount of time.
Does this make sense?
Wouldn't the surgeons try to repair as many labrums as possible if they could, and not debride the "repairable" ones?
Just a thought......