Arthroscopic Labral Reconstruction Research Articles

Return to Sports and Minimum 2-Year Outcomes of Primary Arthroscopic Hip Labral Reconstruction for Irreparable Tears in High-Level Athletes With a Propensity-Matched Benchmarking Against a Labral Repair Control Group

Background: Labral reconstruction has shown promise for the treatment of irreparable labral tears in high-level athletes. The literature is scarce regarding outcomes and timing of return to sports (RTS) in these patients. Purpose: (1) To report minimum 2-year patient-reported outcome (PRO) scores and RTS characteristics for high-level athletes undergoing primary labral reconstruction for irreparable labral tears and (2) to compare clinical results with a matched control group of athletes undergoing labral repair. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed for high school, college, and professional athletes who underwent a primary arthroscopic labral reconstruction between January 2010 and June 2018. Minimum 2-year PROs were compared for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and Hip Outcome Score–Sport Specific Subscale (HOS-SSS), as well as the visual analog scale (VAS) pain score, patient satisfaction, and RTS. The percentages of patients achieving the Patient Acceptable Symptom State (PASS) and minimal clinically important difference (MCID) for the mHHS (PASS, >74 points; MCID, >8 points) and HOS-SSS (PASS, >75 points; MCID, >6 points) were also recorded. These patients were propensity score matched in a 1:3 ratio to other high-level athletes undergoing labral repair. Results: A total of 17 high-level athletes with primary arthroscopic labral reconstruction were included with a median follow-up time of 37.1 months (95% CI, 37.2-60.3 months). They demonstrated significant improvement from preoperatively to the latest follow-up for mHHS, NAHS, HOS-SSS, and VAS for pain (P < .05). Further, patients achieved PASS/MCID for mHHS at high rates (PASS, 84.2%; MCID, 68.4%). Athletes were able to return to sport-specific training at a median of 3.33 months (95% CI, 3.07-4.71 months) and RTS at a median of 6.2 months (95% CI, 5.08-11.98 months). Fourteen (82.4%) of reconstructions and 29 (82.8%) of repairs either returned to sport or decided not to do so for reasons unrelated to the hip. PROs, RTS rate, and PASS/MCID rates were similar between the labral reconstruction group and a control labral repair group (P > .05). Conclusion: Primary arthroscopic labral reconstruction for irreparable labral tears was associated with significant improvement in PROs and high rates of RTS in high-level athletes. These results were comparable with those of a control group of athletes undergoing labral repair.

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

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.

Outcomes After Arthroscopic Anterior Shoulder Stabilization in Professional Handball Players

Background:Although numerous studies have reported on the redislocation rate and functional results of arthroscopic treatment for anterior shoulder instability in athletes, they have not disclosed outcomes in the high-risk group of elite handball players.Purpose:To investigate the postoperative outcomes of arthroscopic treatment for anterior shoulder instability as well as the return-to-sport (RTS) rate in professional handball players.Study Design:Case series; Level of evidence, 4.Methods:Involved in this study were 44 competitive handball players (47 shoulders) who underwent arthroscopic anterior capsulolabral reconstruction between 2010 and 2018 and had a minimum follow-up of 24 months. After surgery, patients completed a questionnaire that collected Rowe and American Shoulder and Elbow Surgeons (ASES) scores and RTS data, and we compared these results with their preoperative scores. We also compared results according to the following subgroups: true dislocations versus recurrent subluxations, younger (<20 years) versus older (≥20 years) age, male versus female sex, and shorter versus longer duration of instability. Statistical analysis included the paired-samples t test and nonparametric Fisher exact test.Results:The mean follow-up period was 52.2 ± 21.4 months. There were 4 shoulders (9%) with recurrent instability. There were significant preoperative to postoperative improvements in the mean Rowe score (from 45.2 to 91.8) and mean ASES score (from 70.6 to 95.7) (P < .001 for both). Overall, the RTS rate was 83%, and 64% (30/47 shoulders) were able to return to their preinjury level. The RTS rate was significantly lower in the younger players than in the older players (46% vs 86%, respectively; P = .005).Conclusion:The study results indicated that handball players with anterior shoulder instability can be treated using arthroscopic labral reconstruction successfully and 83% of the athletes were able to RTS activity. The handball players aged ≥20 years returned to their preinjury level of sport at a higher rate than did those aged <20 years.

Arthroscopic acetabular labral reconstruction: a review.

The function and importance of the acetabular labrum in hip biomechanics have been determined. A labral tear is one of the most common findings in the hip preservation field, commonly associated with femoroacetabular impingement (FAI) syndrome. It has been established that the restoration of labral anatomy and function are key factors to improve patient-reported outcome measurements (PROMs) and psychometric tools following arthroscopic hip arthroscopy in the context of FAI syndrome. Labral repair or refixation is currently the gold-standard surgical option when facing labral tears, with clinical mid to long-term data supporting its use. Labral selective debridement has proven to be a valid alternative in selective patients. Acetabular labral reconstruction has risen as an alternative to labral excision or resection when repair is not an option due to labral tissue deficiency. Restoring the labral sealing mechanism is the goal behind the acetabular labral reconstruction. It has been proven that labral reconstruction leads to superior PROMs when compared with resection. This review presents an analysis of the indications, techniques, and outcomes for arthroscopic acetabular labral reconstruction.

Arthroscopic Circumferential Acetabular Labral Reconstruction for Irreparable Labra in the Revision Setting: Patient-Reported Outcome Scores and Rate of Achieving the Minimal Clinically Important Difference at a Minimum 2-Year Follow-up

Background: There is a paucity in the literature reporting patient-reported outcome (PRO) scores and the minimal clinically important difference (MCID) after revision hip arthroscopic surgery with circumferential labral reconstruction. Purpose: To report minimum 2-year PRO scores and the rate of achieving the MCID in patients who underwent revision hip arthroscopic surgery with circumferential labral reconstruction in the setting of irreparable labral tears. Study Design: Case series; Level of evidence, 4. Methods: Data were retrospectively reviewed for all patients who underwent revision hip arthroscopic surgery between February 2016 and November 2017. Patients were included if they had undergone circumferential labral reconstruction and had preoperative and postoperative scores for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score Sport-Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT-12), 12-Item Short Form Health Survey physical and mental components (SF-12 P and SF-12 M, respectively), Veterans RAND 12-Item Health Survey physical and mental components (VR-12 P and VR-12 M, respectively), and visual analog scale (VAS) for pain. Exclusion criteria were Tönnis grade >1, Legg-Calve-Perthes disease, slipped capital femoral epiphysis, fractures, hip dysplasia, or revision labral treatment different from circumferential labral reconstruction. The MCID was calculated. Secondary surgical procedures were documented. Results: A total of 26 hips (26 patients; 61.5% female) were included. The mean age and body mass index were 33.2 ± 10.4 years and 25.5 ± 4.9, respectively. Significant improvements were reported for the mHHS (17.0 ± 19.5; P = .0002), NAHS (17.9 ± 16.7; P < .0001), HOS-SSS (21.7 ± 23.1; P = .0005), VAS (–2.2 ± 3.0; P = .006), iHOT-12 (25.8 ± 32.5; P = .0007), SF-12 P (8.5 ± 11.2; P = .001), and VR-12 P (8.9 ± 11.6; P = .001). Rates of meeting the MCID for the mHHS, NAHS, HOS-SSS, iHOT-12, and VAS were 76.9%, 80.0%, 65.0%, 62.5%, and 69.2%, respectively. No case of re-revision arthroscopic surgery was documented, but 1 case of conversion to total hip arthroplasty was documented at 38.6 months. Conclusion: In the setting of revision hip arthroscopic surgery and irreparable labral tears, circumferential labral reconstruction resulted in significant improvements in all PRO and VAS scores at a minimum 2-year follow-up with a high rate of achieving the MCID.

Return to Sport and Athletic Function Following Primary Arthroscopic Labral Reconstruction

To report 2-year clinical outcomes and the return to sport rate in athletic patients who underwent primary hip arthroscopy with labral reconstruction in the setting of femoroacetabular impingement (FAI) syndrome and irreparable labral tears Data were prospectively collected for patients who underwent a labral reconstruction between August 2012 and December 2017. Patients were included if they identified as an athlete (high school, college, recreational, or amateur), had follow-up on the following patient-reported outcomes (PROs): modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), visual analog scale (VAS), and completed a return to sport survey at 1-year postoperatively. Patients were excluded if they underwent any previous ipsilateral hip surgery, had dysplasia, or had prior hip conditions. Statistical significance was set at P=0.05. There were 32 (14 females) athletes who underwent primary labral reconstruction during the study period. The mean age and body mass index (BMI) of the group was 40.3 years (15.5–58.7 years) and 27.9 kg/m2 (19.6-40.1 kg/m2), respectively. The mean follow-up time was 26 months (12-64 months). All patients demonstrated significant improvement in mHHS, NAHS, HOS-SSS, and VAS (P < 0.001) at latest follow-up. Additionally, 84.4% achieved MCID and 81.3% achieved PASS for mHHS, and 87.5% achieved MCID and 75% achieved PASS for HOS-SSS. VAS pain scores decreased from 4.4 to 1.8 and the satisfaction with surgery was 7.9 out of 10. The rate of return to sport was 78%, with 40.6% successfully returning to sport at the same or higher level. At average 2-year follow-up, primary arthroscopic labral reconstruction, in the setting of FAI and irreparable labral tears, was associated with significant improvement in PROs in athletic population. The return to sport within 1-year 28 surgery was 78 %, with 40.6% returning to sport at the same or higher level.

Return to Sport After Arthroscopic Treatment of Posterior Shoulder Instability.

Background:Arthroscopic treatment of posterior shoulder instability has become more popular and effective in recent years, but few data are available concerning the rate of return to sport.Purpose:To present our experiences with arthroscopic posterior labral reconstruction in athletes and review our results, with a particular focus on the rate of return to sport.Study Design:Case series; Level of evidence, 4.Methods:Included in the study were 40 arthroscopic stabilizations performed because of posterior shoulder instability in 37 athletes at a single institution. During follow-up, the athletes’ rate of return to sport was calculated. Shoulder function was evaluated based on a pre- versus postoperative comparison of the Rowe instability score and the American Shoulder and Elbow Surgeons score. Additionally, the return-to-sport rate was compared among different subgroups: traumatic versus atraumatic origin of injury, competitive versus recreational athletes, high-risk versus low-risk sport, and posterior-only versus anterior and posterior stabilization. Data were statistically analyzed using paired-samples t test and nonparametric Fisher exact test.Results:The average follow-up period was 54.4 months (range, 24-112 months). Three shoulders (7.5%) continued to have posterior subluxations postoperatively. There were 34 excellent, 3 good, and 3 fair results based on the Rowe score (average postoperative score, 92.9), and patients achieved an average postoperative American Shoulder and Elbow Surgeons score of 92.7. The pre- to postoperative improvement was statistically significant in both scoring systems (P < .001). Of the 37 patients, 36 (98.2%) were able to return to sport activity: 27 of them (72.9%) to their original sport and 19 (51.4%) at their preinjury level. A significantly higher rate of return to the same sport occurred in athletes who had traumatic injury compared with a subgroup of athletes without a traumatic event (P < .02).Conclusion:More than half of the athletes were able to return to their preinjury level of sport after arthroscopic posterior labral reconstruction. In addition, low recurrence rates and good functional outcomes were seen in >90% of the patients, and 98% returned to sport activity. The athletes had a significantly higher rate of return to sport if their posterior shoulder instability had a clear traumatic origin.

Modified Pull-Through Technique for Hip Labral Reconstruction Using A Suture Suspension Bridge

Preservation of hip labral function is a primary goal in hip preservation surgery. Arthroscopic labral reconstruction in the hip is an alternative procedure for irreparable labrum in the nonarthritic hip population, with beneficial outcomes reported. Several challenges occur during labral reconstruction that make the procedure more difficult. The first is measuring the labral defect and matching the graft perfectly to the patient. The second is subsequent suture fixation and passage around the graft when it is loose within the joint. We propose a modification to the pull-through technique that both eliminates the inaccuracies in graft measurement and minimizes graft damage by eliminating the step of suture passage around the graft. This technique can be used for both segmental reconstruction or circumferential reconstruction of the hip labrum and can also accommodate knotless and knot-tied anchors. The advantages of this technique are increased procedure accuracy and efficiency.

Arthroscopic Labral Reconstruction of the Hip: A Decade of Growing Evidence and Technical Evolution

The field of hip arthroscopy has rapidly evolved over the past 2 decades. Originally, surgical treatment of the hip primarily involved resection of damaged tissue. More recently, arthroscopic surgical procedures that aim to preserve and restore the function of the labrum have been advocated and have shown superior results when compared with debridement or excision. Although labral repair has been largely adopted as a standard labral preservation procedure to treat labral tears, continued innovation in hip arthroscopy techniques and tools has paved the way for labral reconstruction as an alternative and even preferable treatment option. As the clinical field has developed and expanded, so too has the availability and quality of evidence on indications, treatments, and outcomes of hip arthroscopy procedures. The purpose of this manuscript is to review the current literature on indications, arthroscopic technique, and outcomes of arthroscopic acetabular labral reconstruction and provide the lead author’s experience with arthroscopic labral reconstruction over the past decade. A growing body of evidence supports the potential to achieve positive patient-reported outcomes and low revision rates with labral reconstruction across different indications. These promising outcomes across a wide variety of settings and pathologies suggest that labral reconstruction can effectively increase function and decrease pain, making it an important hip preservation tool for the hip arthroscopist.

The “Pull-through” Technique for Labral Reconstruction of the Hip

Hip arthroscopy has proved to be a valid option for the management of femoroacetabular impingement syndrome and labral tears. In this context, labral preservation has been advocated as a superior alternative to complete debridement in terms of clinical outcomes. While labral repair remains the gold standard, particularly in the primary setting, labral reconstruction has been suggested for irreparable tears. However, labral reconstruction is highly technical and demanding. The pull-through technique was described to overcome some of the challenges in arthroscopic labral hip reconstruction surgery. The present review describes details, tips and pearls, and outcomes of using the pull-through technique for labral reconstruction of the hip.

Acetabular Labral Reconstruction with Iliotibial Band Autograft: Outcome and Survivorship at a Minimum 10-Year Follow-up.

Labral reconstruction has been shown to result in improved patient-reported outcomes (PROs) at mid-term follow-up in patients with a deficient labrum. The purpose of this study was to determine survivorship and PROs at a minimum 10-year follow-up. A retrospective evaluation of a prospectively collected single-surgeon database included 91 hips (89 patients) that underwent arthroscopic labral reconstruction with iliotibial band autograft between 2006 and 2008. The primary PRO was the Hip Outcome Score (HOS)-activities of daily living (ADL). The modified Harris hip score (mHHS), HOS-sports, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and patient satisfaction (on a scale of 1 to 10) were also collected at a 10-year minimum follow-up. Survivorship analysis curves were evaluated. Eighty-two hips were evaluated at a 10-year minimum follow-up. Overall survivorship, with revision hip arthroscopy or total hip arthroplasty (THA) as the end point, was 70% at 5 years and 61% at 10 years, and the mean survival time was 9 years (95% confidence interval = 7.6 to 10 years). For the patients who did not undergo subsequent surgery, on average the mHHS increased from 60 preoperatively to 82 at the 10-year follow-up (p = 0.001), the HOS-ADL improved from 69 to 90 (p = 0.004), the HOS-sports improved from 43 to 76 (p = 0.001), and the median patient satisfaction was 10 of 10. Eighty percent of the patients achieved the minimal clinically important difference (MCID) in the HOS-ADL, and 87% obtained a patient acceptable symptom state (PASS). Following arthroscopic labral reconstruction with iliotibial band autograft, 9% of the hips underwent revision arthroscopy and 27% underwent THA. At 10 years, the survival rate, with revision hip arthroscopy or THA as the end point, was 61%; however, for those with >2 mm of joint space, the current indication for labral reconstruction, the 10-year survival rate was 90%. Excellent PROs and patient satisfaction were reported by those who did not require revision or THA. With appropriate patient selection and prevention of postoperative adhesions, labral reconstruction results in excellent outcomes and high patient satisfaction that is sustained at a minimum 10-year follow-up. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Hip Arthroscopy in Patients Aged 40 Years and Older: Greater Success With Labral Reconstruction Compared With Labral Repair

To assess the outcomes of complete, primary, arthroscopic hip labral reconstruction among patients aged 40 years and older compared with those who underwent primary labral repair and compared with patients aged 30 to 39 years who underwent complete, primary labral reconstruction. We recruited all patients who underwent arthroscopic labral reconstruction between March 2010 and June 2015 and were aged 30 to 65 years or who underwent arthroscopic labral repair between June 2009 and June 2015 and were aged 40 to 65 years. The modified Harris Hip Score (mHHS), Lower Extremity Function Score, and visual analog scale score for average pain were collected preoperatively and at minimum 2-year follow-up. Failure was defined as the need for revision ipsilateral hip surgery. The rate of conversion to total hip arthroplasty (a subset of failure) was assessed separately. A total of 363 hips in 343 patients met the inclusion criteria. Follow-up was available for 312 hips (86.0%), and the average time to follow-up was 4.2 years (range, 2.0-8.5 years). After adjustment for differences in follow-up time between groups, failure was 3.29 times more likely for hips in the repair group aged 40 years and older than for hips in the reconstruction group aged 40 years and older (relative rate, 3.29; 95% confidence interval, 1.25-8.69; P= .02), and there was no difference in the failure rate for hips in the reconstruction group aged 40 years and older compared with hips in the reconstruction group aged 30 to 39 years (relative rate, 0.58; 95% confidence interval, 0.18-1.89; P= .37). The rate of conversion to total hip arthroplasty was not meaningfully different between the 3 groups. Among hips for which treatment did not fail, average improvement in the mHHS measured 35 points and both labral reconstruction groups saw a greater mHHS improvement than the labral repair group of patients aged 40 years and older (P= .01 and P < .01). Labral reconstruction led to a lower failure rate, greater average improvement in the mHHS, and equivalent postoperative patient-reported outcome scores compared with labral repair among patients aged 40 years and older in this study population, and the outcomes of labral reconstruction were similar between patients aged 40 years and older and those aged 30 to 39 years. Complete labral reconstruction may be particularly advantageous in patients aged 40 years and older. Level III, retrospective comparative study.

Return to Sport and Athletic Function in an Active Population After Primary Arthroscopic Labral Reconstruction of the Hip.

Background:Labral reconstruction has been advocated as an alternative to debridement for the treatment of irreparable labral tears, showing favorable short-term results. However, literature is scarce regarding outcomes and return to sport in the nonelite athletic population.Purpose:To report minimum 1-year clinical outcomes and the rate of return to sport in athletic patients who underwent primary hip arthroscopy with labral reconstruction in the setting of femoroacetabular impingement syndrome and irreparable labral tears.Study Design:Case series; Level of evidence, 4.Methods:Data were prospectively collected and retrospectively analyzed for patients who underwent an arthroscopic labral reconstruction between August 2012 and December 2017. Patients were included if they identified as an athlete (high school, college, recreational, or amateur); had follow-up on the following patient-reported outcomes (PROs): modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sport Specific Subscale (HOS-SSS), and visual analog scale (VAS); and completed a return-to-sport survey at 1 year postoperatively. Patients were excluded if they underwent any previous ipsilateral hip surgery, had dysplasia, or had prior hip conditions. The proportions of patients who achieved the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for mHHS and HOS-SSS were calculated. Statistical significance was set at P = .05.Results:There were 32 (14 females) athletes who underwent primary arthroscopic labral reconstruction during the study period. The mean age and body mass index of the group were 40.3 years (range, 15.5-58.7 years) and 27.9 kg/m2 (range, 19.6-40.1 kg/m2), respectively. The mean follow-up was 26.4 months (range, 12-64.2 months). All patients demonstrated significant improvement in mHHS, NAHS, HOS-SSS, and VAS (P < .001) at latest follow-up. Additionally, 84.4% achieved MCID and 81.3% achieved PASS for mHHS, and 87.5% achieved MCID and 75% achieved PASS for HOS-SSS. VAS pain scores decreased from 4.4 to 1.8, and the satisfaction with surgery was 7.9 out of 10. The rate of return to sport was 78%.Conclusion:At minimum 1-year follow-up, primary arthroscopic labral reconstruction, in the setting of femoroacetabular impingement syndrome and irreparable labral tears, was associated with significant improvement in PROs in athletic populations. Return to sport within 1 year of surgery was 78%.

Radiographic and Demographic Factors Can Predict the Need for Primary Labral Reconstruction in Hip Arthroscopic Surgery: A Predictive Model Using 1398 Hips

Background: Labral tears are the most common findings in patients with symptomatic femoroacetabular impingement (FAI). The restoration of labral function is critical, and labral reconstruction has been proposed as an alternative for irreparable tears. Purpose: To compare preoperative radiographic measurements and demographics of patients who underwent primary arthroscopic labral reconstruction versus primary labral repair and to identify factors that are predictive of the need for reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: Patients who underwent their index hip arthroscopic procedure between October 2010 and November 2018 and underwent either labral reconstruction or repair were included in the study. A total of 18 variables (14 radiographic and 4 demographic) were assessed in a bivariate comparison and analyzed in a multivariate logistic model. Results: A total of 251 primary reconstruction and 1147 primary repair procedures were included. The logistic model selected age, body mass index (BMI), Tönnis grade, lateral center-edge angle (LCEA), and alpha angle. The odds of reconstruction were 2.52 times higher in patients with Tönnis grade 1 than 0 (odds ratio [OR], 2.52 [95% CI, 1.82-3.49]). Each additional degree in the LCEA was associated with a 6% increase in the odds of reconstruction (OR, 1.06 [95% CI, 1.04-1.09]) and 4% for each additional degree in the alpha angle (OR, 1.04 [95% CI, 1.03-1.05]). Higher age (per log 10 unit) and BMI also increased the likelihood of reconstruction (OR, 11.29 [95% CI, 4.23-30.10] and OR, 1.03 [95% CI, 1.00-1.06], respectively). Conclusion: In a multivariate analysis, factors identified as preoperative predictors for primary arthroscopic labral reconstruction in the setting of FAI and labral tears were Tönnis grade, LCEA, age, and BMI. These predictive factors may be useful for the clinician in determining the preoperative likelihood of primary labral reconstruction.

The anatomical properties of the indirect head of the rectus femoris tendon: a cadaveric study with clinical significance for labral reconstruction surgery.

Acetabular labral tear is a common pathology. In some clinical situations, primary labral repair may not be possible and labral reconstruction is indicated. Describe the anatomy of the indirect head of the rectus femoris (IHRF) tendon with clinical application in arthroscopic labral reconstruction surgery. Twenty-six cadaver hips were dissected. Thirteen measurements, each with clinical relevance to arthroscopic labral reconstruction using an IHRF tendon graft were taken on each hip. All measurements were taken in triplicate. Mean values, standard deviations and intra-observer reliability were calculated. The mean footprint of the direct head of the rectus femoris tendon was 10.6mm × 19.6mm. The width and thickness at the confluence of both heads were 10.9mm and 6.9mm, respectively. The mean total length of the footprint and "free portion" of the IHRF was 55.3mm, the mean cranial to caudal footprint measured at the 12 o'clock, 1 o'clock, and 2 o'clock positions were 22.3mm. The mean length of the Indirect Head footprint alone was 38.1mm. The mean length of IHRF tendon suitable for grafting was 46.1mm and the mean number of clock face sectors covered by this graft was 3.3 clock face sectors. Intra-observer reliability was ≥ 0.90 for all recorded measurements. The origin of the IHRF on the acetabulum fans out posteriorly, becoming thinner and wider as the origin travels posteriorly. The tendon footprint is firmly attached on the lateral wall of the ilium and becomes a free tendon overlying the acetabular bone as it travels anteriorly and distally towards its muscular attachment. The IHRF tendon is in an ideal location for harvesting and contains the appropriate thickness, length and triangular architecture to serve as a safe and local graft source for acetabular labral reconstruction surgery.

Outcomes After Arthroscopic Hip Labral Reconstruction: A Systematic Review and Meta-analysis

Background: The acetabular labrum is critical to maintenance of hip stability and has been found to play a key role in preservation of the hip fluid seal. For irreparable labral damage, arthroscopic labral reconstruction is an evolving technique that has been shown to decrease hip pain and restore function. Purpose: To provide a comprehensive review of current literature for arthroscopic hip labral reconstruction, with a focus on determining if outcomes differ between autograft or allograft tissue. Study Design: Systematic review and meta-analysis. Methods: PubMed and Scopus online databases were searched with the key terms “hip,”“labrum,”“reconstruction,” and “graft” in varying combinations. Procedures performed, complications, failures, and functional outcome measures were included in this analysis. The inverse variance method was used to calculate pooled estimates and 95% CIs. Results: Eight studies with 537 hips were included. Mean age was 37.4 years (95% CI, 34.5-40.4 years), and mean follow-up time was 29 months (95% CI, 26-33 months). Survivorship after autograft reconstruction ranged from 75.7% to 100%, as compared with 86.3% to 90.0% in the allograft cohort. In the autograft cohort, failures included 0% to 13.2% conversion to total hip arthroplasty and 0% to 11.0% revision hip arthroscopy. Failures in the allograft cohort included 0% to 12.9% total hip arthroplasty conversion, 0% to 10.0% revision arthroscopy, and 0% to 0.8% open revision surgery. Based on 6 studies, the modified Harris Hip Score improved by a mean 29.0 points after labral reconstruction (P < .0001). Conclusion: Arthroscopic hip labral reconstruction results in clinically significant improvements in patient-reported outcomes. Our analysis indicates that there are no significant differences in outcomes based on graft type alone. A number of factors may determine graft choice, including patient preference, surgeon experience, operative time, morbidity, and cost. Proper patient selection based on age and severity of degenerative joint disease will also optimize outcomes after labral reconstruction.

Risk of Recurrent Instability After Arthroscopic Stabilization for Shoulder Instability in Adolescent Patients.

Background:With the rise of adolescent sports participation, there has been a concomitant increase in not only the incidence but also the treatment of traumatic shoulder instability. Yet, there have been limited data on the failure rates of arthroscopic shoulder stabilization in this population as well as the potential risk factors.Purpose/Hypothesis:The purpose of this study was to determine the failure rates of adolescent patients who underwent arthroscopic labral reconstruction for traumatic anterior shoulder instability. We hypothesized that adolescent failure rates would be significantly higher than what has been reported in the adult population with regard to recurrent instability after surgical intervention.Study Design:Case series; Level of evidence, 4.Methods:This was a retrospective cohort study performed at a single center. Inclusion criteria consisted of all adolescent-aged patients identified who (1) had traumatic anterior shoulder instability, (2) had radiographic findings consistent with anteroinferior capsulolabral injury, and (3) underwent arthroscopic shoulder stabilization. Patient demographics, clinical presentation, imaging, intraoperative findings, and postoperative outcomes were analyzed.Results:A total of 36 patients were identified, with a mean ± SD follow-up of 35.6 ± 13.8 months. The mean patient age at the time of the index procedure was 16.03 ± 1.67 years. All patients underwent arthroscopic shoulder stabilization consisting of arthroscopic Bankart repair. Twelve patients (33.3%) reported either recurrent instability or apprehension, of whom 9 (25.0%) developed recurrent dislocation/subluxation at a mean of 20.67 months postoperatively (range, 16-51 months). No single sport was associated with a statistically significant increased risk of redislocation, although a trend was seen toward those with postoperative participation in high-risk sporting activity. Patients who redislocated their shoulders had a higher frequency of a Hill-Sachs lesion on magnetic resonance imaging (89%) compared with those who did not (52%, P = .048). History of multiple preoperative dislocations, presence of bony Bankart pathology, off-track lesions, and number of anchors utilized were not associated with postoperative dislocation/subluxation.Conclusion:This study demonstrates that adolescent patients treated with arthroscopic shoulder stabilization have a high rate of recurrent instability. The adolescent population may benefit from other stabilization strategies and/or activity modification. Further studies are necessary to determine the reasons for the high rate of redislocation and to develop strategies for prevention.

Minimum 5-Year Outcomes of Arthroscopic Hip Labral Reconstruction with Nested Matched-Pair Benchmarking Against a Labral Repair Control Group

Objectives:Labral reconstruction has demonstrated short-term benefit for the treatment of irreparable labral tears. Nonetheless, there is a scarcity of evidence for mid-term outcomes of this treatment. The purpose of our study was to report 5-year outcomes in patients who underwent segmental labral reconstruction. In addition, we compared 5-year outcomes of patients who underwent primary segmental labral reconstruction (PLRECON) with a matched-pair control group that underwent primary labral repair (PLREPAIR). We hypothesized that arthroscopic segmental reconstruction in the setting of irreparable labral tears would show improvement in patient-reported outcomes (PROs) and high patient satisfaction at minimum 5-year follow-up. Secondly, PLRECON would experience similar improvement in PROs at minimum 5-year follow-up when compared to a matched-pair PLREPAIR control group.Methods:Data from February 2008 to April 2013 was retrospectively reviewed. Patients were included if they underwent hip arthroscopy for segmental labral reconstruction in the setting of irreparable labral tear and femoro-acetabular impingement (FAI), with minimum 5-year follow-up for modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and Visual Analogue Scale (VAS) for pain. Exclusion criteria were Tönnis osteoarthritis grade >1, prior hip conditions, or Workers’ Compensation claims. PLRECON were matched in a 1:3 ratio to a PLREPAIR group based on age ±5 years, gender, and body mass index (BMI) ±5 kg/m2.Results:Twenty-eight patients were eligible for the study, of which 23 (82.14%) had minimum 5-year follow-up. We found significant improvement from preoperative to latest follow-up in all outcome measures recorded: 17.8-point increase in mHHS (P=0.002), 22-point increase in NAHS (P<0.001), 25.4-point increase in HOS-SSS (P=0.003), and a 2.9-point decrease in VAS pain ratings (P<0.001). Average patient satisfaction was 7.1 out of 10. In the nested matched-pair analysis, 17 PLRECON were matched to a control group of 51 PLREPAIR patients. PLRECON demonstrated comparable survivorship and comparable improvements in all PROs with the exception of patient satisfaction.Conclusion:Hip arthroscopy with segmental labral reconstruction resulted in significant improvement in PROs at minimum 5-year follow-up. PLRECON reached comparable functional outcomes when compared to a benchmark PLREPAIR control group, but demonstrated lower patient satisfaction at latest follow-up.Figure:PROs comparison between preoperative, minimum 2-year, and minimum 5-year followup for patients undergoing segmental labral reconstruction.

Minimum 5-Year Outcomes of Arthroscopic Hip Labral Reconstruction With Nested Matched-Pair Benchmarking Against a Labral Repair Control Group

Background: Labral reconstruction has demonstrated short-term benefit for the treatment of irreparable labral tears. Nonetheless, there is a scarcity of evidence for midterm outcomes of this treatment. Hypotheses: Arthroscopic segmental reconstruction in the setting of irreparable labral tears would show improvement in patient-reported outcomes (PROs) and high patient satisfaction at minimum 5-year follow-up. Second, primary labral reconstruction (PLRECON) would result in similar improvement in PROs at minimum 5-year follow-up when compared with a matched-pair primary labral repair (PLREPAIR) control group. Study Design: Cohort study; Level of evidence, 3. Methods: Data from February 2008 to April 2013 were retrospectively reviewed. Patients were included if they underwent hip arthroscopy for segmental labral reconstruction in the setting of irreparable labral tear and femoroacetabular impingement, with minimum 5-year follow-up for modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Sports Specific Subscale, patient satisfaction, and visual analog scale for pain. Exclusion criteria were Tönnis osteoarthritis grade >1, prior hip conditions, or workers’ compensation claims. PLRECON cases were matched in a 1:3 ratio to a PLREPAIR control group based on age ±5 years, sex, and body mass index ±5 kg/m2. Results: Twenty-eight patients were eligible for the study, of which 23 (82.14%) had minimum 5-year follow-up. The authors found significant improvement from preoperative to latest follow-up in all outcome measures recorded: 17.8-point increase in modified Harris Hip Score (P = .002), 22-point increase in Nonarthritic Hip Score (P < .001), 25.4-point increase in Hip Outcome Score–Sports Specific Subscale (P = .003), and a 2.9-point decrease in visual analog scale pain ratings (P < .001). Mean patient satisfaction was 7.1 out of 10. In the nested matched-pair analysis, 17 patients who underwent PLRECON were matched to a control group of 51 patients who underwent PLREPAIR. PLRECON demonstrated comparable survivorship and comparable improvements in all PROs with the exception of patient satisfaction (6.7 vs 8.5, P = .04). Conclusion: Hip arthroscopy with segmental labral reconstruction resulted in significant improvement in PROs at minimum 5-year follow-up. PLRECON reached comparable functional outcomes when compared with a benchmark PLREPAIR control group but demonstrated lower patient satisfaction at latest follow-up.

The Hip Labrum Reconstruction: Indications and Outcomes-an Updated Systematic Review.

To present an updated systematic review of the indications and outcomes of open and arthroscopic labral reconstruction. Due to the increasing popularity and recognition, the arthroscopic procedure has gained in recent years, the aim was to assess for changes in indications, graft selection, and improvement in outcomes within the last 5years. A total of nine eligible studies (six case series, one cohort, and two retrospective comparative studies) with a total of 234 patients (265 hips), and an average 12/16 (non-comparative studies) and 20/24 (comparative studies) quality on the MINORS score were included in this review. All patients underwent labral reconstruction, whether as primary surgery or revision (76% vs 24% respectively). There were 244 hips assessed at final follow- up (92%) with a reported mean range of 12 and 61months. There were more graft variabilities found in this study compared with the previous review (iliotibial band allograft, gracilis tendon autograft, indirect head of rectus femoris autograft, semitendinosus allograft, peroneus brevis allograft, labrum allograft, ligamentum capitus femoris). Surgical approaches differed (open 7.9% (previously 18.7%), arthroscopic 86% (previously 81. 3 %), arthroscopic assisted mini-open technique (AAMOT) (6%)). Overall, improvement was observed in the patient-reported outcomes and functional scores, with variability in their statistical significance. The failure rate or conversion to total hip arthroplasty (THA) decreased compared with the previous review (20% vs 9.5% [conversion to THA was 5.7% and revision surgery rate was 3. 8%]). Indications for labrum reconstruction remained similar (i.e., young, active patients with no or minimal arthritis (Tonnis 0-1), irreparable or ossified labrum, and hypotrophic < 2mm or dysfunctional hypertrophic labrum > 8mm). According to recent evidence, hip labrum reconstruction is a new technique that showed short- and mid-term improvement in patient-reported outcomes and functional scores postoperatively. The primary indication for reconstruction remained similar over time. The failure rates and/or conversion to THA appear to have decreased over time. Long-term follow-up with higher quality studies was not available in the literature based on this review. Level of evidence 2.