Primary Hip Arthroscopic Surgery With Labral Reconstruction: Is There a Difference Between an Autograft and Allograft?

Abstract

Background:Labral reconstruction has been described as a solution for the irreparable labrum. Initial techniques employed autografts, while more recent procedures have utilized allografts. No study, to our knowledge, has compared graft types.Purpose:To compare outcomes between patients who underwent primary labral reconstruction with a hamstring allograft versus hamstring autograft.Hypothesis:No significant differences in outcomes will be found between patients who underwent primary labral reconstruction with an allograft versus autograft.Study Design:Cohort study; Level of evidence, 3.Methods:Data from September 2010 to March 2015 were reviewed. Inclusion criteria were primary hip arthroscopic surgery with labral reconstruction using either a hamstring allograft (ALLO group) or autograft (AUTO group), with minimum 2-year follow-up scores for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Exclusion criteria were previous ipsilateral hip surgery, previous hip conditions, preoperative Tönnis osteoarthritis grade >1, and workers’ compensation claims. Significance was set at P = .05.Results:Twenty-nine patients (29 hips) were included (85.3% follow-up). There were 17 patients (17 hips) in the ALLO group and 12 patients (12 hips) in the AUTO group. All patient-reported outcome scores demonstrated significant improvements at latest follow-up except for the mHHS for the AUTO group (P = .064). Comparisons between the ALLO and AUTO groups at the preoperative and latest follow-up time points showed no significant differences (preoperative mean [range]: mHHS, 67.5 [33.0-100.0] and 65.8 [29.0-96.0], respectively [P = .826]; NAHS, 65.6 [26.3-92.5] and 58.5 [35.0-79.0], respectively [P = .322]; HOS-SSS, 43.7 [12.5-100.0] and 40.1 [19.0-78.0], respectively [P = .707]) (latest follow-up mean [range]: mHHS, 86.4 [56.0-100.0] and 81.4 [57.0-100.0], respectively [P = .46]; NAHS, 87.7 [60.0-100.0] and 82.4 [56.3-100.0], respectively [P = .396]; HOS-SSS, 81.7 [0.0-100.0] and 70.9 [27.8-100.0], respectively [P = .423]).Conclusion:Primary arthroscopic hip labral reconstruction yielded improvements in patient-reported outcome scores and high patient satisfaction. In this small series, no differences were found in clinical outcomes between hamstring allografts and autografts. Based on these results, hamstring allografts and autografts may be considered comparable graft choices for primary reconstruction. Because of the avoidance of donor site morbidity and the possible increase in patient satisfaction, allografts may be the preferred choice in a surgical setting when they are accessible.

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

“…In such instances, the study with the largest patient sample (317 patients) was selected for inclusion. A total of seven studies were included in the final systematic review (15)(16)(17)(18)(19)(20)(21). A cross-reference of bibliographies of the included studies did not yield any additional studies for inclusion.…”

“…A total of 7 studies and 402 patients (229 males, 173 females) were included in this systematic review. Three studies were retrospective cohort studies (level of evidence III) (18,19,21) and four studies were retrospective case series (level of evidence IV) (15)(16)(17)20). All patients underwent arthroscopic labral reconstruction with autografts; however, graft choices were variable across studies.…”

“…All patients underwent arthroscopic labral reconstruction with autografts; however, graft choices were variable across studies. The grafts utilized included iliotibial band (ITB) in two studies (342 patients) (15,19), indirect head of rectus femoris in three studies (32 patients) (16,17,20), gracilis tendon in one study (8 patients) (18), semitendinosus tendon in one study (12 patients) (21), and capsule tissue in one study (8 patients) (20). All studies had a minimum length of follow-up of 12 months (range, 12-120 months).…”

“…Preoperatively, all studies, except one (18), reported lateral center edge angle (LCEA) and alpha-angle measurement with X-rays. Four studies utilized the Tönnis classification ≥2 as a contraindication for the procedure (16,18,19,21), while two studies used a joint space width <2 mm as a contraindication for reconstruction (15,16). Four studies reported the use of magnetic resonance imaging (MRI) or arthrography (MRA) preoperatively to confirm the diagnosis of labral pathology (16,17,19,21).…”

“…In addition to repair, reconstruction techniques have also been developed in order to treat patients with significant labral tears or insufficient labral tissue not amenable to repair (10)(11)(12)(13)(14)(15). Outcomes following reconstruction have also demonstrated significant improvements in patient reported pain and function in clinical studies (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Mechanistically, reconstruction of the labrum has demonstrated an ability to, at least in part, restore the stability of the suction seal effect as shown in in vitro studies (3)(4)(5).…”