Arthroscopic Labral Reconstruction Research Articles

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

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.

Arthroscopic Reconstruction of the Irreparable Acetabular Labrum: A Match-controlled Study

To report clinical outcomes of arthroscopic labral reconstruction in the hip at minimum 2-year follow-up in comparison to a pair-matched labral repair group. Patients were included in this study if they underwent labral reconstruction during hip arthroscopy and had minimum 2-year follow-up data available. Exclusion criteria were active workers' compensation claims or previous ipsilateral hip surgery or conditions. Reconstruction patients were matched 1:2 to patients that underwent arthroscopic labral repair but otherwise metall inclusion and exclusion criteria. Matching criteria were age within 5years, sex, body mass index within 5, same capsular treatment, and whether there was chondral damage of Outerbridge grade II or greater. Three patient-reported outcome (PRO) measures and visual analog scale (VAS) for pain were recorded preoperatively and at a minimum of 2years postoperatively. International Hip Outcome Tool and patient satisfaction were also collected at latest follow-up. Thirty-four reconstruction patients were matched to 68 repair patients. There were no significant differences in age (P= .941), sex (P > .999), body mass index (P= .935), or any other demographics between groups. A statistically significant increase was seen in PROs for both the reconstruction group (Modified Harris Hip Score, P= .002; Hip Outcome Score - Sports Subscale, P<.001; Non-arthritic Hip Score, P<.001) and the repair group (Modified Harris Hip Score, P<.001; Hip Outcome Score - Sports Subscale, P < .001; Non-arthritic Hip Score, P<.001) at minimum 2-year follow-up. Significant decrease was shown for VAS for both groups (reconstruction VAS, P<.001; repair, P<.001) at minimum 2-year follow-up. There were no significant differences in rates of postoperative complications (P>.999), secondary arthroscopy (P>.999), or conversion to total hip arthroplasty (P=.728) between groups. Arthroscopic labral reconstruction is associated with significant improvement in PROs and a low incidence of secondary surgery within 2-year follow-up. Improvements in PROs, VAS, patient satisfaction, and incidence of secondary procedures were comparable to a match control treated with labral repair. Although there were no differences shown in the 2 groups with respect to complication rate, secondary arthroscopy, or conversion to total hip arthroplasty, the study was not powered to compare these outcome parameters. Based on this evidence, either labral repair or reconstruction may be selected depending upon the clinical scenario. Level III; retrospective comparative study.

Clinical Outcomes Following Arthroscopic Labral Augmentation Compared to Matched Cohort of Labral Reconstruction

To compare the clinical outcomes in patients who underwent arthroscopic hip labral augmentation versus labral reconstruction by a single surgeon.

Arthroscopic labral reconstruction using fascia lata allograft: shuttle technique and minimum two-year results.

ABSTRACTThe purpose of this study was to describe the shuttle technique of acetabular labral reconstruction using allograft fascia lata and report minimum two-year clinical outcomes in a prospective patient cohort. We present a shuttle technique to introduce and fixate the allograft, by which the need to fix the free end of the graft from inside the joint is avoided. Between October 2010 and March 2014, 693 hip arthroscopic surgeries were performed by the senior author. Of these 693 patients, 34 patients underwent a labral reconstruction procedure using allograft fascia lata and the shuttle technique and met inclusion criteria. Outcome measures were collected at minimum two years postoperatively. 91.2% (31) of reconstruction patients were available for follow-up at minimum two years after surgery with 12.9% (4) of these patients converting to total hip arthroplasty at average time 27.9 months post-surgery. For the remaining reconstruction patients, mean mHHS increased from 64.0 preoperatively to 84.6 postoperatively (P = 0.0015), SF-12 Physical from 38.9 to 49.0 (P = 0.0004), SF-12 Mental from 49.5 to 55.6 (P = 0.0095), iHOT-12 from 36.4 to 68.1 (P = 0.0017), HOS-ADL from 62.6 to 81.6 (P = 0.0032) and HOS-SS from 32.9 to 65.7 (P < 0.0001). Arthroscopic acetabular labral reconstruction using fascia lata allograft and a shuttle technique appears to be an effective procedure for the treatment of labral pathology through minimum two-year follow-up. While it is difficult to discern the direct influence of the labral reconstructive procedure given the treatment of often concomitant intra-articular pathology, this patient cohort has fared similarly to other cohorts of labral reconstruction patients. No major adverse events are reported.

Outcomes following arthroscopic hip segmental labral reconstruction using autologous capsule tissue or indirect head of the rectus tendon.

ABSTRACTThe purpose of this study was to determine the outcomes following segmental labral reconstruction (labral defects measuring <1 cm) using a segment of capsular tissue or a segment of the indirect head of rectus femoris tendon. Eleven patients (five females and six males) underwent segmental labral reconstruction using a segment of capsule (eight patients) or indirect head of rectus tendon (three patients) by a single surgeon from March 2005 to October 2012. The average age of the patients was 35 years old (range, 20–51 years). Data collected included the pre- and post-operative Hip Outcome Score (HOS-ADL and HOS-SS), the modified Harris Hip Score and patient satisfaction rate (1 = unsatisfied, 10 = very satisfied), complications, necessity of revision hip arthroscopy and conversion to total hip arthroplasty. Average follow-up time was at 62 months (range, 9–120 months). No patient required revision hip arthroscopy or converted to total hip arthroplasty. The HOS-ADL significantly improved from 73 to 89 (P < 0.05). The HOS-SS showed significant improvement from 52 to 79 and the modified Harris Hip Score significantly improved from 66 to 89. Median patient satisfaction rate was 9 out of 10 (range, 3–10). In a small sample, the arthroscopic hip segmental labral reconstruction showed significant improvement in patient-reported outcomes. This treatment provides an option in cases of small labrum defects (<1 cm) or deficits in patients while providing improved function and high patient satisfaction.

Arthroscopic Acetabular Labral Reconstruction with Fascia Lata Allograft: Clinical Outcomes at Minimum One-Year Follow-Up.

Background:The integrity of the acetabular labrum is crucial to normal biomechanics of the hip joint. Disruption of the labral seal could be detrimental to the overall nutrition of the cartilage, leading to its premature degeneration.Purpose:The aim of this study is to determine the clinical effectiveness of arthroscopic hip labral reconstruction using fascia lata allograft. The hypothesis is that labral reconstruction would provide good clinical outcomes.Methods:We retrospectively reviewed all 10 patients who underwent labral reconstruction with fascia lata allograft from January 2013 to October 2015. We assessed improvement in pain and function, complications, and subsequent surgery. The minimum follow-up was 12 months (average, 22.9 months; range, 16–36 months).Results:All patients reported subjective improvement in preoperative pain and function. The mean modified Harris hip score improved significantly from 58 (55-60) to 95 (91-98). The mean change of modified Harris hip score was 36 (31-41) and mean post-operative patient satisfaction score was 9.5(8-10). We observed no radiological progression of arthritis as well as no patient had revision procedure including total hip replacement.Conclusion:Arthroscopic labral reconstruction using a fascia lata tendon allograft is an effective and safe procedure that not only provides excellent clinical outcomes in short term but also potentially prevent continued cartilage degeneration by restoring acetabular labral seal in patients with deficient or resected labrums.

Acetabular labral reconstruction using the indirect head of the rectus femoris tendon significantly improves patient reported outcomes.

The aim of this study was to evaluate outcomes after acetabular labral reconstruction using the indirect head of the rectus femoris tendon. The study hypothesis stated that arthroscopic acetabular labral reconstruction may improve patient reported outcomes in patients with labral tears that were not amenable to repair. Between 2009 and 2015, the senior author performed 31 acetabular labral reconstructions using the indirect head of the rectus femoris tendon. The graft is harvested through the same arthroscopic portals established for the procedure. The graft was gradually secured to the acetabular rim starting at its origin to the myotendinous junction, reestablishing the suction seal of the joint. Medical records and surgical reports were reviewed for demographic data, and outcome measures were assessed with pre- and postoperative modified Harris Hip Scores (mHHS). Twenty-two patients with follow-up of more than 2years were evaluated. Fourteen procedures were revision hip arthroscopy and 8 were primary labral reconstruction in 13 males and 9 females. The median age was 43 (range 22-68years old). The median follow-up time was 36.2months with a range from 24 to 72months. The median preoperative mHHS was 67.1. Postoperatively, patients improved to a median mHHS of 97.8 (range 73.7-100) (p<0.0001). Acetabular labral reconstruction using the indirect head of the rectus femoris tendon is a minimally invasive surgical procedure. The technique was applicable in all patients in this study with good outcomes. This procedure is clinically relevant for patients with large labral tears not amendable to labral repair as it offers good results using a local allograft. The local allograft is clinically advantageous as there is no additional donor-site morbidity and no risk of disease transmission. IV.

Orthopaedic Surgeon

Objectives:Results of revision labral repair and labral debridement of irreparable issue have been poor. A circumferential labral reconstruction (CLR) with ITB allograft between the transverse acetabular ligament antero-inferiorly to the 7-8 o’clock position postero-inferiorly eliminates any tissue damaged beyond repair, restores stability and eliminates any high stress junction points. This study seeks to compare outcomes with this technique relative to our patients with hip problems that are reliably fixed with simple labral repair.Methods:We retrospectively examined 34 consecutive patients undergoing arthroscopic surgery of the hip with CLR with a fascia lata allograft and compared them with 49 consecutive patients undergoing simple labral repair during the same 4 month period. Pre- and post-op surveys included Visual Analog Pain Score (VAS), International Hip Outcome Tool (IHOT-12), modified Harris Hip Score (mHHS), 12-item Short Form Health Survey (SF-12) and Hip Outcome Score (HOS-ADL and HOS-SSS). Pre-op Tonnis grade was recorded. Severity of labral damage was evaluated in separate sidearm study of 20 patient videos not involved in current study to assess intra-observer reliability for grading of severity of labral damage.Results:The mean age of the reconstruction patients was 43.0 vs. 29.1 for the repair patients (p<0.001). The repair group had 45% mild and 55% moderate tears; the CLR group had 80% severe tears or segmental defects and 20% moderate tears. 3.9% of the repair group were revision procedures, while 35% of the CLR group were revision procedures. Pre-op Tonnis grade in the CLR group was 0.44 vs. 0.11 (P<0.001). Follow-up rate was 82% with a minimum follow-up of 23 months (range: 23-28 months). In the CLR group, 5 patients failed; 1 for core muscle repair procedure, 2 went on to subsequent hip arthroplasty, 2 in need of hip arthroplasty. All 4 conversions to arthroplasty had pre-op tonnis grade of 2. 3 procedures failed in the repair group with one subsequent core muscle repair and 2 revisions to labral reconstruction. In the reconstruction group, the mean Pain VAS score decreased from 4.78 preoperatively to 1.9 postoperatively (P<0.001), IHOT-12 scores increased from 32.38 to 68.9 (P<0.001), and mHHS increased from 48.67 to 74.63 (P<0.001). The SF-12 survey exhibited an increase from 36.29 to 43.15 (P=0.028), HOS-ADL scores increased from 56.28 to 87.47 (P<0.001), and HOS-SSS scores increased from 32.40 to 68.55 (P=0.0028). These improvements were not statistically different from those observed in the repair group (Pain VAS: P=0.361; HOS-ADL: P=0.314; HOS-SSS: P=0.288; mHHS: P=0.996; IHOT: P=0.192; SF: P=0.642). Intra-observer reliability of sidearm video study Kappa = 0.66 indicating moderately good reliability in the grading of severity of labral damage.Conclusion:This study shows that patients undergoing circumferential labral reconstruction with ITB allograft exhibit favorable outcome at 2 years postoperatively with respect to pain and activities of daily living—comparable to the results achieved in patients undergoing repairs of labra with lower severity of damage in a more challenging patient population (14 yrs older with far worse labral damage, a higher Tonnis grade, and far higher percentage of revisions). These data suggest that circumferential arthroscopic labral reconstruction is a viable option for patients with missing or severely compromised labral tissue.

Circumferential Labral Reconstruction Using the Knotless Pull-Through Technique—Surgical Technique

Arthroscopic labral reconstruction is an alternative procedure for an irreparable hip labrum in the nonarthritic hip population. Although labral reconstruction is a relatively new procedure, data in the literature show favorable outcomes. Patients have shown beneficial outcomes from labral reconstructive surgery as well as when compared with labral repair and debridement patients. However, one of the challenges in performing labral reconstruction has been correctly measuring the graft to perfectly fit the area of labral deficiency. We propose a labral reconstruction technique that will eliminate inaccuracies in graft measurement while incorporating beneficial characteristics of the knotless suture. The advantages of this technique will increase procedural accuracy and brevity.

Arthroscopic Reconstruction of Segmental Defects of the Hip Labrum: Results in 22 Patients With Mean 2-Year Follow-Up

To report mean 2-year patient-reported outcomes (PROs) and the incidence of revision hip arthroscopy or conversion to total hip arthroplasty (THA) in patients who had undergone arthroscopic reconstruction of the hip labrum for segmental defects. Data were prospectively collected and retrospectively reviewed on all patients who had undergone hip arthroscopy from April 2008 to April 2013. All patients who underwent arthroscopic labral reconstruction with either a semitendinosus allograft or a gracilis autograft with mean 2-year follow-up were part of the inclusion criteria. The following outcomes were recorded: modified Harris hip score, nonarthritic athletic hip score, hip outcome score-sports-specific subscale, hip outcome score-activities of daily living subscale, visual analog scale, for pain, patient satisfaction, revision hip arthroscopies, and conversion to THA. A 2-tailed Student's t-test was used to assess for statistically significant differences between the mean of preoperative and postoperative PROs. P values less than .05 were considered statistically significant. A total of 22 patients (14 females, 8 males) met the inclusion criteria. There was 100% follow-up. The mean age of the study population was 32.2years. Twelve patients had reconstruction as part of a revision procedure and 10 patients had a reconstruction at the time of primary arthroscopy. Concomitant arthroscopic procedures included acetabuloplasty and femoroplasty. There was statistically significant improvement in all PROs (P= .013 to <.001). The mean changes for the modified Harris hip score, nonarthritic athletic hip score, hip outcome score-sports-specific subscale, and hip outcome score-activities of daily living subscale were 11.0 ± 19.5, 22.2 ± 15.0, 23.1 ± 30.9, and 19.1 ± 17.5 points, respectively. The mean improvement in the visual analog scale was 3.33 ± 2.92 points (P < .001), and the mean patient satisfaction was 6.73 out of 10 points. One patient required conversion to THA for presumed progression of osteoarthritis and 2 patients required a revision procedure for adhesions. This arthroscopic technique for labral reconstruction was associated with a significant improvement in PROs and function. Conversion to THA with the procedure was 4.5%. Level IV, therapeutic case series.

Arthroscopic Technique for Acetabular Labral Reconstruction Using Iliotibial Band Autograft

The dynamic function of the acetabular labrum makes it an important structure for both hip stability and motion. Because of this, injuries to the labrum can cause significant dysfunction, leading to altered hip kinematics. Labral repair is the gold standard for symptomatic labral tears to keep as much labral tissue as possible; however, in cases where the labrum has been injured to such a degree that it is either deficient or repair is not possible, arthroscopic labral reconstruction is preferred. This article describes our preferred approach for reconstruction of the acetabular labrum using iliotibial band autograft.

Arthroscopic Labral Reconstruction of the Hip Using Iliotibial Band Allograft and Front-to-Back Fixation Technique

Labral repair has been shown to be an effective treatment option with excellent early outcomes; however, in cases of severe labral damage or when the labral tissue is too large or diminutive, labral repair may be less effective. The purpose of this article is to present a modified technique for hip labral reconstruction using iliotibial band allograft tissue and a front-to-back fixation technique. The described technique is modified from the original report of a technique for arthroscopic labral reconstruction. The front-to-back technique allows the surgeon to make a graft that is longer than necessary and cut excess graft after front-to-back fixation, resulting in the correct graft size and a reproducible procedure. Allograft tissue offers several advantages, including the ability to control graft thickness and length, as well as the ability to eliminate donor-site morbidity. This procedure adds to the available techniques for treatment of labral pathology by providing a labral reconstruction technique using allograft tissue.

Lesiones del labrum de cadera: vascularización y técnicas de reconstrucción

ObjectivesAcetabular labral tears are a common cause of hip pain. The aim of this article is to describe the surgical technique for arthroscopic labral repair, reconstruction, and treatment. Material and methodsA review is presented of the types and classification of labral lesions, vascular supply, and surgical techniques for labral repair. Results and conclusionsA reproducible and reliable surgical technique for arthroscopic labral repair and the intraoperative surgical decision making is very important to achieve success in this kind of hip problem. Clinical relevanceAn improved understanding of labral vasculature, classification of labral lesions, and surgical techniques have implications for the surgical treatment of labral tears. Level of evidenceLevel IV, case series.

Arthroscopic Hip Labral Reconstruction and Augmentation Using Knotless Anchors

Biomechanical stability is the primary function of the acetabular labrum. It provides a hip suction seal and optimal joint function. Labral tears are a common reason for hip arthroscopy, to improve patient function and to prevent long-term degenerative arthropathy. Arthroscopic labral repair has shown significantly better outcomes in return to premorbid activity levels when compared with labral debridement. Injury to the acetabular labrum is a challenge and can lead to long-term complications. In this scenario, arthroscopic labral reconstruction has shown good results regarding patient subjective and objective outcomes. We describe a technique for complete arthroscopic labral reconstruction using tensor fascia lata allograft.

Allograft Use in Arthroscopic Labral Reconstruction of the Hip With Front-to-Back Fixation Technique: Minimum 2-Year Follow-up

To present minimum 2-year outcomes in patients who underwent a modified technique for arthroscopic labral reconstruction using iliotibial band allograft tissue and a front-to-back fixation. From April 2011 to July 2012, all consecutive arthroscopic labral reconstruction patients were included in this Institutional Review Board-approved, prospective case series study. Inclusion criteria were arthroscopic iliotibial band allograft labral reconstruction performed by a single surgeon, age ≥16 years at the time of arthroscopy, and a minimum of 2 years of follow-up. Patients completed subjective questionnaires both preoperatively and postoperatively, including Modified Harris Hip Score (MHHS), the Lower Extremity Function Score (LEFS), Visual Analogue Scale (VAS) pain scores, and patient satisfaction. A modified front-to-back fixation technique for labral reconstruction was used. One hundred fifty-two hips (142 patients) met the inclusion criteria for this study; 131 hips (86.2%) had complete follow-up at a minimum of 2 years, and 21 hips (13.8%) were lost to follow-up or had incomplete data during the study period. Seventy hips had concomitant procedures performed; 27 microfracture, 30 chondroplasty, 26 psoas release, 5 os acetabuli resection, and 3 Ganz osteotomy. Overall, 18 hips (13.7%) required revision procedures at a mean of 17 months (range, 1 to 37 months) after the labral reconstruction. In the remaining 113 hips, there was significant improvement in all outcome measures from preoperative to most recent follow-up (P < .0001). The mean MHHS improved by 34 points (P < .0001), and the mean LEFS improved by 27 points (P < .0001). The mean VAS pain score improved by 3 points at rest (P < .0001), 4 points with average pain with daily activities (P < .0001), and 5 points with sport (P < .0001). Patients reported an overall satisfaction of 9 (range, 1 to 10). Arthroscopic iliotibial band allograft labral reconstruction of the hip shows promising outcomes at minimum 2-year follow-up. Level IV, therapeutic case series.

Arthroscopic Labral Reconstruction of the Hip Using Semitendinosus Allograft

The labrum of the hip is recognized as being important to the stability of the hip and a major cause of hip pain. Damage to the labrum may result in increased joint stress and articular damage. Labral damage is often treated through various methods, among them simple stitch repair, base refixation, and debridement. Labral reconstruction becomes necessary when the labrum is too damaged to salvage, which renders labral repair improbable and labral debridement ineffective. In contrast to other methods that have been described for this treatment, our technique uses a semitendinosus allograft as a graft source, allowing for arthroscopic hip labral reconstruction. This technique has many advantages and is easily reproducible. It has shown promising results in patients with labral damage. The purpose of this article is to detail the step-by-step surgical technique of labral reconstruction using a semitendinosus allograft, in addition to the indications, pearls, and pitfalls of the technique.

Arthroscopic Labral Reconstruction of the Hip Using Local Capsular Autograft

Labral reconstruction is becoming an important treatment modality for hips with nonsalvageable labra. Nonsalvageable labra can be present in cases of intrasubstance damage, revision surgery after debridement, labral calcification, and hypoplasia. Previous methods of reconstruction have been performed in an open manner and arthroscopically using ligamentum teres, iliotibial band, and gracilis autograft. We present an alternate method of arthroscopic labral reconstruction using capsular autograft. The technique uses readily available capsular tissue during arthroscopy with no donor-site morbidity. This technique may be valuable in appropriately selected patients with labral deficiency.

Staged Arthroscopic Labral Reconstruction with Allograft for Labral Deficiency in Femoroacetabular Impingement

The purpose of this study was to investigate the surgical technique and clinical effectiveness for reconstructing the labrum in patients with a labral defect secondary to femoroacetabular impingement (FAI) using a staged arthroscopic labral reconstruction with allograft. The hypothesis was that patients undergoing staged arthroscopic labral reconstruction with allograft for labral deficiency would have symptomatic and functional improvement secondary to this novel procedure. A retrospective review of patients who underwent hip arthroscopy for symptomatic FAI over a 2-year period performed by a single surgeon fellowship trained in hip arthroscopy was performed. Inclusion criteria were young adults (age, 18-50 years old) with symptomatic labral tears with FAI confirmed on MR imaging; without advanced radiographic osteoarthritis (Tonnis grade 0-1); who failed conservative treatment; underwent an index hip arthroscopy for management of FAI where a deficient labrum was documented, and had a second stage arthroscopic semitendinosus allograft reconstruction performed at a later date. Preoperative and postoperative Hip Outcome Scores (HOS) for daily and sports activity were obtained. There were 252 eligible patients and 7 that met inclusion criteria, 6 men and 1 woman. The mean age at time of surgery was 40.3 years (range, 34 to 50 years). The mean time from the onset of symptoms to labral reconstruction was 15.8 months (range, 8 to 36 months). The mean time from index procedure to labral reconstruction was 3.9 months (range, 2 to 7 months). The mean time to follow-up was 12.4 months (range, 2 to 23 months). MR imaging did not demonstrate labral deficiencies in all 7 cases. The mean HOS activity score improved from 55.8 preoperatively to 94.1 postoperatively (p < 0.01). The mean HOS sports score also increased from 29.6 preoperatively to 74.1 postoperatively (p < 0.05). There were no complications and no additional procedures performed after labral reconstruction. The study showed that patients with labral deficiency secondary to FAI showed both symptomatic and functional stabilization after staged arthroscopic labral reconstruction with semitendinosus allograft. Imaging studies do not indicate labral deficiencies in the setting of FAI. The incidence of labral deficiency without significant arthritis in the setting of FAI was 2.8% (7/252). Identifying and staging labral reconstruction is a safe and effective treatment.

Arthroscopic Labral Reconstruction Is Superior to Segmental Resection for Irreparable Labral Tears in the Hip

Background: The acetabular labrum is an important structure that plays a significant role in proper biomechanical function of the hip joint. When the labrum is significantly deficient, arthroscopic reconstruction could provide a potential solution for the nonfunctional labrum. Purpose: To compare the clinical outcomes of arthroscopic labral reconstruction (RECON) with those of arthroscopic segmental labral resection (RESEC) in patients with femoroacetabular impingement (FAI) of the hip. Study Design: Cohort study; Level of evidence, 3. Methods: Between April 2010 and March 2011, all prospectively gathered data for patients with FAI who underwent arthroscopic acetabular labral reconstruction or segmental resection with a minimum 2-year follow-up were reviewed. Eleven cases in the RECON group were matched to 22 cases in the RESEC group according to the preoperative Non-Arthritic Hip Score (NAHS) and sex. The patient-reported outcome scores (PROs) used included the NAHS, the Hip Outcome Score (HOS), and the modified Harris Hip Score (mHHS). Statistical analyses were performed to compare the change in PROs in both groups. Results: There was no statistically significant difference between groups regarding the preoperative NAHS (P = .697), any of the other preoperative PROs, or demographic and radiographic data. The mean change in the NAHS was 24.8 ± 16.0 in the RECON group and 12.5 ± 16.0 in the RESEC group. The mean change in the HOS–activities of daily living (HOS-ADL) was 21.7 ± 16.5 in the RECON group and 9.5 ± 15.5 in the RESEC group. Comparison of the amount of change between groups showed greater improvement in the NAHS and HOS-ADL for the RECON group (P = .046 and .045, respectively). There was no statistically significant difference in the mean changes in the rest of the PROs, although there were trends in all in favor of the RECON group. All PROs in both groups showed a statistically significant improvement at follow-up compared with preoperative levels. Conclusion: Arthroscopic labral reconstruction is an effective and safe procedure that provides good short-term clinical outcomes in hips with insufficient and nonfunctional labra in the setting of FAI.

Results of Arthroscopic Labral Reconstruction of the Hip in Elite Athletes

Background: Femoroacetabular impingement (FAI) has been well characterized as a cause of hip pain and resultant damage to the acetabular labrum. It has become increasingly clear that an intact labrum is essential for normal joint mechanics, hip stability, and preservation of the articular cartilage. Elite athletes with a hypoplastic or irreparable labrum present a difficult clinical challenge. Purpose: To assess clinical outcomes and determine if elite athletes are able to return to a high level of function and sport after labral reconstruction. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of a prospectively collected registry identified 21 elite athletes (23 hips) with an average age of 28.0 years (range, 19-41 years) who underwent an arthroscopic iliotibial band labral reconstruction. Concomitant procedures included femoral and acetabular osteoplasty in all patients and microfracture in 9 of 23 hips. Clinical outcomes were assessed with the modified Harris Hip Score (MHHS), the Hip Outcome Score (HOS), the Short Form–12 (SF-12), and patient satisfaction (on a scale from 1-10). Return to play was determined, as well as level of return to play, based on sport-specific statistics. Results: Two patients progressed to arthroplasty. There were 2 revisions in this group of patients, both for lysis of capsulolabral adhesions in which the graft was found to be well integrated at the time of surgery. The rate of return to play was 85.7% (18/21), with 81% (17/21) returning to a similar level. Subjective follow-up was obtained from 17 of the remaining 19 patients (89%), with an average follow-up of 41.4 months (range, 20-74 months). The average MHHS improved from 67 to 84 (P = .026) and the average HOS Sport subscore from 56 to 77 (P = .009). The overall median patient satisfaction with outcome was 8.2 (range, 3-10). Conclusion: Arthroscopic labral reconstruction using an ipsilateral iliotibial band autograft provides good short-term clinical outcomes, high patient satisfaction, and a satisfactory level of return to play in a select group of elite athletes.