Primary Hip Labral Reconstruction Shows Superior Outcomes Compared With Revision Reconstruction After Primary Repair at Minimum 2-Year Follow-Up.

Abstract

To compare minimum 2-year patient-reported outcomes (PROs) of revision arthroscopic labral reconstruction after failed primary labral repair with those of matched primary labral reconstruction cases. Data from patients who underwent labral reconstruction between June 2008 and November 2024 were retrospectively reviewed. Inclusion criteria required revision hip arthroscopy with labral reconstruction and a minimum 2-year follow-up for PROs, including the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sport-Specific Subscale, International Hip Outcome Tool 12 score, patient satisfaction rating, and visual analog scale pain score. Exclusion criteria included Tönnis grade greater than 1, pre-existing hip conditions, lateral center-edge angle less 20°, intraoperative gluteus medius repair, ongoing Workers' Compensation claims, and patients with microinstability who underwent remplissage or capsular reconstruction. Revision patients (n = 75) were matched 1:1 with a benchmark control group of primary reconstruction patients (n = 75). At a minimum 2-year follow-up, both groups showed significant improvement in all PROs (P < .001), with comparable rates of improvement (P > .05). However, the revision group showed inferior postoperative outcomes across all PROs (P < .01) and lower rates of achieving the patient acceptable symptom state compared with the control group. Both primary and revision labral reconstructions lead to significant clinical improvement. However, primary reconstruction achieves superior outcomes, with a higher percentage of patients reaching clinically meaningful thresholds. These findings suggest that when labral tissue quality is questionable, performing a reconstruction at the index procedure may be preferable to attempting a repair that risks eventual failure and the need for revision. Level III, retrospective comparative matched case series.