Radiographic and Demographic Factors Can Predict the Need for Primary Labral Reconstruction in Hip Arthroscopic Surgery: A Predictive Model Using 1398 Hips

Abstract

Background: Labral tears are the most common findings in patients with symptomatic femoroacetabular impingement (FAI). The restoration of labral function is critical, and labral reconstruction has been proposed as an alternative for irreparable tears. Purpose: To compare preoperative radiographic measurements and demographics of patients who underwent primary arthroscopic labral reconstruction versus primary labral repair and to identify factors that are predictive of the need for reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: Patients who underwent their index hip arthroscopic procedure between October 2010 and November 2018 and underwent either labral reconstruction or repair were included in the study. A total of 18 variables (14 radiographic and 4 demographic) were assessed in a bivariate comparison and analyzed in a multivariate logistic model. Results: A total of 251 primary reconstruction and 1147 primary repair procedures were included. The logistic model selected age, body mass index (BMI), Tönnis grade, lateral center-edge angle (LCEA), and alpha angle. The odds of reconstruction were 2.52 times higher in patients with Tönnis grade 1 than 0 (odds ratio [OR], 2.52 [95% CI, 1.82-3.49]). Each additional degree in the LCEA was associated with a 6% increase in the odds of reconstruction (OR, 1.06 [95% CI, 1.04-1.09]) and 4% for each additional degree in the alpha angle (OR, 1.04 [95% CI, 1.03-1.05]). Higher age (per log 10 unit) and BMI also increased the likelihood of reconstruction (OR, 11.29 [95% CI, 4.23-30.10] and OR, 1.03 [95% CI, 1.00-1.06], respectively). Conclusion: In a multivariate analysis, factors identified as preoperative predictors for primary arthroscopic labral reconstruction in the setting of FAI and labral tears were Tönnis grade, LCEA, age, and BMI. These predictive factors may be useful for the clinician in determining the preoperative likelihood of primary labral reconstruction.

Hip Arthroscopic Surgery in the Context of Femoroacetabular Impingement Syndrome, Labral Tear, and Acetabular Overcoverage: Minimum 5-Year Outcomes With a Subanalysis Against Patients Without Overcoverage

“…Moreover, these patients often have calcified labra that, with the addition of the required extensive acetabuloplasty, may require advanced labral restoration techniques. 39,42,68…”

“…Previous studies have demonstrated interrater reliability in measurements taken at the American Hip Institute. 25,42,65 All patients underwent magnetic resonance arthrography to assess labral tears and another potential extra- and intra-articular pathologies.…”

“…19,71 Third, advanced techniques for labral function restoration may be needed. 42 Nevertheless, significant improvement in PROs has been reported for patients who underwent hip arthroscopy in the setting of overcoverage. 13 Moreover, outcomes have been noted to be similar to those of patients without acetabular overcoverage.…”

Arthroscopic acetabular labral reconstruction: a review

“…Using a multivariate analysis, we identified radiographic and demographic preoperative factors and proposed a predictor model for labral arthroscopic reconstruction. This can be useful to surgeons in the early stages of the learning curve to anticipate the need for this complex procedure [ 40 ]. This study analyzed 18 variables in a cohort of 1398 primary hip arthroscopies (251 primary reconstructions and 1147 primary repairs) and found that the odds of labral reconstruction were 2.52 times higher in patients with Tönnis grade 1 than 0.…”

Prospective Analysis of Arthroscopic Hip Anatomic Labral Repair Utilizing Knotless Suture Anchor Technology: The Controlled-Tension Anatomic Technique at Minimum 2-Year Follow-up

“…39 The American Hip Institute's radiographic measurements have demonstrated good interobserver reliability in previously published studies. 19,42…”