Advertisement

After Revision Hip Arthroscopy, Patients Having Either Circumferential or Segmental Labral Reconstructions for the Management of Irreparable Labra Show Clinical Improvement Based on Proper Indications

Published:February 18, 2022DOI:https://doi.org/10.1016/j.arthro.2022.02.005

      Purpose

      To compare a minimum of two-year follow-up patient-reported outcome scores (PROs) in patients who underwent revision hip arthroscopy for acetabular circumferential labral reconstruction (CLR) and segmental labral reconstruction (SLR) using propensity-matched groups, in the setting of irreparable labral tear.

      Methods

      Prospectively collected data were retrospectively reviewed for patients who underwent revision hip arthroscopy from April 2010 to September 2018. Patients were included if they underwent labral reconstruction and had preoperative and minimum 2-year PROs. Patients unwilling to participate, with Tönnis grade >1, or hip dysplasia were excluded. Patients in the CLR group were propensity-matched on the basis of age, sex, body mass index, and Tönnis grade to patients in the SLR group in a 1:1 ratio. The minimal clinically important difference (MCID) and the patient-acceptable symptomatic state (PASS) rates were calculated.

      Results

      Twenty-six hips (25 patients) with CLR were propensity-matched to 26 hips (26 patients) with SRL. The mean follow-up time 25.92 and 27.78 months for the CLR and SLR, respectively (P = .845). Groups reported comparable findings for sex (P = .773), age (P = .197), body mass index (P = .124), preoperative Tönnis grade (P = .124), lateral-center edge angle (P = .144), and alpha angle (P = .264), and comparable improvement for all PROs at minimum 2-year follow-up. Patient satisfaction was similar (P = .612). Rates of achievement for the MCID and PASS were comparable.

      Conclusion

      Following revision hip arthroscopy, patients who underwent CLR or SLR for complete and segmental irreparable labral tears, respectively, reported significant and comparable postoperative improvement for all PROs and rate of achievement for the MCID and PASS at a minimum 2-year follow-up.

      Level of Evidence

      III, retrospective comparative therapeutic trial.
      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

        • Zusmanovich M.
        • Haselman W.
        • Serrano B.
        • Banffy M.
        The incidence of hip arthroscopy in patients with femoroacetabular impingement syndrome and labral pathology increased by 85% between 2011 and 2018 in the United States.
        Arthroscopy. 2022; 38: 82-87
        • Makhni E.C.
        • Ramkumar P.N.
        • Cvetanovich G.
        • Nho S.J.
        Approach to the patient with failed hip arthroscopy for labral tears and femoroacetabular impingement.
        J Am Acad Orthop Surg. 2020; 28: 538-545
        • Shapira J.
        • Kyin C.
        • Go C.
        • et al.
        Indications and outcomes of secondary hip procedures after failed hip arthroscopy: A systematic review.
        Arthroscopy. 2020; 36: 1992-2007
        • Maldonado D.R.
        • Kyin C.
        • Rosinsky P.J.
        • et al.
        Minimum 5year outcomes for revision hip arthroscopy with a prospective subanalysis against a propensity-matched control primary group.
        Am J Sports Med. 2021; 49: 2090-2101
        • Browning R.B.
        • Clapp I.M.
        • Krivicich L.M.
        • Nwachukwu B.U.
        • Chahla J.
        • Nho S.J.
        Repeat revision hip arthroscopy outcomes match that of initial revision but not that of primary surgery for femoroacetabular impingement syndrome.
        Arthroscopy. 2021; 37: 3434-3441
        • Perets I.
        • Rybalko D.
        • Mu B.H.
        • 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: 3437-3445
        • Rahl M.D.
        • LaPorte C.
        • Steinl G.K.
        • O’Connor M.
        • Lynch T.S.
        • Menge T.J.
        Outcomes after arthroscopic hip labral reconstruction: A systematic review and meta-analysis.
        Am J Sports Med. 2020; 48: 1748-1755
        • Maldonado D.R.
        • Kyin C.
        • Chen S.L.
        • 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: 704-713
        • Trivedi N.N.
        • Sivasundaram L.
        • Su C.A.
        • et al.
        Indications and outcomes of arthroscopic labral reconstruction of the hip: A systematic review.
        Arthroscopy. 2019; 35: 2175-2186
        • Chandrasekaran S.
        • Darwish N.
        • Close M.R.
        • Lodhia P.
        • Suarez-Ahedo C.
        • Domb B.G.
        Arthroscopic reconstruction of segmental defects of the hip labrum: results in 22 patients with mean 2-year follow-up.
        Arthroscopy. 2017; 33: 1685-1693
        • Scanaliato J.P.
        • Chasteen J.
        • Polmear M.M.
        • Salfiti C.
        • Wolff A.B.
        Primary and revision circumferential labral reconstruction for femoroacetabular impingement in athletes: Return to sport and technique.
        Arthroscopy. 2020; 36: 2598-2610
        • Domb B.G.
        • Kyin C.
        • Rosinsky P.J.
        • 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: 2583-2597
        • Philippon M.J.
        • Arner J.W.
        • Crawford M.D.
        • Bolia I.K.
        • Briggs K.K.
        Acetabular labral reconstruction with iliotibial band autograft: Outcome and survivorship at a minimum 10-year follow-up.
        J Bone Joint Surg Am. 2020; 102: 1581-1587
      1. 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 2021;27:S0749-8063(21)00499-0.

        • Domb B.G.
        • Kyin C.
        • Go C.C.
        • et al.
        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.
        Am J Sports Med. 2021; 49: 1750-1758
        • Wolff A.B.
        • Grossman J.
        Management of the acetabular labrum.
        Clinics Sports Med. 2016; 35: 345-360
        • Aprato A.
        • Jayasekera N.
        • Villar R.N.
        Does the modified Harris Hip Score reflect patient satisfaction after hip arthroscopy?.
        Am J Sports Med. 2012; 40: 2557-2560
        • Christensen C.P.
        • Althausen P.L.
        • Mittleman M.A.
        • Lee J ann
        • McCarthy J.C.
        The nonarthritic hip score: Reliable and validated.
        Clin Orthop Relat Res. 2003; : 75-83
        • Martin R.L.
        • Philippon M.J.
        Evidence of validity for the hip outcome score in hip arthroscopy.
        Arthroscopy. 2007; 23: 822-826
        • Chandrasekaran S.
        • Gui C.
        • Walsh J.P.
        • Lodhia P.
        • Suarez-Ahedo C.
        • Domb B.G.
        Correlation between changes in visual analog scale and patient-reported outcome scores and patient satisfaction after hip arthroscopic surgery.
        Orthop J Sports Med. 2017; 5 (2325967117724772)
        • Griffin D.R.
        • Parsons N.
        • Mohtadi N.G.H.
        • Safran M.R.
        A short version of the International Hip Outcome Tool (iHOT-12) for use in routine clinical practice.
        Arthroscopy. 2012; 28: 611-618
        • Gala L.
        • Clohisy J.C.
        • Beaulé P.E.
        Hip dysplasia in the young adult.
        J Bone Joint Surg Am. 2016; 98: 63-73
        • Martin H.D.
        • Kelly B.T.
        • Leunig M.
        • et al.
        The pattern and technique in the clinical evaluation of the adult hip: The common physical examination tests of hip specialists.
        Arthroscopy. 2010; 26: 161-172
        • Clohisy J.C.
        • Carlisle J.C.
        • Beaulé P.E.
        • et al.
        A systematic approach to the plain radiographic evaluation of the young adult hip.
        J Bone Joint Surg Am. 2008; 90: 47-66
        • Chandrasekaran S.
        • Darwish N.
        • Gui C.
        • Lodhia P.
        • Suarez-Ahedo C.
        • Domb B.G.
        Outcomes of hip arthroscopy in patients with Tönnis grade-2 osteoarthritis at a mean 2-year follow-up: Evaluation using a matched-pair analysis with Tönnis grade-0 and grade-1 cohorts.
        J Bone Joint Surg Am. 2016; 98: 973-982
        • Ogata S.
        • Moriya H.
        • Tsuchiya K.
        • Akita T.
        • Kamegaya M.
        • Someya M.
        Acetabular cover in congenital dislocation of the hip.
        J Bone Joint Surg Br. 1990; 72: 190-196
        • Harris M.D.
        • Kapron A.L.
        • Peters C.L.
        • Anderson A.E.
        Correlations between the alpha angle and femoral head asphericity: Implications and recommendations for the diagnosis of cam femoroacetabular impingement.
        Eur J Radiol. 2014; 83: 788-796
        • Griffin D.R.
        • Dickenson E.J.
        • Wall P.D.H.
        • et al.
        Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): A multicentre randomised controlled trial.
        Lancet. 2018; 391: 2225-2235
        • Maldonado D.R.
        • Rosinsky P.J.
        • Shapira J.
        • Domb B.G.
        Stepwise safe access in hip arthroscopy in the supine position: Tips and pearls from A to Z.
        J Am Acad Orthop Surg. 2020; 28: 651-659
        • Perets I.
        • Hartigan D.E.
        • Chaharbakhshi E.O.
        • Walsh J.P.
        • Close M.R.
        • Domb B.G.
        Circumferential labral reconstruction using the knotless pull-through technique-surgical technique.
        Arthrosc Tech. 2017; 6: e695-e698
        • Maldonado D.R.
        • Chen J.W.
        • Walker-Santiago R.
        • et al.
        Forget the greater trochanter! Hip joint access with the 12 o’clock portal in hip arthroscopy.
        Arthrosc Tech. 2019; 8: e575-e584
        • Redmond J.M.
        • Cregar W.M.
        • Martin T.J.
        • Vemula S.P.
        • Gupta A.
        • Domb B.G.
        Arthroscopic labral reconstruction of the hip using semitendinosus allograft.
        Arthrosc Tech. 2015; 4: e323-e329
        • Suarez-Ahedo C.
        • Gui C.
        • Rabe S.M.
        • Chandrasekaran S.
        • Lodhia P.
        • Domb B.G.
        Acetabular chondral lesions in hip arthroscopy: Relationships between grade, topography, and demographics.
        Am J Sports Med. 2017; 45: 2501-2506
        • Bhatia S.
        • Nowak D.D.
        • Briggs K.K.
        • Patterson D.C.
        • Philippon M.J.
        Outerbridge grade IV cartilage lesions in the hip identified at arthroscopy.
        Arthroscopy. 2016; 32: 814-819
        • Seldes R.M.
        • Tan V.
        • Hunt J.
        • Katz M.
        • Winiarsky R.
        • Fitzgerald R.H.
        Anatomy, histologic features, and vascularity of the adult acetabular labrum.
        Clin Orthop Relat Res. 2001; : 232-240
        • Botser I.B.
        • Martin D.E.
        • Stout C.E.
        • Domb B.G.
        Tears of the ligamentum teres: Prevalence in hip arthroscopy using 2 classification systems.
        Am J Sports Med. 2011; 39: 117-125
        • Gray A.J.R.
        • Villar R.N.
        The ligamentum teres of the hip: An arthroscopic classification of its pathology.
        Arthroscopy. 1997; 13: 575-578
        • Mansor Y.
        • Perets I.
        • Close M.R.
        • Mu B.H.
        • Domb B.G.
        In search of the spherical femoroplasty: Cam overresection leads to inferior functional scores before and after revision hip arthroscopic surgery.
        Am J Sports Med. 2018; 46: 2061-2071
        • Ortiz-Declet V.
        • Mu B.
        • Chen A.W.
        • et al.
        The “bird’s eye” and “upper deck” views in hip arthroscopy: Powerful arthroscopic perspectives for acetabuloplasty.
        Arthrosc Tech. 2018; 7: e13-e16
        • Chandrasekaran S.
        • Darwish N.
        • Martin T.J.
        • Suarez-Ahedo C.
        • Lodhia P.
        • Domb B.G.
        Arthroscopic capsular plication and labral seal restoration in borderline hip dysplasia: 2-year clinical outcomes in 55 cases.
        Arthroscopy. 2017; 33: 1332-1340
        • Kalisvaart M.M.
        • Safran M.R.
        Microinstability of the hip-it does exist: Etiology, diagnosis and treatment.
        J Hip Preserv Surg. 2015; 2: 123-135
        • Maldonado D.R.
        • Laseter J.R.
        • Perets I.
        • et al.
        The effect of complete tearing of the ligamentum teres in patients undergoing primary hip arthroscopy for femoroacetabular impingement and labral tears: A match-controlled study.
        Arthroscopy. 2019; 35: 80-88
        • Chandrasekaran S.
        • Darwish N.
        • Mu B.H.
        • et al.
        Arthroscopic reconstruction of the irreparable acetabular labrum: A match-controlled Study.
        Arthroscopy. 2019; 35: 480-488
        • Maldonado D.R.
        • Lall A.C.
        • Laseter J.R.
        • et al.
        Primary hip arthroscopic surgery with labral reconstruction: Is there a difference between an autograft and allograft?.
        Orthop J Sports Med. 2019; 7 (2325967119833715)
      2. Rosenbaum PR, Armitage P, Colton T. Propensity score. In: Encyclopedia of Biostatistics. 2005;6:4267-4272.

        • Austin P.C.
        Some methods of propensity-score matching had superior performance to others: Results of an empirical investigation and Monte Carlo simulations.
        Biomet J. 2009; 51: 171-184
        • Glynn R.J.
        • Schneeweiss S.
        • Stürmer T.
        Indications for propensity scores and review of their use in pharmacoepidemiology.
        Basic Clin Pharmacol Toxicol. 2006; 98: 253-259
        • Norman G.R.
        • Sloan J.A.
        • Wyrwich K.W.
        Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation.
        Med Care. 2003; 41: 582-592
        • Kunze K.N.
        • Bart J.A.
        • Ahmad M.
        • Nho S.J.
        • Chahla J.
        Large heterogeneity among minimal clinically important differences for hip arthroscopy outcomes: A systematic review of reporting trends and quantification methods.
        Arthroscopy. 2021; 37: 1028-1037.e6
        • Jackson T.J.
        Editorial Commentary: Large heterogeneity of minimal clinically important difference utilization in hip arthroscopy studies: Where do we go from here?.
        Arthroscopy. 2021; 37: 1038-1039
        • Monahan P.
        • Jimenez A.
        • Owens J.
        • et al.
        Revision hip arthroscopy in high-level athletes: Minimum 2-year outcomes comparison to a propensity-matched primary hip arthroscopy control group.
        Am J Sports Med. 2021; 49: 3582-3591
      3. Maldonado DR, Kyin C, Shapira J, et al. Comparable minimum 2-year patient-reported outcome scores between circumferential and segmental labral reconstruction for the management of irreparable labral tear and femoroacetabular impingement syndrome in the primary setting: A propensity-matched study. Arthroscopy 2021;30:S0749-8063(21)00400-X.

        • Herickhoff P.K.
        • Safran M.R.
        Surgical decision making for acetabular labral tears: An international perspective.
        Orthop J Sports Med. 2018; 6 (2325967118797324)
        • Sardana V.
        • Philippon M.J.
        • de Sa D.
        • et al.
        Revision hip arthroscopy indications and outcomes: A systematic review.
        Arthroscopy. 2015; 31: 2047-2055
        • White B.J.
        Editorial Commentary: No longer a salvage procedure: Allograft labral reconstruction of the hip rivals the results of labral repair.
        Arthroscopy. 2020; 36: 2611-2613
        • White B.J.
        • Patterson J.
        • Herzog M.M.
        Revision arthroscopic acetabular labral treatment: Repair or reconstruct?.
        Arthroscopy. 2016; 32: 2513-2520
        • Bodendorfer B.M.
        • Alter T.D.
        • Wolff A.B.
        • 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: 2968-2976
        • Levy D.M.
        • Kuhns B.D.
        • Chahal J.
        • Philippon M.J.
        • Kelly B.T.
        • Nho S.J.
        Hip arthroscopy outcomes with respect to patient acceptable symptomatic state and minimal clinically important difference.
        Arthroscopy. 2016; 32: 1877-1886
        • Lubowitz J.H.
        • Brand J.C.
        • Rossi M.J.
        Our measure of medical research should be appreciable benefit to the patient.
        Arthroscopy. 2019; 35: 1943-1944