Acetabular Labral Reconstruction with Iliotibial Band Autograft

Abstract

Background: Labral reconstruction has been shown to result in improved patient-reported outcomes (PROs) at mid-term follow-up in patients with a deficient labrum. The purpose of this study was to determine survivorship and PROs at a minimum 10-year follow-up. Methods: A retrospective evaluation of a prospectively collected single-surgeon database included 91 hips (89 patients) that underwent arthroscopic labral reconstruction with iliotibial band autograft between 2006 and 2008. The primary PRO was the Hip Outcome Score (HOS)-activities of daily living (ADL). The modified Harris hip score (mHHS), HOS-sports, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and patient satisfaction (on a scale of 1 to 10) were also collected at a 10-year minimum follow-up. Survivorship analysis curves were evaluated. Results: Eighty-two hips were evaluated at a 10-year minimum follow-up. Overall survivorship, with revision hip arthroscopy or total hip arthroplasty (THA) as the end point, was 70% at 5 years and 61% at 10 years, and the mean survival time was 9 years (95% confidence interval = 7.6 to 10 years). For the patients who did not undergo subsequent surgery, on average the mHHS increased from 60 preoperatively to 82 at the 10-year follow-up (p = 0.001), the HOS-ADL improved from 69 to 90 (p = 0.004), the HOS-sports improved from 43 to 76 (p = 0.001), and the median patient satisfaction was 10 of 10. Eighty percent of the patients achieved the minimal clinically important difference (MCID) in the HOS-ADL, and 87% obtained a patient acceptable symptom state (PASS). Conclusions: Following arthroscopic labral reconstruction with iliotibial band autograft, 9% of the hips underwent revision arthroscopy and 27% underwent THA. At 10 years, the survival rate, with revision hip arthroscopy or THA as the end point, was 61%; however, for those with >2 mm of joint space, the current indication for labral reconstruction, the 10-year survival rate was 90%. Excellent PROs and patient satisfaction were reported by those who did not require revision or THA. With appropriate patient selection and prevention of postoperative adhesions, labral reconstruction results in excellent outcomes and high patient satisfaction that is sustained at a minimum 10-year follow-up. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Pectoralis major tendon reconstruction using an iliotibial band autograft

“…Autologous ITB grafts have also been used in several other reconstruction procedures, including reconstruction of the anterior cruciate ligament (ACL), acetabular labral, superior J o u r n a l P r e -p r o o f capsule of the shoulder, and trauma-associated soft tissue defects. 5,12,13,17 Having documented their successful clinical outcomes, these studies further demonstrate the versatility of the ITB graft as a viable autologous material for tendon reconstruction. The potential morbidity associated with harvesting the autologous graft include wound infection, superficial phlebitis, seroma, muscle hernia, and deep vein thrombosis; however, these are rarely seen in practice.…”

“…13 Additionally, a case series dealing with acetabular labral reconstruction of 75 patients using ITB autografts observed no reported donor site complications, pain, or weakness. 17 Given the literature regarding minimal donor site morbidity and the excellent outcome observed in this case, the ITB graft has potential to be a viable tissue for reconstruction of pectoralis major tendon ruptures.…”

Labral reconstruction with polyurethane implant

“…Limitations of autograft tissue include a reduced survivorship of 70% at 5 years and 61% at 10 years, with a mean survival time of 9 years with revision or THA as the endpoint. Nine percent of the hips underwent revision arthroscopy and 27% underwent THA [ 28 ].…”

Arthroscopic acetabular labral reconstruction: a review

“…Philippon et al . [ 27 ] concluded that segmental labral reconstruction with an iliotibial band autograft yield excellent results and high patient satisfaction at 10-year follow-up. Labral reconstruction, even in the context of severe chondral damage, has shown favorable results.…”

“…Proponents of the segmental technique argue that healthy labra native tissue can be unnecessarily sacrificed. Additionally, most of the available outcomes data on reconstruction, even in the long-term follow-up, comes from the segmental alternative [ 26 , 27 ]. In the circumferential or total labral reconstruction, the whole native labrum is taken down and reconstructed with the graft ( Fig.…”