In search of labral restoration function with hip arthroscopy: outcomes of hip labral reconstruction versus labral repair: a systematic review

Abstract

Purpose: To perform a systematic review comparing patient-reported outcomes (PROs) in patients who underwent hip arthroscopy with labral repair versus labral reconstruction in the setting of femoroacetabular impingement syndrome (FAIS) and labral tears. Methods: A systematic review of the PubMed, Embase, and Cochrane databases was performed in May 2020 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. Articles were included in the analysis if they compared PROs between a labral repair and labral reconstruction cohort. For all PROs, the standardised mean difference (SMD) was calculated to compare the effect size of labral repair and labral reconstruction. Results: 10 comparative studies, with 582 reconstruction cases and 631 repair cases, were included in this analysis. The mean age for the reconstruction and the repair groups ranged from 27.0 years to 52.6 years and 27.5 years to 47.0 years, respectively. The mean follow-up for the reconstruction and the repair groups ranged from 24.0 months to 66.0 months and 24.0 months to 71.0 months, respectively. The modified Harris Hip Scores (mHHS) was favourable in 8 reconstruction studies (range 80.4–95.0) and 9 repair studies (range 84.1–93.0). Average NAHS scores for the repair and reconstruction cohorts ranged from 77.9–88.6 and 73.9–92.4, respectively. Additionally, the effect sizes regarding NAHS and mHHS scores were large (SMD > 0.8) in both the reconstruction and repair groups for the majority of studies. Finally, reconstruction patients underwent a subsequent total hip arthroplasty (THA) at a slightly higher rate. Conclusions: In the setting of FAIS and labral tears, patients who underwent hip arthroscopy may expect significant improvement in PROs at short-term follow-up with either labral repair or labral reconstruction. Although, not statistically significant, the repair group trended towards higher scores and exhibited a lower risk of conversion to THA.

Labral Tear Management in Patients Aged 40 Years and Older Undergoing Primary Hip Arthroscopy: A Propensity-Matched Case-Control Study With Minimum 2-Year Follow-up

“…70 Labral reconstruction has also become a reliable alternative technique for labral restoration with short-, mid-, and long-term follow-up data supporting its use. 17,21,60,62,68 The main indication for labral reconstruction is irreparable or nonviable labral tearing 41,62,65 ; however, the use of primary labral reconstruction in the setting of reparable labral tears is controversial. 44,74 Increase age at the time of surgery has been established as one of the most important negative predictors of 2-and 5year postoperative outcomes after hip arthroscopy.…”

“…28 Labral function restoration is a key element in the surgical management of FAIS and labral tears. 41,52 Arthroscopically, this can be accomplished with different treatment options that range from selective labral debridement and labral repair 13,20 to more complex and technically demanding procedures, such as labral reconstruction and labral augmentation. 35,37,60 With all of these options, favorable outcomes have been established.…”

Circumferential and Segmental Arthroscopic Labral Reconstruction of the Hip Utilizing the Knotless Pull-Through Technique with All-Suture Anchors

“…Hip labral reconstruction surgery has been described in the past and has had great short-, mid-term, and long-term success. 7,12,14,15 Continued innovation in the field has helped to develop this once highly-demanding surgery into a reproducible and more consistent technique. In addition, this technique may be applied in the future for labral augmentation, broadening the scope of its benefits.…”

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

“…Considering that labral reconstruction is somewhat still in its adolescence, more research is needed to calculate quantifiable trends in the occurrence of this procedure. However, the last few years have shown a noticeable increase in the numbers of studies focusing on labral reconstruction due to technological and evidence-based innovations in surgical techniques and largely promising and positive outcomes data [4][5][6][7][8][9][10][11][12][13][14][15][16]. Six meta-analysis or systematic reviews have been published in the last few years, alone, and point to equivalent or improved results with labral reconstruction compared to repair (Table 1) [7][8][9]11,17,18].…”

“…However, the last few years have shown a noticeable increase in the numbers of studies focusing on labral reconstruction due to technological and evidence-based innovations in surgical techniques and largely promising and positive outcomes data [4][5][6][7][8][9][10][11][12][13][14][15][16]. Six meta-analysis or systematic reviews have been published in the last few years, alone, and point to equivalent or improved results with labral reconstruction compared to repair (Table 1) [7][8][9]11,17,18]. Likewise, at least 17 studies have been published within the last decade evaluating various outcomes of arthroscopic labral reconstruction using allograft [4,5,9,10,[12][13][14]16,[19][20][21][22][23][24][25][26][27] and autograft [28][29][30][31][32][33][34][35][36] techniques ...…”