[Labrum lesions and acetabular dysplasia in adults]

Thirty-seven operatively treated patients with residual acetabular dysplasia without arthritis had a labrum tear in the antero-lateral quadrant. A sensation of hip locking, or of a "dead leg" and episodes of "giving-way" were found to predict the presence of the tear. 95% of patients had an acute onset of pain. We treated the patients with a peri-acetabular osteotomy and in 12 cases the tear was repaired with a transosseous suture. We excised the labrum lesion in 21 cases with an extended avulsion from the bony rim and 4 tears were not severe enough to require attention. Twenty-two patients were available for a 4.5-year follow-up (range 2-8 years): 18 patients had no pain, 3 had mild pain and one had severe pain. Final pain outcome was not influenced by intraarticular treatment of the tear. The labrum tear is responsible for a well-defined clinical presentation of hip dysplasia and precedes secondary arthrosis. Early diagnosis helps to define the time to perform reconstructive surgery. The treatment consists of improving the coverage and stability of the femoral head by means of a multiplanar peri-acetabular osteotomy. The osteotomy unloads the torn fibrocartilage and allows it to heal by moving it out of the weight-bearing area.