between september 2007 and august 2010 , we performed arthroscopic surgery in 207 patients . of them ,
the indications for surgery were hip pain with associated mechanical symptoms and intractable pain after conservative treatment for at least 12 weeks . on physical examination , all had a painful range of motion with positive impingement test ( flexion , adduction , and internal rotation ) .
preoperative imaging included plain radiographs ( pelvis anteroposterior and frog leg ) and computed tomography ( ct ) arthrogram to detect bony impingement and labral tear .
we excluded those who had undergone previous hip surgery and those with avascular necrosis , rheumatologic disorder and patients with arthritis on radiography ( tonnis grade > 2 ) .
there were 10 men and 11 women with a mean age of 35 years ( range , 22 to 57 years ) .
preoperative diagnoses included isolated labral tear in 11 hips , cam - type impingement in six hips , and pincer - type impingement in four hips .
preoperative radiographs revealed tonnis grade 0 to 1 changes in 20 hips and grade 2 changes in one hip ( table 1 ) .
we performed hip arthroscopy using a standard fracture table with patient in the supine position .
traction was applied with slight extension and adduction of the hip joint with enough force to open the joint approximately 1 cm .
two or three portals ( anterolateral , anterior , and/or posterolateral ) were placed for arthroscopic labral repair .
a suture anchor was placed on the capsular side ad secured , followed by a suture passer was used to deliver a limb suture through a small portion of the substance of the labrum .
an arthroscopic sliding knot was tied and passed down the cannular to secure the repair . the operation was completed by joint lavage and injection with local anesthetic .
postoperatively , all patients followed a standardized rehabilitation program . immediately after surgery , passive and active range of movement was permitted .
patients were kept toe - touch weight bearing for 2 weeks with range of motion encouraged but avoiding extremes of external rotation . in general , patients typically required 2 to 3 weeks of crutch assistance .
patients who underwent microfracture were kept toe - touch weight bearing for 6 to 8 weeks .
clinical and radiographic follow - up evaluations were performed at the 6 weeks , 3 months , 6 months , 12 months , and every 6 months thereafter .
clinical evaluations were performed using harris hip score ( hhs),10 ) visual analog scale ( vas ) , western ontario and mcmaster universities ( womac ) osteoarthritis index , university of california , los angeles ( ucla ) activity , and a satisfaction survey .
radiographic analyses included anteroposterior view of pelvis , frog - leg lateral view , and translateral view of hip .
all radiographs were assessed using the tonnis classification,11 ) which was used to grade radiographic degenerative changes , and the outerbridge classification system,12 ) which grades the degree of chondromalacia .
the difference between preoperative and postoperative outcome measures were analyzed using wilcoxon signed rank test for continuous outcome measures and fisher exact test for categorical outcome measures .
eighteen patients reported that they were satisfied with the reduction or elimination of preoperative pain .
although the clinical scores improved compared to preoperative scores , three patients were not satisfied with the results of the surgery . in these patients , the vas score was reduced by 2 points , womac score was reduced by 10 points , hhs score was increased by 3 points , and the ucla score was not changed .
the overall rating for the 21 patients ( 21 hips ) , using the hhs was 73 points ( range , 64 to 84 points ) preoperatively and 83 points ( range , 66 to 95 points ) postoperatively ( p < 0.001 ) .
four hips ( 19% ) had an excellent score , 11 hips ( 52% ) a good score , five hips ( 24% ) a fair score , and one hip ( 5% ) had a poor score ( p < 0.001 ) .
the womac score was 16 points ( range , 2 to 50 points ) at the final follow - up evaluation .
ucla activity at the latest follow - up improved in 16 patients and remained the same in two patients .
the mean vas score decreased from 8 to 2 at the latest follow - up ( table 2 ) . at the time of surgery , arthroscopy showed synovitis in 14 hips .
four of these patients had an outerbridge grade iii articular cartilage lesion of the acetabulum at the time of surgical exploration .
the tonnis grade of osteoarthritis did not change in all patients at the latest follow - up .
significant complications , such as infection , heterotopic ossification , thromboembolic episodes or permanent nerve injury , did not occur at the latest follow - up .
eighteen patients reported that they were satisfied with the reduction or elimination of preoperative pain .
although the clinical scores improved compared to preoperative scores , three patients were not satisfied with the results of the surgery . in these patients , the vas score was reduced by 2 points , womac score was reduced by 10 points , hhs score was increased by 3 points , and the ucla score was not changed .
the overall rating for the 21 patients ( 21 hips ) , using the hhs was 73 points ( range , 64 to 84 points ) preoperatively and 83 points ( range , 66 to 95 points ) postoperatively ( p < 0.001 ) .
four hips ( 19% ) had an excellent score , 11 hips ( 52% ) a good score , five hips ( 24% ) a fair score , and one hip ( 5% ) had a poor score ( p < 0.001 ) .
the womac score was 16 points ( range , 2 to 50 points ) at the final follow - up evaluation .
ucla activity at the latest follow - up improved in 16 patients and remained the same in two patients .
the mean vas score decreased from 8 to 2 at the latest follow - up ( table 2 ) .
four of these patients had an outerbridge grade iii articular cartilage lesion of the acetabulum at the time of surgical exploration .
the tonnis grade of osteoarthritis did not change in all patients at the latest follow - up .
significant complications , such as infection , heterotopic ossification , thromboembolic episodes or permanent nerve injury , did not occur at the latest follow - up .
although most studies reported encouraging short to midterm results of arthroscopic treatment of labral tear , all of these studies were conducted in western countries ( table 3 ) . to our knowledge , this is the first study regarding acetabular labral repair in an asian country .
eighteen of 21 patients were satisfied with relief of pain and/or improvement of their functional outcome with no progression of arthritic change of radiographic evaluation at the minimal 2 year follow - up .
bedi et al.7 ) performed a systemic review to assess outcomes after surgical treatment of labral tears and femoroacetabular impingement ( fai ) .
they reported 65% to 85% of patients who underwent open surgical procedures were satisfied with the outcome at a mean of 40 months after surgery as compared to 67% to 100% of patients who underwent arthroscopic surgery who were satisfied .
however , most of the published research has addressed debridement of torn acetabular labrum . with increasing knowledge about the function and importance of the labrum , surgical techniques including suture anchor repair
must be encouraged to maintain the function of the hip joint and decrease the development of early arthritic change .
larson et al.6 ) compared the outcomes of arthroscopic labral debridement ( 44 patients ) versus refixation ( 50 patients ) in 94 patients at a mean follow - up of 3.5 years .
they concluded that labral refixation resulted in better outcomes and a greater percentage of good to excellent results compared with the results of labral debridement .
schilders et al.8 ) compared arthroscopic labral repair ( 69 hips ) and resection ( 32 hips ) in 96 patients ( 101 hips ) at a mean follow - up of 2.4 years .
although we could not compare debridement with repair in our series , our findings are consistent with previous studies . in this study ,
the hhs improved from 73 points ( range , 64 to 84 points ) preoperatively to 83 points ( range , 66 to 95 points ) postoperatively , and the ucla activity improved in 16 patients and remained similar in two patients at the latest follow - up .
eighty - six percent ( 18/21 ) of patients were satisfied with their arthroscopic labral repair .
beaule et al.5 ) reviewed acetabular labral tear and mentioned that acetabular labral tears rarely occur in the absence of a structural osseous abnormality , such as fai .
fai is a proposed etiology of early osteoarthritis in young patients.13,14,15 ) however , the incidence of hip osteoarthritis in the general population has marked ethnic and racial differences.16 ) the rate of moderate to severe idiopathic and secondary hip osteoarthritis in caucasians is 3%-6% compared with  1% in east indians , blacks , hong kong chinese , and native americans.17,18,19 ) epidemiologic data suggest that the incidence of fai and acetabular labral tear in asian countries might be lower than in western countries.16,17,18,19 ) however , if the patients have acetabular labral tear with osseous abnormality , daily activities are more seriously inconvenienced in asian patients , as the asian life style and culture requires more flexion and abduction motion of the hip joints .
seventy one percent ( 15/21 patients ) in this study reported excellent and good results at the minimum 2-year follow - up .
ilizaliturri et al.20 ) performed arthroscopic surgery on 19 hips who were diagnosed with fai with labral tear and reported 84% good to excellent results at the minimum follow - up of 24 months .
larson and giveans21 ) compared the outcomes of arthroscopic labral debridement ( 36 hips ) with those of labral refixation ( 39 hips ) .
they reported 89.7% good and excellent results in refixation groups at the minimum follow - up of 12 months .
firstly , there was no control group and the total numbers of patients were small .
nevertheless , this study proves the value for athroscopic procedures on acetabular labral tear with or without osseous abnormality . secondly ,
acetabular labral tear is frequently associated with other osseous structural abnormalities , such as cam and/or pincer - type deformities .
however , we evaluated and did confirm the 86% satisfaction rate at minimum 2-year follow - up .
in conclusions , arthroscopic labral repair resulted in 86% satisfaction and 71% good to excellent results at a 2-year follow - up .
therefore , the hip arthroscopic procedure might be an excellent alternative to open surgery and promises greater probability of good to excellent results .
 backgroundacetabular labral tear is a main cause of hip pain and disability , often requiring surgical treatment . 
 improvements of hip arthroscopic technique have produced positive outcomes after labral repair with arthroscopy . 
 the purpose of this study was to determine clinical outcomes and patient satisfaction after arthroscopic repair of acetabular labral tear.methodswe interviewed 21 patients ( 10 men and 11 women ; mean age , 36 years [ range , 22 to 57 years ] ) with acetabular labral tears that had been repaired arthroscopically in terms of satisfaction of the procedure . 
 in addition , clinical outcome was assessed using visual analog scale ( vas ) score , university of california , los angeles ( ucla ) activity , western ontario and mcmaster universities ( womac ) osteoarthritis index , and harris hip score , and radiologic outcome was assessed using serial radiography . 
 the patients were followed for 24 - 50 months.resultsthe mean harris hip score was 73 points ( range , 64 to 84 points ) preoperatively and 83 points ( range , 66 to 95 points ) postoperatively . 
 fifteen hips ( 71% ) were rated excellent and good . 
 the mean womac osteoarthritis index and vas scores were improved at final follow - up . 
 ucla activity at the latest follow - up improved in 16 patients . 
 the tonnis grade of osteoarthritis at the latest follow - up did not change in all patients . 
 eighteen of the patients ( 86% ) were satisfied with the procedure.conclusionshigh rate of satisfaction after arthroscopic repair of acetabular labral tears is an encouraging outcome . 
 arthroscopic treatment of labral tears might be a useful technique in patients with hip pathologies , such as femoroacetabular impingement with labral tears . 
METHODS
RESULTS
Patient Satisfaction
Clinical Outcome
Radiologic Outcome
DISCUSSION