AJSM - 2026-06-04 - Journal Article
Primary Arthroscopic Labral Repair in Acetabular Overcoverage: PROMs and Arthroplasty Rates at Midterm Follow-up.
Iyer S, Ina J, Kang L, Cabarcas B, Okoroha KR, Levy BA, Krych AJ, Hevesi M
Topics
Key Takeaway
At mean 8-year follow-up, pincer morphology patients (LCEA ≥40°) converted to THA at 7% versus 19% in nondysplastic controls (p=0.046), suggesting acetabular overcoverage may be chondroprotective.
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Summary
This study compared minimum 5-year PROMs and THA conversion rates between patients with pincer morphology (LCEA ≥40°) and propensity-matched nondysplastic controls (LCEA 25°–40°) following primary hip arthroscopic labral repair. All PROMs (mHHS, iHOT-12, HOS, VAS, Tegner) were equivalent between cohorts at final follow-up (p≥0.215), and PROMs did not differ between pincer patients with residual overcoverage versus those corrected to LCEA <40° (p≥0.291). Controls converted to THA at nearly three times the rate of pincer patients (19% vs. 7%, p=0.046).
Key Limitation
Single-institution retrospective design with no standardized protocol for degree of rim trimming introduces surgeon-dependent variability in the extent of pincer correction, confounding the dose-response relationship between LCEA reduction and outcomes.
Original Abstract
BACKGROUND
Acetabular overcoverage (pincer morphology) has been suggested to be both a source of pain and dysfunction and potentially protective against osteoarthritic change.
PURPOSE
To compare the minimum 5-year clinical outcomes of patients undergoing primary hip arthroscopic labral repair with a lateral center edge angle (LCEA) of ≥40° as compared with nondysplastic controls with an LCEA of 25° to 40°.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
A retrospective review was performed to identify all patients who underwent primary hip arthroscopic labral repair between 2009 and 2019 at a single academic institution. Patients with an LCEA of ≥40° (pincer) were propensity-matched to nondysplastic controls with an LCEA of 25° to 40° on a 1-to-2 basis by sex, age, body mass index, and surgery year. Patient-reported outcome measures (PROMs)-including visual analog scale, Tegner activity score, modified Harris Hip Score, International Hip Outcome Tool (iHOT-12), and Hip Outcome Score were analyzed-as were reoperations and conversions to total hip arthroplasty (THA).
RESULTS
A total of 55 patients with pincer morphology (preoperative
LCEA
41.9°± 2.1°) were matched to 110 nondysplastic controls (LCEA: 31.2°± 4.1°), resulting in a total of 165 hips in 163 patients (67% women, mean age: 37.7 ± 9 years). Pincer patients were corrected to a mean postoperative LCEA of 38.7°± 4.1º ( P < .001), with 22 pincer patients having residual overcoverage; namely, a postoperative LCEA ≥40° (range, 40°-45.8°). There were no differences between cohorts regarding intraoperative characteristics-including femoral and acetabular Outerbridge grade-as well as capsulotomy type and the presence of capsular repair ( P ≥ .210). At a mean 8-year follow-up (range, 5.1-13.2), there was no difference in any postoperative PROMs between pincers and controls ( P ≥ .215) and no difference in PROMs between patients with residual overcoverage and pincer patients with a postoperatively normalized LCEA ( P ≥ .291). At final follow-up, 4 patients in the pincer cohort (7%) and 21 controls (19%) converted to THA ( P = .046).
CONCLUSION
Patients with lateral acetabular overcoverage demonstrated similar and satisfactory postoperative PROMs at a minimum 5-year follow-up compared with propensity-matched nondysplastic controls, regardless of whether the LCEA was corrected to <40°. Of note, nondysplastic controls demonstrated a higher rate of conversion to THA, suggesting a potentially chondroprotective role for acetabular overcoverage.