Lesões por estresse do Labrum acetabular em atletas de altaperformance : técnica artroscópica e retorno ao esporte

Abstract

Lesions of the acetabular labrum are known causes of hip pain and represent the beginning of a cascade of events that can lead to osteoarthritis. The treatment of FAI (femoroacetabular impingement) and labral tears is crucial for hip preservation in young and active athletes. Purpose: To define hip pathologies seen in high performance athletes, to describe the arthroscopic technique used to treat these diseases and to determine the return to sport of the professional players following hip arthroscopy. Methodology: The athletes included in the study are soccer players tied to International Federation of Football Associated (FIFA), unranked tennis players in the Association of Tennis Professionals (ATP). All patients underwent arthroscopy for intra-articular hip pathologies. Nine tennis players (6 males, 3 females), fifty-four soccer players (39 males, 14 females) were operated between May 2005 and July 2010. The mean age of the athletes was 25 years old (range 18-31). All athletes sought treatment after failure to play. Result: The average preoperative Wiberg’s CE angle was 37 degrees (range 33 to 42) and the average alpha angle was 72 degrees (range 65 to 83). All patients were diagnosed with femoroacetabular impingement (FAI) preoperatively. During arthroscopy, all players underwent labral repair and treatment of FAI (6 isolated pincer type, 57 combined type). The average size of the labral tear was 25 mm (range 5 to 40). On average three (range 2 to 5) suture anchors were used to repair the tear. Six players required microfracture of a chondral lesion on the acetabulum. In forty-one hips there was tear of the ligamentum teres which were treated with debridement. Two players underwent an iliopsoas release. The Modified Harris Hip Score (MHHS) improved from 61 to 90 (p=0.001). The median patient satisfaction was 10 (score from 1 to 10) after one year of surgery. All athletes returned to play professional level. Conclusion: This study demonstrated that arthroscopic treatment of FAI and chondro-labral dysfunction in high performance athletes provides a significant clinical improvement. Arthroscopic treatment of FAI is a safe and effective way for professional players to return to play.