Arthroscopic Hip Labral Reconstruction in Young Adults tied to significant improvement and high patient satisfaction

Arthroscopic Hip Labral Reconstruction in Adolescents and Young Adults is associated with significant improvement and high patient satisfaction, according to  a study published in Journal of pediatric orthopaedics.

Labral repair is generally preferred when facing labral tears. When an irreparable labral tear in the context of femoroacetabular impingement syndrome is present, arthroscopic labral reconstruction has been proven to be a valid option for labral restoration. However, data on this procedure for the adolescent population is scarce.

The study was performed at the American Hip Institute Research Foundation. The purpose of the present study was to report minimum 2-year follow-up patient-reported outcome measures (PROMs) on adolescents and young adults following arthroscopic acetabular labral reconstruction.

Data were prospectively collected and retrospectively reviewed on adolescents and young adults who underwent hip arthroscopy between March 2009 and June 2018.

Patients were deemed eligible for analysis if they had received arthroscopic labral reconstruction in the setting of FAIS (femoro acetabular impingement syndrome) and irreparable labral tear and were under 22 years of age. Patients completed questionnaires containing PROMs preoperatively and postoperatively at 3 months, 12 months,

and annually thereafter. PROMs included the mHHS(modified Harris Hip Score), NAHS(Nonarthritic Hip Score), Hip Outcome Score-Sport Specific Subscale (HOSSSS), VAS(Visual Analog Scale) for pain, and patient satisfaction. The questionnaires were completed by patients either during clinic visits, via encrypted email, or over a phone interview.

Labral tears were repaired or reconstructed depending on the labrum's integrity, viability, and size. Labral reconstruction was performed if the labral tissue was determined to be irreparable. A labral tear was defined as irreparable if the labrum appeared to be mostly or completely calcified or labral tissue was found to be inadequate (nonviable) for labral repair.

Before surgery, all the labral treatment options were explained in detail, discussed with the patients, and part of the informed consent.

At the beginning of the study period, hamstring autograft was used for labral reconstructions; however, it was switched to hamstring allograft to limit donor site morbidity.

Twenty-three hips (22 patients) that underwent labral reconstruction were included. Ten hips (10 patients) underwent primary labral reconstruction, and 13 hips (12 patients) underwent revision reconstruction.

• The mean age was 19.3 years and 56.5% of patients were males.

• All patients improved significantly at minimum 2 years for all PROMs (P< 0.001) with high satisfaction.

• Patients in both groups demonstrated improvement for all PROMs, patient satisfaction, and a rate of achieving the minimal clinically important difference.

• Of the 23 hips included in the study, 10 hips (10 patients) underwent a primary arthroscopic labral reconstruction. High MCID (Minimal Clinically Important change score)achievement rates were for the mHHS (70%), NAHS (60%), HOS-SSS (60%), and VAS for pain (80%).

• No patients in the primary reconstruction group underwent a secondary procedure within the 2-year postoperative timepoint.

• Thirteen hips (12 patients) underwent a revision athroscopic labral reconstruction. MCID achievement rates for mHHS, NAHS, HOS-SSS, and VAS were 76.9%, 61.5%, 53.8%, and 61.5% for the revision reconstruction group. Three patients in the revision reconstruction group underwent a tertiary hip arthroscopy within the 2-year postoperative timepoint at an average of 14.6 months.

They concluded - Arthroscopic labral reconstruction in adolescents and young adults demonstrated significant improvement and high patient satisfaction at minimum 2-year follow-up in the setting of irreparable labral tear. Favorable outcomes, high patient satisfaction, and high achievement rate for the minimal clinically important difference were obtained following labral reconstruction in this population the primary and revision scenarios.

Further reading :

Minimum 2-Year Outcomes Following Arthroscopic Hip Labral Reconstruction in Adolescents and Young Adults. David R. Maldonado, MD et al. J Pediatr Orthop Volume 42, Number 2, February 2022.

DOI: 10.1097/BPO.0000000000001984