Primary Circumferential Acetabular Labral Reconstruction: Achieving Outcomes Similar to Primary Labral Repair Despite More Challenging Patient Characteristics

Scanaliato, John P.; Christensen, Daniel; Salfiti, Catherine; Herzog, Mackenzie M.; Wolff, Andrew B.

doi:10.1177/0363546518775425

Cited by 63 publications

(78 citation statements)

References 39 publications

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“…5,11 Recently, restoring the labral seal mechanism via labral reconstruction has emerged as a viable option as a result of new technology and innovative surgical techniques. 8,35,38 Arthroscopic labral reconstruction is not only complex but also a relatively new procedure. 15,16,29,37,41,44 Limited literature is available on short-and midterm outcomes after hip labral reconstruction.…”

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confidence: 99%

Return to Sport and Athletic Function in an Active Population After Primary Arthroscopic Labral Reconstruction of the Hip

Maldonado

Chen

Yelton

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Labral reconstruction has been advocated as an alternative to debridement for the treatment of irreparable labral tears, showing favorable short-term results. However, literature is scarce regarding outcomes and return to sport in the nonelite athletic population. Purpose: To report minimum 1-year clinical outcomes and the rate of return to sport in athletic patients who underwent primary hip arthroscopy with labral reconstruction in the setting of femoroacetabular impingement syndrome and irreparable labral tears. Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected and retrospectively analyzed for patients who underwent an arthroscopic labral reconstruction between August 2012 and December 2017. Patients were included if they identified as an athlete (high school, college, recreational, or amateur); had follow-up on the following patient-reported outcomes (PROs): modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sport Specific Subscale (HOS-SSS), and visual analog scale (VAS); and completed a return-to-sport survey at 1 year postoperatively. Patients were excluded if they underwent any previous ipsilateral hip surgery, had dysplasia, or had prior hip conditions. The proportions of patients who achieved the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for mHHS and HOS-SSS were calculated. Statistical significance was set at P = .05. Results: There were 32 (14 females) athletes who underwent primary arthroscopic labral reconstruction during the study period. The mean age and body mass index of the group were 40.3 years (range, 15.5-58.7 years) and 27.9 kg/m2 (range, 19.6-40.1 kg/m2), respectively. The mean follow-up was 26.4 months (range, 12-64.2 months). All patients demonstrated significant improvement in mHHS, NAHS, HOS-SSS, and VAS ( P < .001) at latest follow-up. Additionally, 84.4% achieved MCID and 81.3% achieved PASS for mHHS, and 87.5% achieved MCID and 75% achieved PASS for HOS-SSS. VAS pain scores decreased from 4.4 to 1.8, and the satisfaction with surgery was 7.9 out of 10. The rate of return to sport was 78%. Conclusion: At minimum 1-year follow-up, primary arthroscopic labral reconstruction, in the setting of femoroacetabular impingement syndrome and irreparable labral tears, was associated with significant improvement in PROs in athletic populations. Return to sport within 1 year of surgery was 78%.

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confidence: 99%

Return to Sport and Athletic Function in an Active Population After Primary Arthroscopic Labral Reconstruction of the Hip

Maldonado

Chen

Yelton

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…Ó 2020 Published by Elsevier on behalf of the Arthroscopy Association of North America 0749-8063/201134/$36.00 https://doi.org/10.1016/j.arthro.2020.06.036 support that approach, [22][23][24] whereas other studies have showed lower outcome scores for reconstruction but a statistical equivalence to repair. 25,26 Whether one believes in primary reconstruction or not, in my opinion, this study highlights the importance of the native labrum and the challenges we face with reconstructing it. From my perspective, intraoperative management of labral tissue from joint entry to preparation for pincer resection is extremely important and, if done poorly, can have long-term negative consequences for a patient.…”

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confidence: 81%

Editorial Commentary: Hip Labral Reconstruction: A Necessary Skill for Hip Arthroscopy Surgeons

Vap¹

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The surgical treatment of labral deficiency has generated a tremendous amount of discussion and controversy among hip arthroscopists. The surgical reconstruction of the labrum has been viewed as the natural next step, after debridement and repair, in the advancement of our ability to treat patients with hip labral pathology. However, the indications for labral replacement and the profile of patients who would benefit from this complex intervention are still under debate. Every hip arthroscopist must have the technical ability to perform reconstruction when indicated. Repair or debridement does not always achieve best patient outcome.

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“…Other studies have shown similar promising results of labral reconstruction, particularly among patients with challenging hip problems, including those in whom prior treatment has failed, those who have higher preoperative pain scores, and those with more preoperative intra-articular pathology, as well as older patients. 17,25 This procedure may be particularly advantageous in patients aged 40 years and older, who may be more likely to have degenerative or poor-quality labral tissue and significant preoperative intra-articular pathology.…”

Section: Discussionmentioning

confidence: 99%

Hip Arthroscopy in Patients Aged 40 Years and Older: Greater Success With Labral Reconstruction Compared With Labral Repair

White

Patterson²,

Scoles

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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To assess the outcomes of complete, primary, arthroscopic hip labral reconstruction among patients aged 40 years and older compared with those who underwent primary labral repair and compared with patients aged 30 to 39 years who underwent complete, primary labral reconstruction. Methods: We recruited all patients who underwent arthroscopic labral reconstruction between March 2010 and June 2015 and were aged 30 to 65 years or who underwent arthroscopic labral repair between June 2009 and June 2015 and were aged 40 to 65 years. The modified Harris Hip Score (mHHS), Lower Extremity Function Score, and visual analog scale score for average pain were collected preoperatively and at minimum 2year follow-up. Failure was defined as the need for revision ipsilateral hip surgery. The rate of conversion to total hip arthroplasty (a subset of failure) was assessed separately. Results: A total of 363 hips in 343 patients met the inclusion criteria. Follow-up was available for 312 hips (86.0%), and the average time to follow-up was 4.2 years (range, 2.0-8.5 years). After adjustment for differences in follow-up time between groups, failure was 3.29 times more likely for hips in the repair group aged 40 years and older than for hips in the reconstruction group aged 40 years and older (relative rate, 3.29; 95% confidence interval, 1.25-8.69; P ¼ .02), and there was no difference in the failure rate for hips in the reconstruction group aged 40 years and older compared with hips in the reconstruction group aged 30 to 39 years (relative rate, 0.58; 95% confidence interval, 0.18-1.89; P ¼ .37). The rate of conversion to total hip arthroplasty was not meaningfully different between the 3 groups. Among hips for which treatment did not fail, average improvement in the mHHS measured 35 points and both labral reconstruction groups saw a greater mHHS improvement than the labral repair group of patients aged 40 years and older (P ¼ .01 and P < .01). Conclusions: Labral reconstruction led to a lower failure rate, greater average improvement in the mHHS, and equivalent postoperative patient-reported outcome scores compared with labral repair among patients aged 40 years and older in this study population, and the outcomes of labral reconstruction were similar between patients aged 40 years and older and those aged 30 to 39 years. Complete labral reconstruction may be particularly advantageous in patients aged 40 years and older. Level of Evidence: Level III, retrospective comparative study.

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Primary Circumferential Acetabular Labral Reconstruction: Achieving Outcomes Similar to Primary Labral Repair Despite More Challenging Patient Characteristics

Cited by 63 publications

References 39 publications

Return to Sport and Athletic Function in an Active Population After Primary Arthroscopic Labral Reconstruction of the Hip

Return to Sport and Athletic Function in an Active Population After Primary Arthroscopic Labral Reconstruction of the Hip

Editorial Commentary: Hip Labral Reconstruction: A Necessary Skill for Hip Arthroscopy Surgeons

Hip Arthroscopy in Patients Aged 40 Years and Older: Greater Success With Labral Reconstruction Compared With Labral Repair

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