Historical Context

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Although Burman first reported arthroscopy of the hip in cadavers in 1921, clinical experience with this technique was not forthcoming until the 1950s. In 1957 Patterson described tearing of the acetabular labrum following posterior hip dis-location.4 The displacement of this tissue prevented concentric hip reduction. Dameron published a similar bucket-handle tear of the labrum following posterior dislocation in 1959.5 Altenberg, in 1977, was the first to suggest that a torn labrum may predispose to degenerative arthritis. He performed an open arthrotomy to resect the labrum in his two cases.6

Harris and Bourne, in 1979, implicated the infolded intra-articular labrum as an etiologic factor in hip osteoarthritis.5 This work was corroborated three years later by Cartlidge and Scott.7 In 1984 Ueo and Hamabuchi found that labral tears may result in cystic degeneration and subsequent osteoarthri-tis.8 Four years later Ikeda found that labral tears occur not only in adults, but also in adolescents in Japan.9 Other international authors published the association of dysplasia with acetabular labral tears. Dorrell and Catterall reported 11 cases in England.10 Nishina et al from Japan visualized the labral lesion at the time of Chiari osteotomy.11 Klaue, Durnin, and Ganz published the Swiss experience.12 They showed the association of lateral acetabular rim separation with labral tearing. Legg-Calve-Perthes disease may also be associated with labral disease. Grossbard and later Fitzgerald described this finding.13

The recognition that labral tears do exist and are the byproduct of diverse developmental and traumatic etiologies facilitated the development of arthroscopic techniques to access, image, and treat these chondral injuries. McCarthy et al reported on 94 patients following hip arthroscopy. Fifty-five of these had abnormalities of the labrum.1 In a second report, he presented a classification of labral lesions. For the first time the relationship between labral tearing, associated articular chondral changes, and patient outcome was correlated.14

Lage also classified 37 cases from Villar's practice that had labral tears.15 Farjo et al reported on their experience of 28 patients and corroborated the poor results of hip arthroscopy for labral tear in the presence of arthritis.16 Finally, McCarthy, Aluisio, et al presented the association of labral tears with occult trauma.17 The chondral lesions occurred in this group of patients without major hip trauma. Often the inciting event was a pivoting maneuver during an athletic activity, such as tennis, karate, hockey, football, or soccer.

The previous skepticism that labral tears occur has now been supplanted by the development of techniques to better diagnose and treat them. The poor sensitivity and specificity of conventional radiographic studies has now evolved to high-contrast, multiplanar, thin-section magnetic resonance imaging and more recently to gadolinium-enhanced arthro MR scanning. (see Chapter 3.) The techniques and equipment for performing hip arthroscopy have also improved. The minimally invasive nature of this operation has led to its performance, for both diagnostic and therapeutic applications, as an outpatient procedure. The risks of this procedure, when compared to an open arthrotomy, have been remarkably reduced.18 As experience in arthroscopic hip surgery has increased, clinical, cadaveric, and basic science research has been stimulated to further understand the morphology and function of the labrum, both in health and disease. These efforts recently have focused on cadaveric anatomic features as well as classification systems associated with labral tears.

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Arthritis Relief and Prevention

Arthritis Relief and Prevention

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