Clinical outcomes of arthroscopic hip labral reconstruction versus repair in the primary setting: A systematic review and meta-analysis.

Abstract

Advancements in understanding the acetabular labrum's role in hip biomechanics have emphasized preserving its native anatomy. However, severe labral pathology may make labral repair unfeasible in certain cases. The primary aim of the present study is to review existing literature comparing clinical outcomes of arthroscopic hip labral reconstruction versus repair in the primary setting. A search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed in PubMed, Embase, and Scopus to identify studies comparing clinical outcomes of arthroscopic hip labral reconstruction versus repair for the treatment of labral tears in the primary setting. Meta-analyses comparing patient-reported outcomes (PROs), achievement of a minimal clinically important difference (MCID) or patient acceptable symptomatic state (PASS), and revision or conversion to total hip arthroplasty (THA) were performed using a random-effects model. A P-value <0.05 was statistically significant. Six studies (level of evidence 3) with 429 hips undergoing reconstruction and 1278 undergoing repair were included. Indications for reconstruction in the primary setting based on authors' preferences included nonviable or inadequate size of remaining labrum for repair, labral calcification, >8 mm or <2-3 mm of labral tissue, complex or extensive tear, labral hypotrophy or hypertrophy, tears with severe (or moderate in patients >40 years old) intrasubstance damage, labral ossification, and segmental defects. All studies reported statistically significantly more severe labral and cartilage pathology in the reconstruction group compared to the repair group. The results of the meta-analysis are as follows: No statistically significant difference between labral repair and reconstruction in PROs, odds of achieving an MCID or PASS for the modified Harris Hip Score and International Hip Outcome Tool, and risk of revision (P > 0.05). However, the risk of conversion to THA was statistically significantly higher in the reconstruction group compared to the repair group (P < 0.001). While PROs, achievement of clinically significant outcomes, and risk of revision were not statistically significantly different for primary labral reconstruction versus repair, the risk of conversion to THA was found to be statistically significantly higher for patients undergoing primary labral reconstruction, although this may be related to increased severity of labral/cartilage pathology in patients undergoing labral reconstruction. III.