Advertisement

Revision Arthroscopic Acetabular Labral Treatment: Repair or Reconstruct?

Published:October 05, 2016DOI:https://doi.org/10.1016/j.arthro.2016.07.024

      Purpose

      To compare the outcome of labral repair versus labral reconstruction in patients presenting to a single surgeon for revision hip arthroscopy following previous labral treatment.

      Methods

      Patients who underwent revision labral repair or labral reconstruction using iliotibial band allograft, after previous labral debridement or repair, between 2009 and 2013 were identified. Hips that underwent revision labral reconstruction were further stratified into 2 graft groups (freeze-dried vs frozen allograft). Exclusion criteria were age <16 years, previous open hip surgery, or previous labral reconstruction. Failure was defined by subsequent intra-articular hip surgery.

      Results

      113 hips (15 repair, 98 reconstruction) met the inclusion criteria. Patients who underwent revision labral repair were younger than patients who underwent revision labral reconstruction (27.8 years vs 34.6 years; P = .02). Follow-up was obtained from 14 (93%) labral repairs at an average of 4.7 years postoperation (range: 2.0-6.0 years) and 90 (92%) labral reconstructions at an average of 2.4 years postoperation (range: 2.0-4.0 years). Seven of 14 (50%) labral repair hips failed compared with 11/90 (12%) labral reconstruction hips (P < .01). Six of 61 (10%) frozen allografts failed compared with 5/29 (17%) freeze-dried allografts (P = .32). Patients who underwent revision labral repair were 4.1 (95% confidence interval 1.9, 8.8) times more likely to fail than patients who underwent revision labral reconstruction.

      Conclusions

      Patients who underwent revision labral repair following previous repair or debridement were 2.6 times more likely to fail than patients who underwent revision labral reconstruction, controlling for calendar time. In addition, revision labral reconstruction with frozen allograft had lower propensity of failure than freeze-dried allograft. However, there was no statistically significant difference in patient-reported outcome scores between the 2 groups. Based on these results, complete labral reconstruction with longer, nonsegmental graft led to a lower failure rate in this study population and can be considered for treatment of patients presenting for revision labral treatment.

      Level of Evidence

      Level III, retrospective comparative study.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Byrd J.W.
        Hip arthroscopy utilizing the supine position.
        Arthroscopy. 1994; 10: 275-280
        • Kelly B.T.
        • Weiland D.E.
        • Schenker M.L.
        • Philippon M.J.
        Arthroscopic labral repair in the hip: Surgical technique and review of the literature.
        Arthroscopy. 2005; 21: 1496-1504
        • Philippon M.J.
        • Briggs K.K.
        • Hay C.J.
        • Kuppersmith D.A.
        • Dewing C.B.
        • Huang M.J.
        Arthroscopic labral reconstruction in the hip using iliotibial band autograft: Technique and early outcomes.
        Arthroscopy. 2010; 26: 750-756
        • White B.J.
        • Herzog M.M.
        Arthroscopic labral reconstruction of the hip using iliotibial band allograft and front-to-back fixation technique.
        Arthrosc Tech. 2016; 5: e89-e97
        • Byrd J.W.
        • Jones K.S.
        Primary repair of the acetabular labrum: Outcomes with 2 years' follow-up.
        Arthroscopy. 2014; 30: 588-592
        • Larson C.M.
        • Giveans M.R.
        • Stone R.M.
        Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: Mean 3.5-year follow-up.
        Am J Sports Med. 2012; 40: 1015-1021
        • Harris J.D.
        • McCormick F.M.
        • Abrams G.D.
        • et al.
        Complications and reoperations during and after hip arthroscopy: A systematic review of 92 studies and more than 6,000 patients.
        Arthroscopy. 2013; 29: 589-595
        • Sardana V.
        • Philippon M.J.
        • de Sa D.
        • et al.
        Revision hip arthroscopy indications and outcomes: A systematic review.
        Arthroscopy. 2015; 31: 2047-2055
        • Philippon M.J.
        • Schenker M.L.
        • Briggs K.K.
        • Kuppersmith D.A.
        • Maxwell R.B.
        • Stubbs A.J.
        Revision hip arthroscopy.
        Am J Sports Med. 2007; 35: 1918-1921
        • White B.J.
        • Stapleford A.B.
        • Hawkes T.K.
        • Finger M.J.
        • Herzog M.M.
        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
        • Byrd J.W.
        • Jones K.S.
        Prospective analysis of hip arthroscopy with 2-year follow-up.
        Arthroscopy. 2000; 16: 578-587
        • Binkley J.M.
        • Stratford P.W.
        • Lott S.A.
        • Riddle D.L.
        The Lower Extremity Functional Scale (LEFS): Scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network.
        Phys Ther. 1999; 79: 371-383
        • Naal F.D.
        • Impellizzeri F.M.
        • Torka S.
        • Wellauer V.
        • Leunig M.
        • von Eisenhart-Rothe R.
        The German Lower Extremity Functional Scale (LEFS) is reliable, valid and responsive in patients undergoing hip or knee replacement.
        Qual Life Res. 2015; 24: 405-410
      1. Smeatham A, Powell R, Moore S, Chauhan R, Wilson M. Does treatment by a specialist physiotherapist change pain and function in young adults with symptoms from femoroacetabular impingement? A pilot project for a randomised controlled trial [published online February 27, 2016]. Physiotherapy. doi:10.1016/j.physio.2016.02.004.

        • Pavkovich R.
        Effectiveness of dry needling, stretching, and strengthening to reduce pain and improve function in subjects with chronic lateral hip and thigh pain: A retrospective case series.
        Int J Sports Phys Ther. 2015; 10: 540-551
        • Nepple J.J.
        • Philippon M.J.
        • Campbell K.J.
        • 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: 730-736
        • Philippon M.J.
        • Nepple J.J.
        • Campbell K.J.
        • 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: 722-729
        • Domb B.G.
        • Stake C.E.
        • Lindner D.
        • El-Bitar Y.
        • Jackson T.J.
        Revision hip preservation surgery with hip arthroscopy: Clinical outcomes.
        Arthroscopy. 2014; 30: 581-587
        • Larson C.M.
        • Giveans M.R.
        • Samuelson K.M.
        • Stone R.M.
        • Bedi A.
        Arthroscopic hip revision surgery for residual femoroacetabular impingement (FAI): Surgical outcomes compared with a matched cohort after primary arthroscopic FAI correction.
        Am J Sports Med. 2014; 42: 1785-1790
        • Gupta A.
        • Redmond J.M.
        • Stake C.E.
        • Dunne K.F.
        • Hammarstedt J.E.
        • Domb B.G.
        Outcomes of revision hip arthroscopy: 2-year clinical follow-up.
        Arthroscopy. 2016; 32: 788-797