The Hip Labrum Reconstruction: Indications and Outcomes—an Updated Systematic Review

Abstract

Purpose of Review To present an updated systematic review of the indications and outcomes of open and arthroscopic labral reconstruction. Due to the increasing popularity and recognition, the arthroscopic procedure has gained in recent years, the aim was to assess for changes in indications, graft selection, and improvement in outcomes within the last 5 years. Recent Findings A total of nine eligible studies (six case series, one cohort, and two retrospective comparative studies) with a total of 234 patients (265 hips), and an average 12/16 (non-comparative studies) and 20/24 (comparative studies) quality on the MINORS score were included in this review. All patients underwent labral reconstruction, whether as primary surgery or revision (76% vs 24% respectively). There were 244 hips assessed at final follow-up (92%) with a reported mean range of 12 and 61 months. There were more graft variabilities found in this study compared with the previous review (iliotibial band allograft, gracilis tendon autograft, indirect head of rectus femoris autograft, semitendinosus allograft, peroneus brevis allograft, labrum allograft, ligamentum capitus femoris). Surgical approaches differed (open 7.9% (previously 18.7%), arthroscopic 86% (previously 81. 3 %), arthroscopic assisted mini-open technique (AAMOT) (6%)). Overall, improvement was observed in the patientreported outcomes and functional scores, with variability in their statistical significance. The failure rate or conversion to total hip arthroplasty (THA) decreased compared with the previous review (20% vs 9.5% [conversion to THA was 5.7% and revision surgery rate was 3. 8%]). Indications for labrum reconstruction remained similar (i.e., young, active patients with no or minimal arthritis (Tonnis 0-1), irreparable or ossified labrum, and hypotrophic < 2 mm or dysfunctional hypertrophic labrum > 8 mm). Summary According to recent evidence, hip labrum reconstruction is a new technique that showed short-and mid-term improvement in patient-reported outcomes and functional scores postoperatively. The primary indication for reconstruction remained similar over time. The failure rates and/or conversion to THA appear to have decreased over time. Long-term follow-up with higher quality studies was not available in the literature based on this review. Level of evidence 2

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

“…The results of this systematic review are corroborated by previous reviews, which have demonstrated labral reconstruction to be an effective treatment for irreparable labrum, with good outcomes in properly indicated cases (11,13,23,24). Trivedi et al (11) reported that the score change for mHHS in 10 of 11 studies included in their systematic review ranged from 11 to 36, with the minimal clinically important difference (MCID) being 8 (33,34,41).…”

“…Hip arthroscopy represents the modern and preferred method for labral reconstruction, with arthroscopic procedures constituting 86% of these procedures (24). Arthroscopic procedures result in superior outcomes, lower reoperation rates (25), and expedited recovery compared to surgical dislocation of the hip (26).…”

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: Hip Hypotrophic Labrum Should Not Change Our Treatment Algorithm: Welcome to the Augmented Reality of the Hip-Preservation Zone

“…A recent systematic review suggests that current indications for labral reconstruction are young, active patients with no or minimal arthritis (Tönnis 0-1), irreparable or ossified labrum, and hypotrophic <2 mm or dysfunctional hypertrophic labrum >8 mm. 7 The current study by Drager et al 4 now adds evidence for repair in a primary procedure with good quality tissue, even if hypotrophic. Anatomy has to have a place in our hip-preservation approach.…”