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Hip Labral Repair versus Reconstruction: Meta-analysis

  • Jean Tarchichi (Department of Orthopedic Surgery, Hotel-Dieu de France) ;
  • Mohammad Daher (Department of Orthopaedics, Brown University) ;
  • Ali Ghoul (Department of Orthopedic Surgery, Hotel-Dieu de France) ;
  • Michel Estephan (Division of Orthopaedic Surgery and Sports Medicine, McGill University Health Centre) ;
  • Karl Boulos (Orthopedics Department, LAU Medical Center-Rizk Hospital) ;
  • Jad Mansour (Division of Orthopaedic Surgery and Sports Medicine, McGill University Health Centre)
  • Received : 2023.08.30
  • Accepted : 2023.11.07
  • Published : 2024.09.01

Abstract

The purpose of this meta-analysis is to compare the postoperative outcomes and complications of labral repair with those of labral reconstruction. An electronic search strategy was conducted from 1986 until August 2023 using the following databases: PubMed, Cochrane, and Google Scholar (pages 1-20). The primary objectives included the postoperative clinical outcomes determined by the number of patients who reached minimal clinical important difference (MCID) on the visual analog scale (VAS), modified Harris hip score (mHHS), Hip Outcome Score-Sports Subscale (HOS-SS), Hip Outcome Score-Activities of Daily Life (HOS-ADL), and International Hip Outcome Tool-12 (iHOT-12). In addition, analysis of the rate of revision arthroscopy, the rate of conversion to total hip arthroplasty (THA), the postoperative VAS, mHHS, HOS-SS, HOS-ADL, iHOT-12, nonarthritic hip score (NAHS), patient satisfaction, lower extremity function scale (LEFS), and the SF-12 (12-item shortform) was also performed. Any differences arising between the investigators were resolved by discussion. Seventeen studies were relevant to the inclusion criteria and were included in this meta-analysis. A higher rate of patients who reached MCID in the mHHS (P=0.02) as well as a higher rate of revision arthroscopy was observed for labral repair (P=0.03). The remaining studied outcomes were comparable. Despite the greater predictability of success in the reconstruction group, conduct of additional studies will be required for evaluation of the benefits of such findings. In addition, labral reconstruction is more technically demanding than a labral repair.

Keywords

References

  1. Seldes RM, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald RH Jr. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res. 2001;(382):232-40. https://doi.org/10.1097/00003086-200101000-00031
  2. Safran MR. Microinstability of the hip-gaining acceptance. J Am Acad Orthop Surg. 2019;27:12-22. https://doi.org/10.5435/JAAOS-D-17-00664
  3. Reiman MP, Mather RC 3rd, Hash TW 2nd, Cook CE. Examination of acetabular labral tear: a continued diagnostic challenge. Br J Sports Med. 2014;48:311-9. https://doi.org/10.1136/bjsports-2012-091994
  4. Bozic KJ, Chan V, Valone FH 3rd, Feeley BT, Vail TP. Trends in hip arthroscopy utilization in the United States. J Arthroplasty. 2013;28(8 Suppl):140-3. https://doi.org/10.1016/j.arth.2013.02.039
  5. Palmer AJ, Malak TT, Broomfield J, et al. Past and projected temporal trends in arthroscopic hip surgery in England between 2002 and 2013. BMJ Open Sport Exerc Med. 2016;2:e000082. https://doi.org/10.1136/bmjsem-2015-000082
  6. Bsat S, Frei H, Beaule PE. The acetabular labrum: a review of its function. Bone Joint J. 2016;98-B:730-5. https://doi.org/10.1302/0301-620X.98B6.37099
  7. Haddad B, Konan S, Haddad FS. Debridement versus reattachment of acetabular labral tears: a review of the literature and quantitative analysis. Bone Joint J. 2014;96-B:24-30. https://doi.org/10.1302/0301-620X.96B1.32425
  8. Nepple JJ, Philippon MJ, Campbell KJ, et al. The hip fluid seal--part II: the effect of an acetabular labral tear, repair, resection, and reconstruction on hip stability to distraction. Knee Surg Sports Traumatol Arthrosc. 2014;22:730-6. https://doi.org/10.1007/s00167-014-2875-y
  9. Philippon MJ, Nepple JJ, Campbell KJ, et al. The hip fluid seal--part I: the effect of an acetabular labral tear, repair, resection, and reconstruction on hip fluid pressurization. Knee Surg Sports Traumatol Arthrosc. 2014;22:722-9. https://doi.org/10.1007/s00167-014-2874-z
  10. Weber AE, Kuhns BD, Cvetanovich GL, Grzybowski JS, Salata MJ, Nho SJ. Amateur and recreational athletes return to sport at a high rate following hip arthroscopy for femoroacetabular impingement. Arthroscopy. 2017;33:748-55. https://doi.org/10.1016/j.arthro.2016.10.015
  11. Frangiamore SJ, Mannava S, Briggs KK, McNamara S, Philippon MJ. Career length and performance among professional baseball players returning to play after hip arthroscopy. Am J Sports Med. 2018;46:2588-93. https://doi.org/10.1177/0363546518775420
  12. Menge TJ, Bhatia S, McNamara SC, Briggs KK, Philippon MJ. Femoroacetabular impingement in professional football players: return to play and predictors of career length after hip arthroscopy. Am J Sports Med. 2017;45:1740-4. https://doi.org/10.1177/0363546517700118
  13. Begly JP, Buckley PS, Utsunomiya H, Briggs KK, Philippon MJ. Femoroacetabular impingement in professional basketball players: return to play, career length, and performance after hip arthroscopy. Am J Sports Med. 2018;46:3090-6. https://doi.org/10.1177/0363546518801320
  14. Lee S, Cvetanovich GL, Mascarenhas R, et al. Ability to return to work without restrictions in workers compensation patients undergoing hip arthroscopy. J Hip Preserv Surg. 2016;4:30-8. https://doi.org/10.1093/jhps/hnw037
  15. Philippon MJ, Briggs KK, Hay CJ, Kuppersmith DA, Dewing CB, Huang MJ. Arthroscopic labral reconstruction in the hip using iliotibial band autograft: technique and early outcomes. Arthroscopy. 2010;26:750-6. https://doi.org/10.1016/j.arthro.2009.10.016
  16. Chandrasekaran S, Darwish N, Close MR, Lodhia P, Suarez-Ahedo C, Domb BG. Arthroscopic reconstruction of segmental defects of the hip labrum: results in 22 patients with mean 2-year follow-up. Arthroscopy. 2017;33:1685-93. https://doi.org/10.1016/j.arthro.2017.03.015
  17. Scanaliato JP, Christensen DL, Salfiti C, Herzog MM, Wolff AB. Primary circumferential acetabular labral reconstruction: achieving outcomes similar to primary labral repair despite more challenging patient characteristics. Am J Sports Med. 2018;46:2079-88. https://doi.org/10.1177/0363546518775425
  18. White BJ, Stapleford AB, Hawkes TK, Finger MJ, Herzog MM. Allograft use in arthroscopic labral reconstruction of the hip with front-to-back fixation technique: minimum 2-year follow-up. Arthroscopy. 2016;32:26-32. https://doi.org/10.1016/j.arthro.2015.07.016
  19. Cadet ER, Chan AK, Vorys GC, Gardner T, Yin B. Investigation of the preservation of the fluid seal effect in the repaired, partially resected, and reconstructed acetabular labrum in a cadaveric hip model. Am J Sports Med. 2012;40:2218-23. https://doi.org/10.1177/0363546512457645
  20. Scanaliato JP, Green CK, Salfiti CE, Patrick CM, Wolff AB. Primary arthroscopic labral management: labral repair and complete labral reconstruction both offer durable, promising results at minimum 5-year follow-up. Am J Sports Med. 2022;50:2622-8. https://doi.org/10.1177/03635465221109237
  21. Sterne JA, Hernan MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. https://doi.org/10.1136/bmj.i4919
  22. Bodendorfer BM, Alter TD, Carreira DS, et al. Multicenter outcomes after primary hip arthroscopy: a comparative analysis of two-year outcomes after labral repair, segmental labral reconstruction, or circumferential labral reconstruction. Arthroscopy. 2022;38:352-61. https://doi.org/10.1016/j.arthro.2021.05.013
  23. Bodendorfer BM, Alter TD, Wolff AB, et al. Multicenter outcomes after revision hip arthroscopy: comparative analysis of 2-year outcomes after labral repair versus labral reconstruction. Am J Sports Med. 2021;49:2968-76. https://doi.org/10.1177/03635465211030511
  24. Chandrasekaran S, Darwish N, Mu BH, et al. Arthroscopic reconstruction of the irreparable acetabular labrum: a match-controlled study. Arthroscopy. 2019;35:480-8. https://doi.org/10.1016/j.arthro.2018.09.024
  25. Domb BG, Battaglia MR, Perets I, et al. Minimum 5-year outcomes of arthroscopic hip labral reconstruction with nested matched-pair benchmarking against a labral repair control group. Am J Sports Med. 2019;47:2045-55. https://doi.org/10.1177/0363546518825259
  26. Domb BG, Kyin C, Rosinsky PJ, et al. Circumferential labral reconstruction for irreparable labral tears in the primary setting: minimum 2-year outcomes with a nested matched-pair labral repair control group. Arthroscopy. 2020;36:2583-97. https://doi.org/10.1016/j.arthro.2020.02.014
  27. Jimenez AE, Lee MS, Owens JS, et al. Revision hip arthroscopy with labral reconstruction for irreparable labral tears in athletes: minimum 2-year outcomes with a benchmark control group. Am J Sports Med. 2022;50:1571-81. https://doi.org/10.1177/03635465221085030
  28. Jimenez AE, Monahan PF, Owens JS, et al. 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. Am J Sports Med. 2021;49:3261-9. https://doi.org/10.1177/03635465211032593
  29. Maldonado DR, Ouyang VW, Owens JS, et al. 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. Am J Sports Med. 2021;49:3925-36. https://doi.org/10.1177/03635465211046915
  30. Matsuda DK, Burchette RJ. Arthroscopic hip labral reconstruction with a gracilis autograft versus labral refixation: 2-year minimum outcomes. Am J Sports Med. 2013;41:980-7. https://doi.org/10.1177/0363546513482884
  31. Nakashima H, Tsukamoto M, Ohnishi Y, et al. Clinical and radiographic predictors for unsalvageable labral tear at the time of initial hip arthroscopic management for femoroacetabular impingement. Am J Sports Med. 2019;47:2029-37. https://doi.org/10.1177/0363546519856018
  32. Perets I, Rybalko D, Mu BH, et al. In revision hip arthroscopy, labral reconstruction can address a deficient labrum, but labral repair retains its role for the reparable labrum: a matched control study. Am J Sports Med. 2018;46:3437-45. https://doi.org/10.1177/0363546518809063
  33. Philippon MJ, Bolia IK, Locks R, Briggs KK. Labral preservation: outcomes following labrum augmentation versus labrum reconstruction. Arthroscopy. 2018;34:2604-11. https://doi.org/10.1016/j.arthro.2018.04.021
  34. White BJ, Patterson J, Herzog MM. Revision arthroscopic acetabular labral treatment: repair or reconstruct? Arthroscopy. 2016;32:2513-20. https://doi.org/10.1016/j.arthro.2016.07.024
  35. White BJ, Patterson J, Herzog MM. Bilateral hip arthroscopy: direct comparison of primary acetabular labral repair and primary acetabular labral reconstruction. Arthroscopy. 2018;34:433-40. https://doi.org/10.1016/j.arthro.2017.08.240
  36. White BJ, Patterson J, Scoles AM, Lilo AT, Herzog MM. Hip arthroscopy in patients aged 40 years and older: greater success with labral reconstruction compared with labral repair. Arthroscopy. 2020;36:2137-44. https://doi.org/10.1016/j.arthro.2020.04.031
  37. Maldonado DR, Kyin C, Chen SL, et al. In search of labral restoration function with hip arthroscopy: outcomes of hip labral reconstruction versus labral repair: a systematic review. Hip Int. 2021;31:704-13. https://doi.org/10.1177/1120700020965162
  38. Herickhoff PK, Safran MR. Surgical decision making for acetabular labral tears: an international perspective. Orthop J Sports Med. 2018;6:2325967118797324. https://doi.org/10.1177/2325967118797324
  39. Rosinsky PJ, Kyin C, Maldonado DR, et al. Determining clinically meaningful thresholds for the Nonarthritic Hip Score in patients undergoing arthroscopy for femoroacetabular impingement syndrome. Arthroscopy. 2021;37:3113-21. https://doi.org/10.1016/j.arthro.2021.03.059
  40. Wolff AB, Grossman J. Management of the acetabular labrum. Clin Sports Med. 2016;35:345-60. https://doi.org/10.1016/j.csm.2016.02.004
  41. Domb BG, Hartigan DE, Perets I. Decision making for labral treatment in the hip: repair versus debridement versus reconstruction. J Am Acad Orthop Surg. 2017;25:e53-62. https://doi.org/10.5435/JAAOS-D-16-00144
  42. Westermann RW, Day MA, Duchman KR, Glass NA, Lynch TS, Rosneck JT. Trends in hip arthroscopic labral repair: An American Board of Orthopaedic Surgery database study. Arthroscopy. 2019;35:1413-9. https://doi.org/10.1016/j.arthro.2018.11.016
  43. Maldonado DR, Lall AC, Walker-Santiago R, et al. Hip labral reconstruction: consensus study on indications, graft type and technique among high-volume surgeons. J Hip Preserv Surg. 2019;6:41-9. https://doi.org/10.1093/jhps/hnz008
  44. Domb BG, Stake CE, Lindner D, El-Bitar Y, Jackson TJ. Revision hip preservation surgery with hip arthroscopy: clinical outcomes. Arthroscopy. 2014;30:581-7. https://doi.org/10.1016/j.arthro.2014.02.005
  45. Perets I, Hartigan DE, Chaharbakhshi EO, Walsh JP, Close MR, Domb BG. Circumferential labral reconstruction using the knotless pull-through technique-surgical technique. Arthrosc Tech. 2017;6:e695-8. https://doi.org/10.1016/j.eats.2017.01.014