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

Introduction:Revision hip arthroscopy is increasingly common and often addresses the acetabular labrum pathology. There is a lack of consensus on indications or outcomes of revision labral repair versus reconstruction. We aim to report clinical outcomes of labral reconstruction during revision hip arthroscopy at minimum two-year follow-up compared to a pair-matched revision labral repair control group, and to suggest a decision-making algorithm for labral treatment in revision hip arthroscopy.

Methods:Patients who underwent revision hip arthroscopy with labral reconstruction were matched 1:2 with patients who underwent revision arthroscopic labral repair. Patients were matched based on age, sex and BMI. Patient reported outcomes were collected preoperatively and at minimum two-year follow-up. At latest follow-up, patient satisfaction on a 0-10 scale and the abbreviated International Hip Outcome Tool (iHOT-12) were collected.

Results:A total of 15 revision labral reconstructions were pair-matched to 30 revision labral repairs. The reconstructions had fewer isolated Seldes type I detachments (p= 0.008), and lower postoperative LCEA, but there were otherwise no significant differences in demographics, radiographics, intraoperative findings, or procedures. Both groups demonstrated significant improvements in all outcomes and visual analog scale (VAS) at minimum two-year follow-up. The revision repairs trended toward higher preoperative scores and had higher follow-up modified Harris Hip Score (mHHS) (p= 0.043) and iHOT-12 (p= 0.023) scores. The magnitudes of improvement from preoperative to follow-up between the two groups were comparable.

Conclusion: Labral reconstruction safely and effectively treats irreparable labra in revision hip arthroscopy. However, labral repair is another treatment option for reparable labra, and this patient population may have more favorable revision hip arthroscopy outcomes. A proposed algorithm may assist in surgical decision-making to achieve optimal outcomes based on the condition and history of each patient’s acetabular labrum.