Summary

This study of 87 hips that underwent labral repair with all-arthroscopic capsular autograft labral reconstruction found excellent outcomes that exceeded the minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) thresholds in majority of patients at an average of 64.0±7.2 months follow-up.

Abstract

Introduction

Acetabular labral tears that are uncomplicated can be treated with labral repair techniques. However, tears that are hypoplastic or complicated require further reconstruction including the addition of grafted tissue to areas with severe labral damage. Previous studies have found the addition of allograft tissue for acetabular labral reconstruction improves patient reported outcome measures (PROMs). However, the use of allograft tissue requires debridement and damage to the chondrolabral junction. Arthroscopic capsular labral reconstruction in the hip by use of capsular autograft is a technique without donor site morbidity and disruption of the chondrolabral junction. Since it is a novel technique, there is limited data reporting its long-term outcomes. Therefore, the objective of this study is to evaluate minimum 5-year functional outcomes and secondary surgery rates after hip acetabular labral repair with all-arthroscopic capsular autograft labral reconstruction.

Methods

This study received Institutional Review Board approval. Patients who underwent hip arthroscopy by the senior surgeon between May 2014 and May 2019 were prospectively evaluated. Patients ≥ 18 years old with minimum 5-year follow-up PROMs who underwent primary hip arthroscopy for arthroscopic capsular autograft labral reconstruction were included. Patients with <5 years post-operative follow-up were excluded. Capsular autograft augmentation was performed if patients had a labrum with hypoplastic tissue (width<5mm), complex tearing, or frank degeneration of native tissue. International Hip Outcome Tool-33 (iHOT-33), Hip Outcome Score Activity of Daily Living/Sports Scale (HOS-ADL/SS), and Modified Harris Hip Score(mHHS)PROMs were collected. Rates of minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) were calculated for each PROMs at latest follow-up.

Results

Overall, 87 hips (86 patients) met inclusion criteria with a mean final follow-up of 64.0±7.2 months. Patients had a mean age of 39.5±10.7 years and body mass index of 25.7±4.1 kg/m2. The mean difference between baseline and latest follow-up for all 4 PROMs was statistically significant (P<0.001), with majority of patient improvement exceeding the MCID/PASS/SCB thresholds: iHOT-33: 96.6/75.0/63.4%, HOS-ADL: 68.1/75.0/65.9%, HOS-SS: 80.7/72.7/62.5%, mHHS: 81.2/80/7/59.1%. 4 patients underwent conversion to total hip arthroplasty (4.6%) and no patients underwent revision hip arthroscopy (0.0%).

Discussion

This study of 87 hips that underwent labral repair with all-arthroscopic capsular autograft labral reconstruction found excellent outcomes that exceeded the MCID/PASS/SCB thresholds in majority of patients at an average of 64.0±7.2 months follow-up. This novel technique offers the advantages of utilizing locally available tissue, preserving the chondrolabral junction, and minimizing significant donor-site morbidity.