Hip labral reconstruction: consensus study on indications, graft type and technique among high-volume surgeons

Abstract

To survey high-volume hip arthroscopists regarding their current indications for labral reconstruction, graft preference and technique. In May 2018, a cross-sectional based survey was conducted on high-volume hip arthroscopists. A high-volume surgeon was defined as an orthopaedist who had case experience ranging from 50 to 5000 hip arthroscopies performed annually. The survey included their current indications for labral reconstruction, graft preference and technique. Twelve high-volume surgeons successfully completed the questionnaire. The mean arthroscopic procedures performed by the surgeons annually was 188.7 (range 60–350). Four surgeons (33.3%) performed <5 labral reconstruction cases per year, three (25.0%) 5–10 cases per year, two (16.7%) 11–15 cases per year and three (25.0%) over 20 cases per year. Of the 12 surgeons, 11 (91.6%) would reconstruct in certain primary settings and 100% would reconstruct in revision settings. In the primary setting, the main indications for reconstruction were poor quality labral tissue, calcified labrum and hypoplastic labrum. None of the surgeons recommended labral reconstruction for reparable labral tears in primary cases. In primary cases of irreparable labra, 58.3% of the surgeons favoured reconstruction over debridement. In revisions, 100% of the surgeon favoured reconstruction over debridement; 91.7% chose an allograft option versus an autograft alternative. Amongst high-volume arthroscopists, labral reconstruction was considered a valuable technique to restore labral function. Labral reconstruction was more often advocated in revision than in primary settings. Allograft was the preferred choice for reconstruction. Excision of the labral tissue prior to reconstruction was favoured over augmentation. Fewer surgeons performed circumferential reconstruction than segmental reconstruction.

Achieving Successful Outcomes of Hip Arthroscopy in the Setting of Generalized Ligamentous Laxity With Labral Preservation and Appropriate Capsular Management: A Propensity Matched Controlled Study

“…Labral tears were debrided, repaired, or reconstructed on the basis of the size of the labrum, the extent of tearing, and the morphology/quality of the labrum. 21,47 Acetabuloplasty and femoral osteoplasty were performed under fluoroscopic guidance to treat pincer- and cam-type impingement, respectively. 50,68 Capsular plication was performed in all patients except those with excessive stiffness, adhesive capsulitis, or insufficient capsular tissue.…”

Editorial Commentary: No Longer a Salvage Procedure: Allograft Labral Reconstruction of the Hip Rivals the Results of Labral Repair

“…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: Predicting the Size of the Labrum: We Have the Technology, Should We Put it to Use?

“…Furthermore, labral reconstruction is a technically challenging technique with a steep learning curve, and it may be a procedure that many hip arthroscopists may not be facile to generate predictably positive outcomes. 9,10 Hence, it is critical to preoperatively identify patients who may potentially require labral reconstruction. In this population, adequately assessing labral size preoperatively may be an important part of the preoperative workup.…”