Hip Arthroscopy for Femoroacetabular Impingement-Associated Labral Tears: Current Status and Future Prospects

Figures & data

Figure 1 The senior author’s (TY) preferred algorithm for workup and diagnosis of femoroacetabular impingement (FAI) and comorbid conditions.

Figure 2 The senior author’s (TY) preferred algorithm for treatment of confirmed femoroacetabular impingement (FAI) with or without concomitant labral tears.

Table 1 A Summary of the Recent Literature on Labral Repair and Labral Reconstruction

Authors	Study Design	Population Included	Key Findings
Martin et al. (2021)^Citation59	Randomized controlled trial with single surgeon; patients were randomized 1:1 to labral repair (SPT) or physical therapy alone (PTA).	n = 90; age >40 with symptomatic MRI-confirmed labral tears, Tönnis grades 0–2	- 63.6% crossover rate from PTA to SPT group - Greater iHOT-33 and mHHS scores in SPT group than PTA group at 12 months - Difference in scores exceeded MCID
Drager et al. (2020)^Citation86	Case-control study; patients with hypotrophic labrum were matched 1:1 by age and BMI to patients with normal labral width	n = 346; patients who underwent primary arthroscopic labral repair for FAI	- No significant differences in HOS, mHHS, and iHOT-12 scores at 1 year - No significant differences in achieving MCID or PASS at 1 year
White et al. (2020)^Citation85	Retrospective comparative study; patients who underwent labral reconstruction were compared with patients who underwent labral repair	n = 343 patients (363 hips); age 30–65 and underwent labral reconstruction OR age 40–65 and underwent labral repair	- Failure was 3.29 times more likely for repair group versus reconstruction group at mean 4.2-year follow-up - No difference in rate of conversion to THA - Greater improvement in mHHS among successful reconstruction patients versus successful repair patients
Domb et al. (2020)^Citation87	Case-control study; patients who underwent primary circumferential labral reconstruction with tibialis anterior allograft were matched 1:3 on age, sex, and BMI to patients who underwent labral repair	n = 37 patients (37 hips); irreparable labral tears and FAIS, Tönnis grade <2, no dysplasia (LCEA ≤ 18°)	- Circumferential labral reconstruction group had significant improvement in mHHS, NAHS, HOS - Sport-Specific Subscale, iHOT-12, and VAS scores at minimum 2-year follow-up - Improvements in PROs were comparable between reconstruction and repair groups
Scanaliato et al. (2018)^Citation84	Prospective cohort study with single surgeon; patients who underwent primary circumferential labral reconstruction with allograft were compared with patients who underwent primary labral repair	n = 162 hips; patients with labral tears that limited desired activity level and failed 6 months of non-operative treatment	- No significant difference in failure rates between repair and reconstruction groups - Significant improvement in mHHS, iHOT-12, SF-12, and VAS scores at mean 2-year follow-up in both groups - No significant difference in improvement in PROs between both groups
Chandrasekaran et al. (2019)^Citation88	Retrospective comparative study; patients who underwent primary labral reconstruction were matched 1:2 on age, sex, BMI, capsular treatment, and level of chondral damage (outerbridge grade) to patients who underwent primary labral repair	n = 102; patients with labral tears and minimum 2-year follow-up	- Significant improvement in mHHS, HOS - Sports Subscale, NAHS, and VAS scores in both repair and reconstruction groups at minimum 2-year follow-up - No significant differences in rates of postoperative complications, secondary arthroscopy, or conversion to THA

Abbreviations: iHOT, International Hip Outcome Tool; mHHS, Modified Harris Hip Score; HOS, Hip Outcome Score; MCID, minimum clinically important difference; PASS, Patient Acceptable Symptom State; THA, total hip arthroplasty; NAHS, Non-Arthritic Hip Score; VAS, Visual Analog Scale.

Martin SD, Abraham PF, Varady NH, et al. Hip arthroscopy versus physical therapy for the treatment of symptomatic acetabular labral tears in patients older than 40 years: a randomized controlled trial. Am J Sports Med. 2021;49(5):1199–1208. doi:10.1177/0363546521990789

 PubMed Web of Science ®Google Scholar

Drager J, Rasio J, Newhouse A, Beck E, Chahla J, Nho SJ. Patients with a hypotrophic labrum achieve similar outcomes after primary labral repair compared with patients with a normal-sized labrum: a matched cohort analysis of 346 patients with femoroacetabular impingement syndrome. Arthroscopy. 2020;36(10):2614–2620. doi:10.1016/j.arthro.2020.05.039

 PubMed Web of Science ®Google Scholar

White BJ, Patterson J, Scoles AM, Lilo AT, Herzog MM. Hip arthroscopy in patients aged 40 years and older: greater success with labral reconstruction compared with labral repair. Arthroscopy. 2020;36(8):2137–2144. doi:10.1016/j.arthro.2020.04.031

 PubMed Web of Science ®Google Scholar

Domb BG, Kyin C, Rosinsky PJ, et al. Circumferential labral reconstruction for irreparable labral tears in the primary setting: minimum 2-year outcomes with a Nested Matched-Pair Labral Repair Control Group. Arthroscopy. 2020;36(10):2583–2597. doi:10.1016/j.arthro.2020.02.014

 PubMed Web of Science ®Google Scholar

Scanaliato JP, Christensen DL, Salfiti C, Herzog MM, Wolff AB. Primary circumferential acetabular labral reconstruction: achieving outcomes similar to primary labral repair despite more challenging patient characteristics. Am J Sports Med. 2018;46(9):2079–2088. doi:10.1177/0363546518775425

 PubMed Web of Science ®Google Scholar

Chandrasekaran S, Darwish N, Mu BH, et al. Arthroscopic reconstruction of the irreparable acetabular labrum: a match-controlled study. Arthroscopy. 2019;35(2):480–488. doi:10.1016/j.arthro.2018.09.024

 PubMed Web of Science ®Google Scholar