Minimum 2-Year Functional Outcomes of Patients Undergoing Capsular Autograft Hip Labral Reconstruction

Abstract

Background: There is a paucity of literature on arthroscopic capsular autograft labral reconstruction. Purpose: To report midterm functional outcomes for patients undergoing acetabular labral repair with capsular autograft labral reconstruction. Study Design: Case series; Level of evidence, 4. Methods: This is a retrospective case series of prospectively collected data on patients who underwent arthroscopic acetabular labral repair by the senior surgeon between March 2013 and August 2018. The inclusion criteria for this study were adult patients aged 18 years or older who underwent primary hip arthroscopy for arthroscopic capsular autograft labral reconstruction. Exclusion criteria were <2 years of postoperative follow-up, elective disenrollment from study before 2-year follow-up, or repeat ipsilateral hip surgery before 2-year follow-up. Intraoperatively, patients underwent capsular autograft hip labral reconstruction if they were found to have a labrum with hypoplastic tissue (width <5 mm), complex tearing, or frank degeneration of native tissue. Clinical outcome data consisted of patient-reported outcome measures. Results: A total of 97 hips (94 patients) met the inclusion criteria with a mean final follow-up of 28.2 months (95% CI, 26.0-30.4). Patients had a mean age of 39.0 years (95% CI, 36.8-41.2) with a mean body mass index of 25.8 (95% CI, 24.9-26.7). When compared with baseline (40.4 [95% CI, 36.7-44.2]), the mean international Hip-Outcome Tool-33 (iHOT-33) scores were significantly greater at 3-month (60.9 [95% CI, 56.8-64.9]; P < .001), 6-month (68.8 [95% CI, 64.7-72.9]; P < .001), 12-month (73.2 [95% CI, 68.9-77.5]; P < .001), and final (76.6 [95% CI, 72.4-80.8]; P < .001) follow-up. At 2-year follow-up, 76.3%, 65.5%, and 60.8% of patients’ iHOT-33 scores exceeded clinically meaningful outcome thresholds for minimally clinically important difference (MCID), patient-acceptable symptomatic state, and substantial clinical benefit, respectively. Conclusions: In this study of 97 hips undergoing arthroscopic labral repair with capsular autograft labral reconstruction, we found favorable outcomes that exceeded the MCID thresholds in the majority of patients at a mean 28.2 months’ follow-up. Future studies should compare outcomes between this technique and other methods of autograft and allograft reconstruction to determine differences in patient-reported outcomes, donor-site morbidity, and complications.

Arthroscopic Acetabular Labral Repair Versus Labral Debridement: Long-term Survivorship and Functional Outcomes

“…Moreover, recent literature has demonstrated the utility of local capsular autograft as an effective approach to labral reconstruction that minimizes donor-site morbidity and preserves the chondrolabral junction. 13 As such, the senior author has expanded his repair indications to encompass labra that were previously deemed fit for debridement given the development of novel techniques and supporting evidence. 3 , 13 , 24 , 31 Overall, as the approaches to labral reconstruction advance, there is continued opportunity for joint preservation and increased survivorship.…”

“… 13 As such, the senior author has expanded his repair indications to encompass labra that were previously deemed fit for debridement given the development of novel techniques and supporting evidence. 3 , 13 , 24 , 31 Overall, as the approaches to labral reconstruction advance, there is continued opportunity for joint preservation and increased survivorship.…”

Acetabular Labral Tear with a Missed Posterior Wall Fracture in an Adolescent Athlete

“…The acetabular labrum is a fibrocartilaginous structure that plays an essential role in maintaining proper hip joint function, with tears commonly presenting with anterior hip or groin pain [34][35][36] . Owing to symptom overlap and the association of posterior acetabular wall fractures with posterior labral tears 13 , healthcare providers should maintain a low threshold for investigating the concomitant injuries in a traumatic setting, especially because posterior wall fractures can occur with or without gross hip dislocation 1 .…”

Graft Options for Hip Labral Reconstruction

“…No serious complications were reported, and no patients needed revision or further operation at the final follow-up of 24 months postoperatively. Similarly, Kucharik et al 51 examined 97 hips undergoing hip labral reconstruction with capsular autograft, reporting improved outcomes at an average follow-up of 28.2 months, including iHOT-33 (40.4-76.2), HOS-ADL (71.3-89.9), HOS-SS (43.3-75.8), and mHHS (61.5-84.6). Both studies reported statistically significant improvements in all patient-reported outcome measures.…”