Outcomes After Arthroscopic Hip Labral Reconstruction: A Systematic Review and Meta-analysis

Abstract

Background: The acetabular labrum is critical to maintenance of hip stability and has been found to play a key role in preservation of the hip fluid seal. For irreparable labral damage, arthroscopic labral reconstruction is an evolving technique that has been shown to decrease hip pain and restore function. Purpose: To provide a comprehensive review of current literature for arthroscopic hip labral reconstruction, with a focus on determining if outcomes differ between autograft or allograft tissue. Study Design: Systematic review and meta-analysis. Methods: PubMed and Scopus online databases were searched with the key terms “hip,”“labrum,”“reconstruction,” and “graft” in varying combinations. Procedures performed, complications, failures, and functional outcome measures were included in this analysis. The inverse variance method was used to calculate pooled estimates and 95% CIs. Results: Eight studies with 537 hips were included. Mean age was 37.4 years (95% CI, 34.5-40.4 years), and mean follow-up time was 29 months (95% CI, 26-33 months). Survivorship after autograft reconstruction ranged from 75.7% to 100%, as compared with 86.3% to 90.0% in the allograft cohort. In the autograft cohort, failures included 0% to 13.2% conversion to total hip arthroplasty and 0% to 11.0% revision hip arthroscopy. Failures in the allograft cohort included 0% to 12.9% total hip arthroplasty conversion, 0% to 10.0% revision arthroscopy, and 0% to 0.8% open revision surgery. Based on 6 studies, the modified Harris Hip Score improved by a mean 29.0 points after labral reconstruction ( P < .0001). Conclusion: Arthroscopic hip labral reconstruction results in clinically significant improvements in patient-reported outcomes. Our analysis indicates that there are no significant differences in outcomes based on graft type alone. A number of factors may determine graft choice, including patient preference, surgeon experience, operative time, morbidity, and cost. Proper patient selection based on age and severity of degenerative joint disease will also optimize outcomes after labral reconstruction.

Editorial Commentary: No Longer a Salvage Procedure: Allograft Labral Reconstruction of the Hip Rivals the Results of Labral Repair

“…In line with my anecdotal experience, hips that undergo labral reconstruction have been shown to have positive outcomes at minimum 2-year follow-up, despite the fact that in many cases, these hips have more damage and a poorer preoperative prognosis, across previously published outcome studies to date [1][2][3] and in this most recent study by Scanaliato et al 5 In this cohort, all hips achieved substantial clinical benefit and exceeded the minimally clinically important difference from preoperatively to postoperatively. Of the 30 hips, 26 (86.7%) returned to play at a median of approximately 6 months.…”

“…Use of this procedure has expanded because of innovation in hip arthroscopy techniques and tools; over time, so too has evidence expanded to support this use with high-quality data on patient-reported outcomes. Four review or consensus statements on labral reconstruction outcomes have been published in the past 2 years alone, [1][2][3][4] and outcomes after labral reconstruction have been overwhelmingly positive. The study "Primary and Revision Circumferential Labral Reconstruction for Femoroacetabular Impingement in Athletes: Return to Sport and Technique" by Scanaliato, Chasteen, Polmear, Salfiti, and Wolff 5 in this issue of Arthroscopy provides the next key piece of the puzzle to validating this procedure by reviewing return to sports participation.…”

Editorial Commentary: Predicting the Size of the Labrum: We Have the Technology, Should We Put it to Use?

“…Furthermore, labral reconstruction is a technically challenging technique with a steep learning curve, and it may be a procedure that many hip arthroscopists may not be facile to generate predictably positive outcomes. 9,10 Hence, it is critical to preoperatively identify patients who may potentially require labral reconstruction. In this population, adequately assessing labral size preoperatively may be an important part of the preoperative workup.…”

Indications and Outcomes for Arthroscopic Hip Labral Reconstruction With Autografts: A Systematic Review

“…The overall improvements in outcomes have been since summarized in recent systematic reviews (11,13,23). However, prior systematic reviews have included studies with significant heterogeneity regarding the type and source of graft tissue utilized in the procedure, including both auto-and allografts, and the technique, including both open and arthroscopic reconstructions.…”

“…Arthroscopic procedures result in superior outcomes, lower reoperation rates (25), and expedited recovery compared to surgical dislocation of the hip (26). Despite inherent advantages of allografts, such as decreased surgical time and avoidance of donor-site morbidity, some disadvantages should be taken into account such as potential disease transmission, delayed incorporation, increased costs and patient refusal, making autografts the preferred source for a subset of surgeons (10,23,(27)(28)(29). Allografts may also be less readily available, or nonexistent options for surgeons in certain parts of the world.…”