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| LETTER TO EDITOR |
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| Year : 2023 | Volume
: 43
| Issue : 6 | Page : 296 |
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Refixation of labrum in pincer type of femoroacetabular impingement
Jui-Yen Weng1, Zhi-Hong Zheng2
1 Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
2 Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Orthopedic Surgery, Hualien Armed Forces General Hospital, Hualien; Department of Orthopedic Surgery, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan
| Date of Submission | 18-Feb-2023 |
| Date of Acceptance | 06-May-2023 |
| Date of Web Publication | 04-Aug-2023 |
Correspondence Address:
Dr. Zhi-Hong Zheng
Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei 114
Taiwan
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jmedsci.jmedsci_49_23
How to cite this article:
Weng JY, Zheng ZH. Refixation of labrum in pincer type of femoroacetabular impingement. J Med Sci 2023;43:296 |
Dear Editor,
We read the article “Refixation of labrum in pincer type of femoroacetabular impingement” by Shao et al.,[1] with a lot of interest. We commend the authors' efforts. Accurate radiographs are very important for foot and ankle deformity diagnosis. We have to point out some issues of this study, as some might lead to biased results.
The author only mentioned the parameters such as crossover sign, lateral center-edge angle (LCEA) was 40.6°, and preoperative degenerative tear of the upper anterior labrum with prominent pincer lesion when examined by magnetic resonance imaging. Alpha-angle, anterior center-edge angle, and Tönnis grade for osteoarthritis were not mentioned.
Litrenta et al.[2] mentioned that the crossover signs in their definition, these signs were the only defining feature. The presence of the crossed sign does not necessarily indicate an actual retroversion and may be caused by an overhanging anterior inferior iliac spine. In addition, the presence of the crossed sign or other findings of acetabular retroversion can also be found in asymptomatic individuals.[3]
Enhanced diagnostic specificity and accuracy for the diagnosis of femoroacetabular impaction (FAI) may help to avoid misdiagnosis. Lerch et al.[4] mentioned that the definition of acetabular retroversion is a positive cross-over sign, positive ischial spine sign, positive posterior wall sign, and retroversion index >30%, independent from an alpha angle. Cam-type FAI: alpha angle >50° with the neck-shaft angle of 125°–140° and with normal acetabulum (LCEA 23°–33°), not all retroversion signs positive. Mixed-type FAI: Alpha-angle >50° and LCEA 34°–39°, not all retroversion signs positive. Moreover, a study reported that higher preoperative Tönnis grades were associated with decreased hip survival.[5]
On the basis of the systematic review by Litrenta et al.,[2] arthroscopic procedures can also be used safely and adequately for trimming the rims of the pincer impingement caused by the retroversion. However, it is probable that patients with more severe retroversion or with significant dysplasia may be better indicated for anteverting periacetabular osteotomy. We appreciate the author's effort again, and we wrote this letter to express our opinion that it should offer much more information to let the readers know the differential diagnosis of this case report.
Data availability statement
Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Shao TS, Shen PH, Pan RY. Refixation of labrum in pincer type of femoroacetabular impingement. J Med Sci 2023;43:43-6.  [Full text] |
| 2. | Litrenta J, Mu B, Ortiz-Decletss V, Chen AW, Perets I, Domb BG. Should acetabular retroversion be treated arthroscopically? A systematic review of open versus arthroscopic techniques. Arthroscopy 2018;34:953-66. |
| 3. | Frank JM, Harris JD, Erickson BJ, Slikker W 3 rd, Bush-Joseph CA, Salata MJ, et al. Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: A systematic review. Arthroscopy 2015;31:1199-204. |
| 4. | Lerch TD, Meier MK, Boschung A, Steppacher SD, Siebenrock KA, Tannast M, et al. Diagnosis of acetabular retroversion: Three signs positive and increased retroversion index have higher specificity and higher diagnostic accuracy compared to isolated positive cross over sign. Eur J Radiol Open 2022;9:100407. |
| 5. | Hanke MS, Steppacher SD, Zurmühle CA, Siebenrock KA, Tannast M. Erratum to: Hips with protrusio acetabuli are at increased risk for failure after femoroacetabular impingement surgery: A 10-year followup. Clin Orthop Relat Res 2016;474:2319. |
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