Revision Hip Arthroscopy With Labral Reconstruction for Irreparable Labral Tears in Athletes: Minimum 2-Year Outcomes With a Benchmark Control Group

Abstract

Background: The incidence of revision hip arthroscopy with labral reconstruction in athletes is increasing. However, the outcomes of revision hip arthroscopy with labral reconstruction in athletes have not been well established. Purposes: (1) To report minimum 2–year patient–reported outcome (PRO) scores and return to sports (RTS) characteristics for high–level athletes undergoing revision hip arthroscopy with labral reconstruction and (2) to compare clinical results with those of a propensity–matched control group of high–level athletes undergoing revision hip arthroscopy with labral repair. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed for athletes at any level who underwent a revision hip arthroscopy and a labral reconstruction between April 2010 and March 2019. Minimum 2–year PROs were reported for the modified Harris Hip Score (mHHS), the Nonarthritic Hip Score (NAHS), the Hip Outcome Score–Sport Specific Subscale (HOS-SSS), the visual analog scale (VAS) for pain, and RTS. The percentages of athletes achieving the minimal clinically important difference (MCID) and the maximum outcome improvement satisfaction threshold (MOIST) were also recorded. These patients were propensity matched in a 1: 1 ratio to athletes undergoing revision hip arthroscopy with labral repair for comparison. Results: A total of 46 athletes (N = 47 hips) were reported from 50 (n = 51 hips) athletes who underwent revision with labral reconstruction. A subanalysis of 30 propensity–matched athletes undergoing revision labral reconstruction was performed, with a mean follow–up time of 26.3 ± 2.4 months and an age of 28.5 ± 10.1 years, and compared with a revision labral repair group. Significant improvements were obtained for the mHHS, the NAHS, the HOS-SSS, and the VAS from preoperative to the latest follow–up ( P < .001), with an achievement MCID rate of 61.5%, 72%, 62.5%, and 76.9% for the mHHS, the NAHS, the HOS-SSS, and the VAS, respectively. The rate for re–revision surgery (2 tertiary arthroscopy and 1 conversion to total hip arthroplasty) was 10%, and 14 patients (63.6%) were able to RTS. Improvements in PROs, rates of achieving MCID/MOIST, rate of re–revision surgery (re-revision hip arthroscopy, P = .671; conversion to total hip arthroplasty, P > .999), and RTS rate ( P = .337) were similar when compared with those of the propensity–matched control labral repair group ( P > .05). Conclusion: Revision hip arthroscopy with labral reconstruction, in the context of an irreparable labral tear, seems to be a valid treatment option in the athletic population, demonstrating significant improvements in all PROs and low rates of undergoing revision surgery. Athletes experienced a similar magnitude of improvement in PROs, RTS rate, and revision surgery rate to that of a propensity–matched control group of athletes undergoing revision hip arthroscopy with labral repair.

Tissue Regrowth and Its Vascularization Through Bone Marrow Stimulation: Microfracture at the Acetabular Rim for Irreparable Labral Tear in a Porcine Model

“…When the labrum is too damaged to be repaired or augmented, labral reconstruction seems to be the only surgical option to restore the morphology and function of the torn labrum. 11,15,22,23,31 However, our previous results have shown that poor tissue healing occurred because of the slow and insufficient vascular ingrowth within the articular half of the reconstructed autograft. 25 Given that, this study aimed to explore the possibility of improving the vascularization of the inner half through bone marrow stimulation and to find out whether the volume of the regrown tissue is sufficient to fill the labral defect after microfracture at the bony rim of the acetabulum.…”

“…When the chondrolabral junction is too damaged to be preserved, labral reconstruction is recommended given its promising short- to midterm clinical outcomes. 11,15,19,20,31 Nonetheless, the reported conversion rate of labral reconstruction to total hip arthroplasty (THA) is relatively high, 7,15,20,28,32 which remains a great challenge for the treatment of irreparable labral tears. Moreover, our previous study in a porcine model showed that the slow and insufficient vascular ingrowth within the articular half could cause poor healing of the reconstructed autograft labrum.…”

Hip & Pelvis

“…The series from Chicago (Illinois, USA) is a propensity-matched study comparing athletes undergoing revision labral repair with non-athletes. 5 Outcomes are to a very satisfactory two years, and the authors assessed them with patient-reported outcome measures (PROMs) and based on return to sports. The PROMs reported by the authors are the modified Harris Hip Score (mHHS), the Nonarthritic Hip Score (NAHS), the Hip Outcome Score-Sport Specific Subscale (HOS-SSS), and the visual analogue scale (VAS) for pain.…”

Modified Technique for Labral Reconstruction of Hip Joint Using Autologous Iliotibial Band (ITB)—Make Labral Reconstruction Stress-Free

“…Therefore, several authors now believe that labral reconstruction should be the treatment of first choice for labral degeneration or defect. 3 , 4 , 5 …”