Autograft Versus Allograft: The Evidence in Hip Labral Reconstruction and Augmentation

Abstract

Background: Labral augmentation and labral reconstruction have emerged as essential procedures for restoring the anatomic and functional characteristics of the hip joint in patients with a deficient hip labrum or irreparable labral tear. Hypothesis/Purpose: The purpose of this study was to compare allograft and autograft hip labral reconstruction and augmentation. We hypothesized that autografts would entail fewer revision arthroscopic procedures. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were identified who underwent labral reconstruction or labral augmentation using iliotibial band (ITB) allograft or ITB autograft performed by a single surgeon between 2011 and 2017. Patient-reported outcome measures collected before surgery and at minimum 2-year follow-up included the following: Hip Outcome Score Activities of Daily Living and Hip Outcome Score Sports-Specific Subscale and, at follow-up, patient satisfaction (range, 1-10, with 10 being very satisfied). Patients followed a standardized rehabilitation protocol after surgery with relative individualization to address each patient's needs. For continuous variables, comparisons between allografts and autografts were made using Student t tests or Mann-Whitney tests. Categorical comparisons were assessed using chi-square or Fisher exact test. Multiple logistic regression was performed to determine the influence of graft choice on risk of revision or THA. Results: A total of 205 hips met 2-year inclusion criteria. ITB allografts were used for 55 patients (37 augmentations, 18 reconstructions) and ITB autografts for 150 patients (34 augmentations, 116 reconstructions). Females represented a greater proportion of allograft versus autograft patients (71% vs 46%, respectively; P = .001). Overall, autograft patients had larger alpha angles (66.6° vs 59.1°; P = .001) and longer grafts (46 vs 41 mm; P = .03) compared with allograft patients. A total of 13 (23.6%) patients required revision surgery in the allograft group compared with 11 (7.3%) in the autograft group ( P < .001). After controlling for sex, procedure (reconstruction vs augmentation), and previous surgery, the odds of revision were higher for allograft patients (OR, 4.1; 95% CI, 1.5-11.6). No significant differences in conversion to THA were observed between groups (allograft = 9%; autograft = 6%; P = .50), even after adjustment for the above covariates (OR, 2.3; 95% CI, 0.6-7.9). No differences in postoperative patient-reported outcome measures or patient satisfaction were observed between groups. Conclusion: Labral augmentation or reconstruction with autograft has a significantly lower revision rate than labral augmentation or reconstruction with allograft.

Minimum 5-Year Outcomes After Primary Segmental Labral Reconstruction for Irreparable Labral Tears in the Hip With Hamstring Grafts: With a Subanalysis Comparing Autograft Versus Allograft

“…Additionally, the rate for secondary surgeries was also comparable. Previously, Cooper et al 10 reported results comparing iliotibial band autografts and allografts, with 150 and 55 patients in each group, respectively. The mean follow-up time was 3.3 6 1.2 years and 4.2 6 1.6 years for the allograft and autograft groups, respectively.…”

Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Chinese Patients: A Minimum 2-Year Follow-up Study

“…Extensive labral calcification, insufficient viable labral tissue (<6 mm), and iatrogenic labral insufficiency was considered irreparable. 6 Labral reconstruction with iliotibial band or gracilis autograft from the operative side was considered in the case of an irreparable labral tear. 4 , 24 …”

“…Extensive labral calcification, insufficient viable labral tissue (<6 mm), and iatrogenic labral insufficiency was considered irreparable. 6 Labral reconstruction with iliotibial band or gracilis autograft from the operative side was considered in the case of an irreparable labral tear. 4,24 Chondroplasty was performed for partial-thickness cartilage lesions and chondral flaps with an arthroscopic shaver and/or electrocautery device (Smith & Nephew).…”

Hip Labral Reconstruction With a Polyurethane Scaffold: Restoration of Femoroacetabular Contact Biomechanics

“…24,28 The use of these autografts requires express authorization from the patient through informed consent and can also lead to possible morbidity in the donor area and an increase in surgical time. 2,7,9 As an alternative to human tissue usage, biodegradable, synthetic, polyethylene scaffolds were developed more than 15 years ago for restoration of the meniscus in the knee, with successful results clinically up to 10 years. 3,6,15,41 Owing to the abundant vascular supply in the acetabulum, 33 integration of the scaffold can be expected.…”

“…24,28 The use of these autografts requires express authorization from the patient through informed consent and can also lead to possible morbidity in the donor area and an increase in surgical time. 2,7,9…”