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The Hip Labrum Reconstruction: Indications and Outcomes—an Updated Systematic Review

  • Latifah Al Mana
  • Ryan P. Coughlin
  • Veeral Desai
  • Nicole Simunovic
  • Andrew Duong
  • Olufemi R. AyeniEmail author
Outcomes Research in Orthopedics (O Ayeni, Section Editor)
  • 23 Downloads
Part of the following topical collections:
  1. Topical Collection on Outcomes Research in Orthopedics

Abstract

Purpose of Review

To present an updated systematic review of the indications and outcomes of open and arthroscopic labral reconstruction. Due to the increasing popularity and recognition, the arthroscopic procedure has gained in recent years, the aim was to assess for changes in indications, graft selection, and improvement in outcomes within the last 5 years.

Recent Findings

A total of nine eligible studies (six case series, one cohort, and two retrospective comparative studies) with a total of 234 patients (265 hips), and an average 12/16 (non-comparative studies) and 20/24 (comparative studies) quality on the MINORS score were included in this review. All patients underwent labral reconstruction, whether as primary surgery or revision (76% vs 24% respectively). There were 244 hips assessed at final follow- up (92%) with a reported mean range of 12 and 61 months. There were more graft variabilities found in this study compared with the previous review (iliotibial band allograft, gracilis tendon autograft, indirect head of rectus femoris autograft, semitendinosus allograft, peroneus brevis allograft, labrum allograft, ligamentum capitus femoris). Surgical approaches differed (open 7.9% (previously 18.7%), arthroscopic 86% (previously 81. 3 %), arthroscopic assisted mini-open technique (AAMOT) (6%)). Overall, improvement was observed in the patient-reported outcomes and functional scores, with variability in their statistical significance. The failure rate or conversion to total hip arthroplasty (THA) decreased compared with the previous review (20% vs 9.5% [conversion to THA was 5.7% and revision surgery rate was 3. 8%]). Indications for labrum reconstruction remained similar (i.e., young, active patients with no or minimal arthritis (Tonnis 0–1), irreparable or ossified labrum, and hypotrophic < 2 mm or dysfunctional hypertrophic labrum > 8 mm).

Summary

According to recent evidence, hip labrum reconstruction is a new technique that showed short- and mid-term improvement in patient-reported outcomes and functional scores postoperatively. The primary indication for reconstruction remained similar over time. The failure rates and/or conversion to THA appear to have decreased over time. Long-term follow-up with higher quality studies was not available in the literature based on this review.

Level of evidence 2

Keywords

Hip labrum Reconstruction Hip joint Technique 

Notes

Compliance with Ethical Standards

Conflict of Interest

Latifah Al Mana, Ryan P. Coughlin, Veeral Desai, Nicole Simunovic, Andrew Duong.

Olufemi R. Ayeni is a section editor for Current Reviews in Musculoskeletal Medicine. Dr. Ayeni is on the speakers’ bureau for Conmed and Smith and Nephew.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Philippon MJ, Nepple JJ, Campbell KJ, Dornan GJ, Jansson KS, LaPrade RF, et al. The hip fluid seal—part I: the effect of an acetabular labral tear, repair, resection, and reconstruction on hip fluid pressurization. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):722–9.CrossRefGoogle Scholar
  2. 2.
    Nepple JJ, Philippon MJ, Campbell KJ, Dornan GJ, Jansson KS, LaPrade RF, et al. The hip fluid seal—part II: the effect of an acetabular labral tear, repair, resection, and reconstruction on hip stability to distraction. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):730–6.CrossRefGoogle Scholar
  3. 3.
    Alzaharani A, Bali K, Gudena R, Railton P, Ponjevic D, Matyas JR, et al. The innervation of the human acetabular labrum and hip joint: an anatomic study. BMC Musculoskelet Disord. 2014;15(15):41.CrossRefPubMedCentralGoogle Scholar
  4. 4.
    McCarthy JC, Noble PC, Schuck MR, Wright J, Lee J. The Otto E. Aufranc Award: the role of labral lesions to development of early degenerative hip disease. Clin Orthop Relat Res. 2001;393:25–37.CrossRefGoogle Scholar
  5. 5.
    Mook WR, Briggs KK, Philippon MJ. Evidence and approach for management of labral deficiency: the role for labral reconstruction. Sports Med Arthrosc. 2015;23:205–12.CrossRefGoogle Scholar
  6. 6.
    Kalhor MMD, Horowitz KMD, Beck MMD, Nazparvar BMD, Ganz RMD. Vascular supply to the acetabular labrum. J Bone Joint Surg. 2010;92(15):2570–5.CrossRefGoogle Scholar
  7. 7.
    Selders RM, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald RH. Anatomy, histological features and vascularity of the adult acetabular labrum. Clin Orthop Relate Res. 2001;382:232–40.CrossRefGoogle Scholar
  8. 8.
    Larson CM, Giveans MR. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement. Arthroscopy. 2009;25(4):369–76.CrossRefGoogle Scholar
  9. 9.
    Benjamin G, Domb MD, et al. Arthroscopic labral base repair in the hip: 5-year minimum clinical outcomes. Am J Sports Med. 2017;45(12):2882–90.CrossRefGoogle Scholar
  10. 10.
    Byrd JW, Jones KS. Primary repair of the acetabular labrum: outcomes with 2 years’ follow-up. Arthroscopy. 2014;30:588–92.CrossRefGoogle Scholar
  11. 11.
    Brian J, White MD, Andrea B, Stapleford MS, Tara K, Hawkes BS, et al. Allograft use in arthroscopic labral reconstruction of the hip with front-to-back fixation technique: minimum 2-year follow-up. Arthroscopy. 2016;32(1):26–32.CrossRefGoogle Scholar
  12. 12.
    Boykin RE, Patterson D, Briggs KK, Dee A, Philippon MJ. Results of arthroscopic labral reconstruction of the hip in elite athletes. Am J Sports Med. 2013;41(10):2296–301.CrossRefGoogle Scholar
  13. 13.
    Geyer MR, Philippon MJ, Fagrelius TS, Briggs KK. Acetabular labral reconstruction with an iliotibial band autograft: outcome and survivorship analysis at minimum 3-year follow-up. Am J Sports Med. 2013;41(8):1750–6.CrossRefGoogle Scholar
  14. 14.
    Matsuda DK, Burchette RJ. Arthroscopic hip labral reconstruction with a gracilis autograft versus labral refixation: 2-year minimum outcomes. Am J Sports Med. 2013;41(5):980–7.CrossRefGoogle Scholar
  15. 15.
    Sierra RJ, Trousdale RT. Labral reconstruction using the ligamentum teres capitis: report of a new technique. Clin Orthop Relat Res. 2009;467(3):753–9.CrossRefGoogle Scholar
  16. 16.
    Walker JA, Pagnotto M, Trousdale RT, Sierra RJ. Preliminary pain and function after labral reconstruction during femoroacetabular impingement surgery. Clin Orthop Relat Res. 2012;470(12):3414–20.CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. Syst Rev. 2015;4(1):1.CrossRefPubMedCentralGoogle Scholar
  18. 18.
    McGinn T, Wyer PC, Newman TB, Keitz S, Leipzig R, For GG. Evidence-based medicine teaching tips working group tips for learners of evidence-based medicine: 3 measures of observer variability (kappa statistic). CMAJ. 2004;171(11):1369–73.CrossRefPubMedCentralGoogle Scholar
  19. 19.
    Chandrasekaran S, Darwish N, Close MR, Lodhia P, Suarez-Ahedo C, Domb BG. Arthroscopic reconstruction of segmental defects of the hip labrum: results in 22 patients with mean 2-year follow-up. Arthroscopy. 2017;33(9):1685–93.CrossRefGoogle Scholar
  20. 20.
    Nance E, Hamula M, Bharam S. Staged arthroscopic labral reconstruction with allograft for labral deficiency in femoroacetabular impingement. 2013 ISHA Abstracts; 2013.Google Scholar
  21. 21.
    Rocha PC, Klingenstein G, Ganz R, Kelly BT, Leunig M. Circumferential reconstruction of severe acetabular labral damage using hamstring allograft: surgical technique and case series. Hip Int. 2013;23(9):42–53.CrossRefGoogle Scholar
  22. 22.
    • Rathia R, Mazekb J. Arthroscopic acetabular labral reconstruction with rectus femoris tendon autograft: our experiences and early results. J Orthop. 2018;15:783–6 Using indirect head of the rectus femoris tendon autograft is a new technique that shows improvement in pain and function post-operatively in short term follow up. with the advantage of utilizing same incision, avoiding donor site morbidity, and preserving graft blood supply. CrossRefGoogle Scholar
  23. 23.
    Moya E, Ribas M, Natera L, Cardenas C, Bellotti V, Astarita E. Reconstruction of nonrepairable acetabular labral tears with allografts: mid-term results. Hip Int. 2016;26(1):43–7.CrossRefGoogle Scholar
  24. 24.
    Domb BG, El Bitar YF, Stake CE, Trenga AP, Jackson TJ, Lindner D. Arthroscopic labral reconstruction is superior to segmental resection for irreparable labral tears in the hip a matched-pair controlled study with minimum 2-year follow-up. Am J Sports Med. 2014;42(1):122–30.CrossRefGoogle Scholar
  25. 25.
    • White BJ, Patterson J, Herzog MM. Bilateral hip arthroscopy: direct comparison of primary acetabular labral repair and primary acetabular labral reconstruction. Arthroscopy. 2018;34(2):433–40 A retrospective (self-control) comparison study between primary labral repair and reconstruction, mentioning results of sensitivity analysis that was restricted to hips that underwent surgery during the transition period from labral repair into reconstruction. CrossRefGoogle Scholar
  26. 26.
    Camenzind RS, Steurer-Dober I, Beck M. Outcome after labral reconstruction for treatment of femoroacetabular impingement. Conference: 73. Jahreskongress der SGOT 2013. 2013.Google Scholar
  27. 27.
    Ayeni OR, Alradwan H, de Sa D, Philippon MJ. The hip labrum reconstruction: indications and outcomes systematic review. Knee Surg Sports Traumatol Arthrosc. 2014;22:737–43.CrossRefGoogle Scholar
  28. 28.
    Domb BG, Gupta A, Stake CE, Hammarstedt JE, Redmond JM. Arthroscopic labral reconstruction of the hip using local capsular autograft. Arthrosc Tech. 2014;3:355–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Latifah Al Mana
    • 1
  • Ryan P. Coughlin
    • 1
  • Veeral Desai
    • 1
  • Nicole Simunovic
    • 1
  • Andrew Duong
    • 1
  • Olufemi R. Ayeni
    • 1
    Email author
  1. 1.Division of Orthopaedic Surgery, Department of SurgeryMcMaster UniversityHamiltonCanada

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