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Indications and Outcomes of Arthroscopic Labral Reconstruction of the Hip: A Systematic Review

      Purpose

      The primary purpose of this investigation was to systematically evaluate the literature for the current indications and outcomes of arthroscopic labral reconstruction of the hip. Our secondary purpose was to evaluate the role of arthroscopic labral reconstruction in the management of reparable labral tears.

      Methods

      A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using a PRISMA checklist. Studies published between June 2009 and June 2018 that evaluated outcomes after arthroscopic labral reconstruction with a minimum of 1 year of follow-up were included.

      Results

      Eleven studies met the inclusion and exclusion criteria. A total of 373 patients were identified. Of the 11 studies, 9 reported that an irreparable labrum was their indication for reconstruction, with 8 reporting that this was ultimately determined intraoperatively. Substantial variability in surgical technique, graft choice, and concurrent pathology was found. All 11 studies used at least 1 validated functional outcome metric to evaluate surgical outcomes, with all studies reporting improvement greater than the minimal clinically important difference. Donor-site pain was the most common complication, although it was reported in only 2 studies. Reported rates of revision surgery and conversion to arthroplasty were low (range, 0%-9.1% for both).

      Conclusions

      All 11 studies included in this systematic review reported clinically significant functional improvements after arthroscopic labral reconstruction and low rates of complications, revision surgery, and progression of arthritis, although graft types and concomitant procedures confound the results. The most common indication for reconstruction was a deficient labrum on intraoperative evaluation. The 6 studies that evaluated patient satisfaction reported favorable results, with a range of 6.73 to 8.7.

      Level of Evidence

      Level IV, systematic review of Level III and IV studies.
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      Linked Article

      • Editorial Commentary: Errors of Omission Versus Errors of Commission: The Case of Hip Labral Reconstruction
        ArthroscopyVol. 35Issue 7
        • Preview
          As hip arthroscopy grows at an increasingly rapid pace, hip surgeons are faced with significant challenges in addressing various pathologies, such as irreparable hip labral tears. As technology and skill sets evolve, the ability to perform hip labral reconstruction in the setting of irreparable labral tears becomes not a matter of “Can we” but rather “Should we” be doing these. Basic science studies have demonstrated the vital role of the hip labrum for normal hip functioning and chondral health.
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