Multicenter Outcomes After Revision Hip Arthroscopy: Comparative Analysis of 2-Year Outcomes After Labral Repair Versus Labral Reconstruction

Background: There is a paucity of literature evaluating patient outcomes in patients undergoing revision labral repair and labral reconstruction. Purpose: To compare outcomes in patients undergoing revision hip arthroscopy for treatment of labral tears by labral repair or labral reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of a prospectively maintained multicenter database of patients undergoing hip arthroscopy was performed. An a priori power analysis determined that a total of 62 patients were required. Patients undergoing revision hip arthroscopy for labral tears with completed 2-year outcome scores were included. Patients undergoing primary hip arthroscopy, labral debridement, concomitant gluteal repair, and patients with hip dysplasia (lateral center-edge angle <20°) were excluded. Patients were grouped into revision labral repair and labral reconstruction groups. Patient demographics and patient-reported outcomes (PROs) including Hip Outcome Score – Activities of Daily Living, Hip Outcome Score – Sport Subscale, modified Harris Hip Score, international Hip Outcome Tool-12, visual analog scale for pain and satisfaction, and achievement of minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) were analyzed. Results: A total of 40 patients underwent revision labral repair and 55 patients underwent labral reconstruction. Patients undergoing revision labral repair were younger (mean age, 30.0 ± 10.7 years vs 34.4 ± 9.7 years; P = .048), had lower rates of labral degeneration (25.0% vs 62.7%; P = .004), and had lower rates of severe complexity of tears (21.1% vs 66.0%; P = .003). However, the labral repair group had higher rates of articular cartilage damage (62.5% vs 33.3%; P = .009). There were no differences in any preoperative or 2-year postoperative PROs. Furthermore, no differences were seen in achievement of MCID or PASS in any PRO. Conclusion: In this multicenter study on revision hip arthroscopy, patients undergoing revision labral repair were younger and had better labral characteristics but greater cartilage damage compared with patients undergoing labral reconstructions. Despite these differences, patients who underwent labral repair reported similar outcomes to those undergoing labral reconstruction.

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Return to Play After Hip Arthroscopy Among Tennis Players: Outcomes with Minimum Five-Year Follow-up

10.21203/rs.2.14819/v4 ◽

2020 ◽

Author(s):

David R. Maldonado ◽

Mitchell J. Yelton ◽

Philip J. Rosinsky ◽

Jacob Shapira ◽

Mitchell Meghpara ◽

...

Keyword(s):

Hip Arthroscopy ◽

Cartilage Damage ◽

Arthroscopic Surgery ◽

Return To Sport ◽

Return To Play ◽

Harris Hip Score ◽

Level Of Evidence ◽

Tennis Players ◽

Patient Reported

Abstract Background: Playing tennis is associated with various movements that can lead to labral injuries and may require arthroscopic surgery. While hip arthroscopies have demonstrated good outcomes in athletes, there is limited literature reporting Patient Reported Outcomes (PROs) and return to play in competitive or recreational tennis players after hip arthroscopic surgery. Therefore, the purpose of the present study was to (1) report minimum five-year PROs and return to sport in tennis players who underwent hip arthroscopic surgery and (2) compare outcomes between recreational and competitive tennis players.Methods: Data for patients who underwent hip arthroscopy surgery in the setting of femoroacetabular impingement (FAI) and labral tears between March 2009 and January 2014 and who played tennis at any level within one-year of surgery were retrospectively reviewed. Patients with preoperative and minimum five-year postoperative scores for the following PROs were included: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Patients with preoperative Tönnis osteoarthritis Grade >1, Workers’ Compensation claims, age > 60 years old, or previous ipsilateral hip surgeries or conditions were excluded. Patient Acceptable Symptomatic State (PASS) and Minimal Clinically Important Difference (MCID) for mHHS and HOS-SSS were calculated. Results: Of 28 patients, 31 hips met all inclusion and exclusion criteria of which 28 (90.3%) had minimum 5-year follow-up (mean: 72.8 ± 13.9 months). There were 3 professional, 3 collegiate, 2 high school, 2 organized amateur, and 18 recreational level tennis players. All PROs significantly improved at latest follow-up: mHHS from 67.0 to 86.7 (P < 0.001), NAHS from 65.9 to 87.2 (P < 0.001), HOS-SSS from 50.0 to 77.9 (P = 0.009), and VAS from 5.4 to 1.8 (P < 0.001). There was a 75.0% return to sport rate. Additionally, 66.7% of patients achieved MCID and 83.3% achieved PASS for mHHS, and 63.6% achieved MCID and 58.3% achieved PASS for HOS-SSS.Conclusion: Regardless of the level of participation, tennis players who underwent hip arthroscopic surgery reported statistically significant PRO improvements. A favorable rate of return to sport was also achieved by players with a continued interest in playing. The severity of cartilage damage was shown to not influence rate of returned to sport nor PROs in this population. The data here may be useful in counseling tennis players of various levels who are considering arthroscopic treatment of a hip injury. Level of Evidence: IV

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Is Microfracture Necessary? Acetabular Chondrolabral Debridement/Abrasion Demonstrates Similar Outcomes and Survival to Microfracture in Hip Arthroscopy: A Multicenter Analysis

The American Journal of Sports Medicine ◽

10.1177/0363546519845346 ◽

2019 ◽

Vol 47 (7) ◽

pp. 1670-1678 ◽

Cited By ~ 5

Author(s):

Mario Hevesi ◽

Christopher Bernard ◽

David E. Hartigan ◽

Bruce A. Levy ◽

Benjamin G. Domb ◽

...

Keyword(s):

Hip Arthroscopy ◽

Labral Repair ◽

Harris Hip Score ◽

Treatment Technique ◽

High Grade ◽

Acetabular Cartilage ◽

Level Of Evidence ◽

Cartilage Lesions ◽

Patient Reported ◽

Grade 3

Background: Hip arthroscopy is becoming more advanced and commonly performed. However, significant controversy exists regarding whether high-grade acetabular cartilage lesions should be treated with debridement/abrasion or microfracture. In addition, patients treated with microfracture are subject to extended protected weightbearing rehabilitation to mitigate risk of subchondral plate fracture and to protect fibrocartilage tissue formation. Purpose: To determine the midterm patient-reported outcomes and failure rate of patients with grade 3 and 4 acetabular labrum articular disruption (ALAD) lesions managed with debridement/abrasion or microfracture. Study Design: Cohort study; Level of evidence, 3. Methods: Primary arthroscopic labral repair cases at 2 centers from November 2008 to April 2016 were reviewed for patients aged <55 years with unipolar ALAD grade 3 and 4 chondrolabral acetabular delamination. Patients undergoing microfracture and debridement/abrasion were compared using the visual analog pain scale (VAS), modified Harris Hip Score (mHHS), and Hip Outcome Score–Sports-Specific Subscale (HOS-SSS) to determine predictors of outcomes and failure. Results: A total of 113 hips in 110 patients (66 males, 44 females; mean age, 34.5 ± 1.1 years) undergoing debridement/abrasion (n = 82) or microfracture (n = 31) were followed for a mean of 4.9 years (range, 2.0-8.5 years). Lesion size was not statistically different between the debridement/abrasion (1.3 ± 1.0 cm2) and microfracture cohorts (1.4 ± 1.0 cm2) ( P = .47). Patients undergoing debridement/abrasion achieved 3.6-point mean improvements in VAS ( P < .01), 21.2-point improvements in mHHS ( P < .01), and 25.4-point improvements in HOS-SSS ( P < .01), which were not significantly different from those observed in microfracture patients ( P≥ .20). The 5-year rate of survival free of revision surgery was 84.0% in the debridement/abrasion group and 85.6% in the microfracture group ( P = .78). The cartilage treatment technique was found not to be predictive of revision risk during both univariate (hazard ratio [HR], 1.01; P = .98) and multivariate (HR, 0.93; P = .90) analysis accounting for patient age, lesion grade, and acetabular coverage. Conclusion: Patients undergoing debridement/abrasion of high-grade unipolar acetabular cartilage lesions demonstrate similar outcome scores and revision rates compared with those of patients undergoing microfracture. These outcomes support the consideration of preferential debridement/abrasion at the discretion of the treating surgeon to optimize recovery while maintaining established positive outcomes after hip arthroscopy.

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Prospective Randomized Comparison of Capsule Management Techniques During Hip Arthroscopy

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00200 ◽

2019 ◽

Vol 7 (3_suppl2) ◽

pp. 2325967119S0020 ◽

Cited By ~ 1

Author(s):

Kostas John Economopoulos ◽

Christopher Y. Kweon

Keyword(s):

Activities Of Daily Living ◽

Hip Arthroscopy ◽

Daily Living ◽

Alpha Angle ◽

Labral Repair ◽

Harris Hip Score ◽

Outcome Score ◽

Patient Reported ◽

Management Techniques

Objectives: Capsular management during hip arthroscopy remains controversial. Studies evaluating this topic consist mostly of retrospective comparative reviews of prospectively gathered data on a large series of patients. The purpose of this study was to perform a prospective randomized trial to comparatively assess three commonly performed capsule management techniques. It was hypothesized that capsular closure during hip arthroscopy would result in superior outcomes compared to non-closing capsulotomy management techniques. Methods: Patients undergoing hip arthroscopy were randomly assigned into three groups at the time of surgery: 1) T-capsulotomy without closure (TC), 2) interportal capsulotomy without closure (IC), and 3) interportal capsulotomy with closure (CC). Inclusion criteria included patients with labral tear on advanced imaging, cam lesion with alpha angle greater than 55 degrees, center-edge angle less than 40 degrees, and Tönnis grade 0 or 1. Patients younger than 18, older than 55, or those with signs of clinical hip hypermobility or radiographic dysplasia were excluded from the trial. All patients underwent labral repair and femoral osteoplasty. Modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sports Specific Subscale (HOS-SSS) was obtained preoperatively and at intervals up to 2 years. Other outcomes obtained included need for future hip surgery. Results: 50 patients were randomly allocated into each group. Patient demographics, preoperative patient-reported outcomes (PROs) and radiographic measures of impingement were similar between all three groups. Revision hip arthroscopy was performed in 5 TC patients, 2 IC patients and 0 CC patients (p=0.17). Conversion to hip arthroplasty occurred in 4 patients in the TC group, none in the IC or CC groups (p=0.48). All three groups showed increased PRO scores postoperatively compared to preoperative values (p<0.01). The CC group when compared to the TC group demonstrated superior mHHS (86.2 vs 76), HOS-ADL (85.6 vs 76.8), and HOS-SSS (74.4 vs 65.3) at the final 2 year follow up (p<0.001). The IC group demonstrated more modest improvements in outcomes compared to the TC group. The CC group showed greater improvement in HOS-SSS compared to the IC group at early follow up (65.6 vs 55.1, p>.001) that was not maintained at 2 years (74.4 vs 71.4, p=.28). Conclusion: Patients undergoing capsular closure during hip arthroscopy showed improved patient-reported and surgical outcomes compared to those with unrepaired T-capsulotomy or interportal capsulotomy. These results suggest that repair after capsulotomy may be a favorable arthroscopic capsule management technique, especially in respect to optimizing postoperative activities of daily living.

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Prospective Randomized Comparison of Capsular Management Techniques During Hip Arthroscopy

The American Journal of Sports Medicine ◽

10.1177/0363546519894301 ◽

2019 ◽

Vol 48 (2) ◽

pp. 395-402 ◽

Cited By ~ 2

Author(s):

Kostas J. Economopoulos ◽

Anikar Chhabra ◽

Christopher Kweon

Keyword(s):

Hip Arthroscopy ◽

Patient Reported Outcomes ◽

Labral Repair ◽

Harris Hip Score ◽

Management Technique ◽

Outcome Score ◽

Radiographic Measurements ◽

Patient Reported ◽

Management Techniques

Background: Capsular management during hip arthroscopy remains controversial. Studies evaluating this topic consist mostly of retrospective comparative reviews of prospectively gathered data on a large series of patients. Purpose/Hypothesis: The purpose was to perform a prospective randomized trial to comparatively assess 3 commonly performed capsular management techniques. It was hypothesized that capsular closure during hip arthroscopy would result in superior outcomes when compared with unclosed capsulotomy management techniques. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Patients (N = 150) who had hip arthroscopy with labral repairs and femoral osteoplasties performed by the senior author were randomly assigned into 3 groups at the time of their surgery: T-capsulotomy without closure (TC), interportal capsulotomy without closure (IC), and interportal capsulotomy with closure (CC). All patients underwent labral repair and femoral osteoplasty. Patient-reported outcomes were obtained preoperatively and at 3, 6, 12, and 24 months postoperatively. Other outcomes obtained included the need for future hip surgery. Results: Patient demographics, preoperative patient-reported outcomes, and radiographic measurements were similar among all 3 groups. Revision hip arthroscopy was performed in 5 TC cases, 2 IC cases, and 1 CC case ( P = .17). Conversion to hip arthroplasty occurred in 4 patients in the TC group and none in the IC and CC groups ( P = .02). The CC group showed higher modified Harris Hip Score (mHHS) and Hip Outcome Score–Activities of Daily Living (HOS-ADL) at the 2-year follow-up when compared with the IC group ( P = .003 and P < .001, respectively). When compared with the TC group, the CC group demonstrated superior mHHS (86.2 vs 76), HOS-ADL (85.6 vs 76.8), and HOS-SSS (Hip Outcome Score–Sports-Specific Subscale; 74.4 vs 65.3) at the final 2-year follow-up ( P < .001). At the 2-year follow-up, the IC group had a higher mHHS (81.7 vs 76), HOS-ADL (82 vs 76.8), and HOS-SSS (71.4 vs 65.3; P > .001) as compared with the TC group. Conclusion: Patients undergoing complete capsular closure during hip arthroscopy showed improved patient-reported and surgical outcomes when compared with those with unrepaired T-capsulotomy or interportal capsulotomy. These results suggest that repair after capsulotomy may be a favorable arthroscopic capsular management technique.

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Minimum 5-Year Outcomes of Arthroscopic Hip Labral Reconstruction with Nested Matched-Pair Benchmarking Against a Labral Repair Control Group

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00433 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0043

Author(s):

Benjamin G. Domb ◽

Muriel R. Battaglia ◽

Itay Perets ◽

Ajay C. Lall ◽

Austin Chen ◽

...

Keyword(s):

Patient Satisfaction ◽

Hip Arthroscopy ◽

Labral Repair ◽

Matched Pair ◽

Harris Hip Score ◽

Control Group ◽

Labral Tears ◽

Point Increase ◽

Patient Reported

Objectives: Labral reconstruction has demonstrated short-term benefit for the treatment of irreparable labral tears. Nonetheless, there is a scarcity of evidence for mid-term outcomes of this treatment. The purpose of our study was to report 5-year outcomes in patients who underwent segmental labral reconstruction. In addition, we compared 5-year outcomes of patients who underwent primary segmental labral reconstruction (PLRECON) with a matched-pair control group that underwent primary labral repair (PLREPAIR). We hypothesized that arthroscopic segmental reconstruction in the setting of irreparable labral tears would show improvement in patient-reported outcomes (PROs) and high patient satisfaction at minimum 5-year follow-up. Secondly, PLRECON would experience similar improvement in PROs at minimum 5-year follow-up when compared to a matched-pair PLREPAIR control group. Methods: Data from February 2008 to April 2013 was retrospectively reviewed. Patients were included if they underwent hip arthroscopy for segmental labral reconstruction in the setting of irreparable labral tear and femoro-acetabular impingement (FAI), with minimum 5-year follow-up for modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and Visual Analogue Scale (VAS) for pain. Exclusion criteria were Tönnis osteoarthritis grade >1, prior hip conditions, or Workers’ Compensation claims. PLRECON were matched in a 1:3 ratio to a PLREPAIR group based on age ±5 years, gender, and body mass index (BMI) ±5 kg/m2. Results: Twenty-eight patients were eligible for the study, of which 23 (82.14%) had minimum 5-year follow-up. We found significant improvement from preoperative to latest follow-up in all outcome measures recorded: 17.8-point increase in mHHS (P=0.002), 22-point increase in NAHS (P<0.001), 25.4-point increase in HOS-SSS (P=0.003), and a 2.9-point decrease in VAS pain ratings (P<0.001). Average patient satisfaction was 7.1 out of 10. In the nested matched-pair analysis, 17 PLRECON were matched to a control group of 51 PLREPAIR patients. PLRECON demonstrated comparable survivorship and comparable improvements in all PROs with the exception of patient satisfaction. Conclusion: Hip arthroscopy with segmental labral reconstruction resulted in significant improvement in PROs at minimum 5-year follow-up. PLRECON reached comparable functional outcomes when compared to a benchmark PLREPAIR control group, but demonstrated lower patient satisfaction at latest follow-up. [Figure: see text]

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Treatment of Full-Thickness Acetabular Chondral Flaps During Hip Arthroscopy: Bone Marrow Aspirate Concentrate Versus Microfracture

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211059170 ◽

2021 ◽

Vol 9 (12) ◽

pp. 232596712110591

Author(s):

Michael P. Kucharik ◽

Paul F. Abraham ◽

Mark R. Nazal ◽

Nathan H. Varady ◽

Christopher T. Eberlin ◽

...

Keyword(s):

Bone Marrow ◽

Hip Arthroscopy ◽

Bone Marrow Aspirate ◽

Labral Repair ◽

Harris Hip Score ◽

Full Thickness ◽

Bone Marrow Aspirate Concentrate ◽

Outcome Score ◽

Patient Reported

Background: The optimal treatment strategy for patients with full-thickness chondral flaps undergoing hip arthroscopy is controversial. Purpose: To compare functional outcomes of patients who underwent bone marrow aspirate concentrate (BMAC) application with those of patients who underwent microfracture. Study Design: Cohort study; Level of evidence, 3. Methods: This was a retrospective case series of prospectively collected data on patients who underwent arthroscopic acetabular labral repair by 1 surgeon between June 2014 and April 2020. The inclusion criteria for this study were age ≥18 years, preoperative radiographs of the pelvis, arthroscopic acetabular labral repair, exposed subchondral bone with overlying chondral flap seen at the time of hip arthroscopy, microfracture or BMAC to address this lesion, and completed patient-reported outcome measures (PROMs) (International Hip Outcome Tool–33 [iHOT-33], Hip Outcome Score–Activities of Daily Living [HOS-ADL], Hip Outcome Score–Sports Subscale [HOS-Sport], modified Harris Hip Score [mHHS], and visual analog scale [VAS] for pain) at enrollment and 12-month follow-up. Clinical outcomes were assessed using PROM scores. Results: A total of 81 hips with full-thickness chondral flaps were included in this study: 50 treated with BMAC and 31 treated with microfracture. There were no significant differences between groups in age, sex, body mass index, tear size, radiographic osteoarthritis, or radiographic femoroacetabular impingement. In the BMAC cohort, all PROM scores improved significantly from preoperatively to follow-up: 41.7 to 75.6 for iHOT-33, 67.6 to 91.0 for HOS-ADL, 41.5 to 72.3 for HOS-Sport, 59.4 to 87.2 for mHHS, and 6.2 to 2.2 for VAS pain ( P < .001 for all). In the microfracture cohort, the score improvements were 48.0 to 65.1 for iHOT-33 ( P = .001), 80.5 to 83.3 for HOS-ADL ( P = .275), 59.2 to 62.4 for HOS-Sport ( P = .568), 70.4 to 78.3 for mHHS ( P = .028), and 4.9 to 3.6 for VAS pain ( P = .036). Regarding clinically meaningful outcomes, 77.6% of the BMAC group and 50.0% of the microfracture group met the minimal clinically important difference for iHOT-33 at the 12-month follow-up ( P = .013). Conclusion: Patients with full-thickness chondral flaps at the time of hip arthroscopy experienced greater improvements in functional outcome scores at the 12-month follow-up when treated with BMAC as opposed to microfracture.

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Arthroscopic Labral Treatment in Adolescents: Clinical Outcomes With Minimum 5-Year Follow-up

The American Journal of Sports Medicine ◽

10.1177/0363546519825627 ◽

2019 ◽

Vol 47 (4) ◽

pp. 870-875 ◽

Cited By ~ 3

Author(s):

Jody M. Litrenta ◽

Brian H. Mu ◽

Austin W. Chen ◽

Itay Perets ◽

Victor Ortiz-Declet ◽

...

Keyword(s):

Clinical Outcomes ◽

Outcome Measures ◽

Hip Arthroscopy ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Labral Repair ◽

Harris Hip Score ◽

Labral Tears ◽

Patient Reported

Background: The success of hip arthroscopy has led to increased application in younger populations. However, hip arthroscopy remains a challenging procedure, and its safety and efficacy in the adolescent population have been controversial. Most existing literature on outcomes in such patients contains only short-term follow-up, and a paucity of evidence is available regarding long-term outcomes in adolescents. Purpose: To report on clinical outcomes at a minimum 5-year follow-up in patients younger than 18 years who underwent arthroscopic treatment of labral tears. Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected and retrospectively reviewed on all patients younger than 18 years who underwent hip arthroscopy in a tertiary hip preservation setting at a single institution. Patients were excluded if they had previous ipsilateral hip conditions or surgery. All patients underwent either labral repair or debridement for treatment of a labral tear. Patient-reported outcome measures were recorded at 3 months and at 1, 2, or a minimum of 5 years. These included the modified Harris Hip Score (mHHS), Nonarthritic Hip Score, Hip Outcome Score–Sports Specific Subscale (HOS-SSS), visual analog scale, and patient satisfaction. Additionally, the abbreviated International Hip Outcome Tool and Short Form Health Survey were collected at latest follow-up. Results: The study included 44 hips in 32 patients that underwent arthroscopic labral repair (86.4%) or labral debridement (13.6%) between April 2008 and April 2011, with latest follow-up at a mean of 69.2 months (range, 60.0-89.9 months) postoperatively. The average age at surgery was 16.3 years (range, 14.2-17.9 years), and 39 hips from female patients. Statistically significant improvements were seen in all patient-reported outcome measures from preoperative to minimum 5-year follow-up. Improvements were noted at 1-year follow-up and maintained at minimum 5-year follow-up. At the latest follow-up, the Patient Acceptable Symptomatic State was achieved in 95.5% of patients for the mHHS and 72.7% for the HOS-SSS. Two patients subsequently underwent secondary arthroscopy on the ipsilateral hip; however, the survivorship of all hips was 100%. Conclusion: Hip arthroscopy for the treatment of labral tears in adolescents remains a technically challenging procedure that should be approached with appropriate caution. The results of the present study on a population treated in a specialized hip preservation center demonstrate that hip arthroscopy is a safe procedure with stable improvement in patient-reported outcome measures at 5 years.

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Are Results of Arthroscopic Labral Repair Durable in Dysplasia at Midterm Follow-up? A 2-Center Matched Cohort Analysis

The American Journal of Sports Medicine ◽

10.1177/0363546518767399 ◽

2018 ◽

Vol 46 (7) ◽

pp. 1674-1684 ◽

Cited By ~ 11

Author(s):

Mario Hevesi ◽

David E. Hartigan ◽

Isabella T. Wu ◽

Bruce A. Levy ◽

Benjamin G. Domb ◽

...

Keyword(s):

Cohort Analysis ◽

Labral Repair ◽

Harris Hip Score ◽

Control Group ◽

Level Of Evidence ◽

Capsular Repair ◽

Center Edge ◽

Patient Reported ◽

Tönnis Grade

Background: Studies assessing dysplasia’s effect on hip arthroscopy are often limited to the short term and unable to account for demographic factors that may vary between dysplastic and nondysplastic populations. Purpose: To determine the midterm failure rate and patient-reported outcomes of arthroscopic labral repair in the setting of dysplasia and make subsequent failure and outcome comparisons with a rigorously matched nondysplastic control group. Study Design: Cohort study; Level of evidence, 3. Methods: Primary arthroscopic labral repair cases at 2 centers from 2008 to 2011 were reviewed. Patients with lateral center edge angle (LCEA) <25° were matched to nondysplastic controls by age, sex, laterality, body mass index (BMI), Tönnis grade, and capsular repair per a 1:2 matching algorithm. Groups were compared with a visual analog scale (VAS) for pain, modified Harris Hip Score (mHHS), and Hip Outcome Score–Sports Specific Subscale (HOS-SSS) to determine predictors of outcome and failure. Results: Forty-eight patients with dysplasia (mean LCEA, 21.6°; range, 13.0°-24.9°; n = 25 with capsular repair) were matched to 96 controls (mean LCEA, 32.1°; range, 25°-52°; n = 50 with capsular repair) and followed for a mean of 5.7 years (range, 5.0-7.7 years). Patients achieved mean VAS improvements of 3.3 points, mHHS of 19.5, and HOS-SSS of 29.0 points ( P < .01) with no significant differences between the dysplasia and control populations ( P > .05). Five-year failure-free survival was 83.3% for patients with dysplasia and 78.1% for controls ( P = .53). No survival or outcomes difference was observed between patients with dysplasia who did or did not have capsular repair ( P ≥ .45) or when comparing LCEA <20° and LCEA 20° to 25° ( P ≥ .60). BMI ≤30 was associated with increased revision surgery risk ( P < .01). Age >35 years ( P < .05) and Tönnis grade 0 radiographs ( P < .01) predicted failure to reach minimal clinically important differences. Conclusion: With careful selection and modern techniques, patients with dysplasia can benefit significantly and durably from arthroscopic labral repair. The dysplastic cohort had outcomes and failure rates similar to those of rigorously matched controls at midterm follow-up. Subanalyses comparing LCEA <20° and LCEA 20° to 25° are presented for completeness; however, this study was not designed to detect differences in dysplastic subpopulations. BMI ≤30 was associated with increased revision risk. Age >35 years and Tönnis grade 0 radiographs predicted failure to achieve minimal clinically important differences.

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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

The American Journal of Sports Medicine ◽

10.1177/03635465211032593 ◽

2021 ◽

pp. 036354652110325

Author(s):

Andrew E. Jimenez ◽

Peter F. Monahan ◽

Jade S. Owens ◽

David R. Maldonado ◽

Benjamin R. Saks ◽

...

Keyword(s):

Return To Sport ◽

Labral Repair ◽

Harris Hip Score ◽

Control Group ◽

Return To Sports ◽

Level Of Evidence ◽

Labral Tears ◽

Patient Reported ◽

High Level

Background: Labral reconstruction has shown promise for the treatment of irreparable labral tears in high-level athletes. The literature is scarce regarding outcomes and timing of return to sports (RTS) in these patients. Purpose: (1) To report minimum 2-year patient-reported outcome (PRO) scores and RTS characteristics for high-level athletes undergoing primary labral reconstruction for irreparable labral tears and (2) to compare clinical results with a matched control group of athletes undergoing labral repair. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed for high school, college, and professional athletes who underwent a primary arthroscopic labral reconstruction between January 2010 and June 2018. Minimum 2-year PROs were compared for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and Hip Outcome Score–Sport Specific Subscale (HOS-SSS), as well as the visual analog scale (VAS) pain score, patient satisfaction, and RTS. The percentages of patients achieving the Patient Acceptable Symptom State (PASS) and minimal clinically important difference (MCID) for the mHHS (PASS, >74 points; MCID, >8 points) and HOS-SSS (PASS, >75 points; MCID, >6 points) were also recorded. These patients were propensity score matched in a 1:3 ratio to other high-level athletes undergoing labral repair. Results: A total of 17 high-level athletes with primary arthroscopic labral reconstruction were included with a median follow-up time of 37.1 months (95% CI, 37.2-60.3 months). They demonstrated significant improvement from preoperatively to the latest follow-up for mHHS, NAHS, HOS-SSS, and VAS for pain ( P < .05). Further, patients achieved PASS/MCID for mHHS at high rates (PASS, 84.2%; MCID, 68.4%). Athletes were able to return to sport-specific training at a median of 3.33 months (95% CI, 3.07-4.71 months) and RTS at a median of 6.2 months (95% CI, 5.08-11.98 months). Fourteen (82.4%) of reconstructions and 29 (82.8%) of repairs either returned to sport or decided not to do so for reasons unrelated to the hip. PROs, RTS rate, and PASS/MCID rates were similar between the labral reconstruction group and a control labral repair group ( P > .05). Conclusion: Primary arthroscopic labral reconstruction for irreparable labral tears was associated with significant improvement in PROs and high rates of RTS in high-level athletes. These results were comparable with those of a control group of athletes undergoing labral repair.

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