Graft Options in Hip Labral Reconstruction

Lodhia, Parth; McConkey, Mark O.; Leith, Jordan; Maldonado, David R.; Brick, Matthew J.; Domb, Benjamin G.

doi:10.1007/s12178-020-09690-4

Cited by 20 publications

(36 citation statements)

References 66 publications

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“…32 Allografts have the disadvantages of the theoretical risk of disease transmission, restricted availability, higher costs, and delayed incorporation when compared with autografts. 14,28 Conversely, autografts may have increased morbidity for the patient, as harvesting may cause increased operating time, graft-site pain, nerve injury, infection, and wound healing complications. 12,37 Biomechanically, autograft and allograft properties have been shown to be similar.…”

Section: Discussionmentioning

confidence: 99%

“…The calculated MCID values for the mHHS, VAS, and NAHS were 8.8, -1.1, and 9.7, respectively. At the latest follow-up, the rates of achieving the MCID for the mHHS, VAS, and NAHS were 76.7% (23), 86.7% (26), and 93.3% (28), respectively. The rates of achieving the PASS for the mHHS and the iHOT-12 were 96.7% (29) and 80% (24), respectively.…”

Section: Psychometric Tools and Secondary Surgeriesmentioning

confidence: 95%

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Minimum 5-Year Outcomes After Primary Segmental Labral Reconstruction for Irreparable Labral Tears in the Hip With Hamstring Grafts: With a Subanalysis Comparing Autograft Versus Allograft

et al. 2022

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Background: Comparable short-term outcomes have been obtained using hamstring allografts versus autografts after primary segmental labral reconstruction (SLR). Midterm results have not yet been determined. Purpose: (1) To evaluate minimum 5-year patient-reported outcome (PRO) scores in patients who underwent primary SLR with hamstring grafts in the setting of femoroacetabular impingement syndrome (FAIS) and irreparable labral tears and (2) to compare the outcomes of hamstring autografts versus allografts in a subanalysis using propensity-matched groups. Study Design: Cohort study; Level of evidence, 3. Methods: Prospectively collected data were retrospectively reviewed for patients who underwent primary hip arthroscopy between September 2010 and November 2015. Patients were included if they underwent SLR using hamstring autografts or allografts and had preoperative and minimum 5-year PROs. The exclusion criteria were previous ipsilateral hip surgery or conditions, dysplasia, or Tönnis grade >1. Patients with autograft SLR were propensity matched 1 to 1 based on age, sex, and body mass index (BMI) to patients who underwent SLR using hamstring allografts. The minimal clinically important difference (MCID) and the Patient Acceptable Symptom State (PASS) were calculated. Results: Overall, 48 patients (N = hips 48) were eligible to be included in this study, and 41 patients (n = 41 hips [85.4%]) had a minimum 5-year follow-up reporting significant improvements in all PROs. Within the entire cohort, 9.8% required a secondary arthroscopy, with a mean time of 19 ± 1.8 months, and survivorship was 82.9%. Of the 41 included patients, 15 underwent an SLR with a hamstring autograft and were matched to 15 patients with labral reconstruction using a hamstring allograft. Groups were similar for sex ( P > .999), age ( P = .775), and BMI ( P = .486). The mean follow-up times were 80.8 ± 25.5 and 66.1 ± 8.3 months ( P = .223) for the autograft and allograft groups, respectively. Baseline PROs, preoperative radiographic measurements, surgical findings, and intraoperative procedures were similar. The groups achieved significant and comparable improvements for all PROs ( P < .0001), satisfaction ( P = .187), and the rate of achieving the MCID and the PASS. However, a tendency for higher postoperative PROs favoring allograft reconstruction was found. Conclusion: At a minimum 5-year follow-up, patients who underwent primary arthroscopic SLR in the context of FAIS and irreparable labra, with either autograft or allograft hamstring tendons, reported significant improvements and comparable postoperative scores for all PROs, patient satisfaction, MCID, and PASS.

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Section: Discussionmentioning

confidence: 99%

Section: Psychometric Tools and Secondary Surgeriesmentioning

confidence: 95%

Minimum 5-Year Outcomes After Primary Segmental Labral Reconstruction for Irreparable Labral Tears in the Hip With Hamstring Grafts: With a Subanalysis Comparing Autograft Versus Allograft

et al. 2022

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“…Key advantages of segmental labral reconstruction with a synthetic off-the-shelf scaffold may include ad hoc availability compared to allograft limitations [ 26 ], a faster operative time through concurrent scaffold preparation instead of tissue harvesting or allograft preparation, no donor-site morbidity, a potentially reduced infection rate, and avoidance of disease transmission. Further economic advantages may become apparent with future commercialization of this scaffold in the hip.…”

Section: Discussionmentioning

confidence: 99%

Labral reconstruction with polyurethane implant

Tey

Capurro

Torres-Eguia³

et al. 2021

Journal of Hip Preservation Surgery

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Surgical treatment of labral injuries has shifted from debridement to preservation over the past decades. Primary repair and secondary augmentation or reconstruction techniques are aimed at restoring the labral seal and preserving or improving contact mechanics. Currently, the standard of care for non-repairable tears favours the use of auto- or allografts. As an alternative, we present our initial experience using a synthetic, off-the-shelf polyurethane scaffold for augmentation and reconstruction of segmental labral tissue loss or irreparable labral damage. Three patients aged 37–44 (two male, one female) with femoroacetabular impingement without associated dysplasia (Wiberg > 25°) or osteoarthritis (Tönnis <2) were included in this series. Labral reconstruction (one case) and augmentation (two cases) were performed using a synthetic polyurethane scaffold developed for meniscal substitution (Actifit®, Orteq Ltd, London, UK) and adapted to the hip. Clinical results were analysed with patient-reported outcomes (PROMs) using non-arthritic hip score (NAHS) and daily live activities hip outcome score (DLA HOS) and magnetic resonance images (MRI) at 2- and 4-year follow-up. Clinically improvement was seen in all PROMs at 4 years. The NAHS scores improved from 57.7 to 82.3 (50.9% improvement) and HOS from 59 to 79.3 (35.3% improvement). Last follow-up MRIs confirmed the presence of the scaffold; however, the scaffold signal was still hyperintense compared to native labrum. There was no shrinkage in any scaffold and no progression to hip osteoarthritis seen. Reconstruction or augmentation of segmental labral defects with a polyurethane scaffold may be an effective procedure. At 4 years after implantation, our small cases series resulted in improved hip joint function, reduced pain and scaffold preservation on follow-up imaging.

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“…Surgeon preferences for allograft included hamstring, fascia lata, anterior tibialis, and tissue bank acetabular labrum [23]. Other recent literature has documented use of the peroneus brevis [43][44][45] and medial meniscus [46] as alternate sources of allograft tissue. In a 2020 systematic review and meta-analysis, Rahl et al [7] found that in regard to allograft choice, the most commonly utilized tissues included iliotibial band (76.2%) and tensor fascia lata (23.8%).…”

Section: Graft Choicementioning

confidence: 99%

Allograft Labral Reconstruction of the Hip: Expanding Evidence Supporting Greater Utilization in Hip Arthroscopy

White

Constantinides²

2022

Curr Rev Musculoskelet Med

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Purpose of Review The current review investigates outcomes and failure rates associated with arthroscopic circumferential allograft labral reconstruction of the hip, both as a revision and primary procedure in treating femoroacetabular hip impingement and labral-related pathology. Recent Findings Numerous studies within the last decade have demonstrated excellent patient-reported outcomes, high rates of return-to-play in athletes, and low failure rates in patients having undergone arthroscopic circumferential allograft labral reconstruction of the hip. Removal of chronically diseased and injured labral tissue can eliminate a significant pain-generator from the hip joint. Additionally, circumferential reconstruction of the labrum restores the hoop fiber strength and fluid seal akin to what would be seen with native, healthy labral tissue. Recent research has shown that arthroscopic circumferential allograft labral reconstruction may be used not only in the revision setting, but as a primary procedure. Circumferential labral reconstruction should be considered when a surgeon feels that the labrum is irreparable or has failed previous repair. Summary Arthroscopic circumferential allograft labral reconstruction of the hip can be utilized as treatment option not only in revision settings, but also in primary treatment for femoroacetabular impingement and labral pathology

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Graft Options in Hip Labral Reconstruction

Cited by 20 publications

References 66 publications

Minimum 5-Year Outcomes After Primary Segmental Labral Reconstruction for Irreparable Labral Tears in the Hip With Hamstring Grafts: With a Subanalysis Comparing Autograft Versus Allograft

Minimum 5-Year Outcomes After Primary Segmental Labral Reconstruction for Irreparable Labral Tears in the Hip With Hamstring Grafts: With a Subanalysis Comparing Autograft Versus Allograft

Labral reconstruction with polyurethane implant

Allograft Labral Reconstruction of the Hip: Expanding Evidence Supporting Greater Utilization in Hip Arthroscopy

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