Labral Repair, Reconstruction, and Augmentation Improve Postoperative Outcomes in Patients with Irreparable or Hypoplastic Labra: A Systematic Review

Jansen Johnson; Prushoth Vivekanantha; Benjamin Blackman; Dan Cohen; Nicole Simunovic; Olufemi R Ayeni

doi:10.1016/j.jisako.2024.04.012

Labral Repair, Reconstruction, and Augmentation Improve Postoperative Outcomes in Patients with Irreparable or Hypoplastic Labra: A Systematic Review

J ISAKOS. 2024 Apr 24:S2059-7754(24)00082-8. doi: 10.1016/j.jisako.2024.04.012. Online ahead of print.

Authors

Jansen Johnson¹, Prushoth Vivekanantha², Benjamin Blackman³, Dan Cohen¹, Nicole Simunovic¹, Olufemi R Ayeni⁴

Affiliations

¹ Division of Orthopedic Surgery, Department of Surgery, McMaster, Hamilton, ON, Canada.
² Michael deGroote School of Medicine, McMaster University, Hamilton, Ontario.
³ Department of Medicine, Department of Surgery, University of Limerick, Limerick, Ireland.
⁴ Division of Orthopedic Surgery, Department of Surgery, McMaster, Hamilton, ON, Canada. Electronic address: ayenif@mcmaster.ca.

PMID: 38670346
DOI: 10.1016/j.jisako.2024.04.012

Abstract

Purpose: To review the postoperative outcomes of arthroscopic surgical options in treating irreparable and hypoplastic labrum of the hip.

Methods: Three online databases (PubMed, MEDLINE, EMBASE) were searched from database inception to June 27, 2023 to identify literature on treatment strategies for hypoplastic/irreparable acetabular labrum. Data pertaining to classification of irreparable tears or labral hypoplasia, indication for surgery, description of treatment, radiographic findings, and clinical outcomes were recorded and described. The methodological quality of included studies was assessed by the Methodological Index for Non-Randomized Studies (MINORS) criteria.

Results: Seven level IV case series, eleven level III retrospective cohort studies, and two level II prospective cohort studies comprising 1,937 patients were included for analysis. Studies were divided into an irreparable labral group comprising 1,002 patients and a hypoplastic labral group comprising 935 patients. Treatments included repair, augmentation, or reconstruction. In the irreparable group, 12 studies recorded improvement of modified Harris Hip Score (mHHS) with preoperative scores ranging from 50.3-67.3 and postoperative scores ranging from 76.2-95.0. The rate of conversion to total hip arthroplasty (THA) and rate of revision arthroscopy were 6.6% and 5.9%, respectively across all studies. In the hypoplastic group, two studies that focused on repair noted no statistical difference in mHHS for repair in hypoplastic labrum vs repair in non-hypoplastic labrum. One study showed that there was a difference in post-operative mHHS for labral repair for hypoplastic vs non-hypoplastic labrum, with repair in non-hypoplastic labrum showing superior mHHS (p <0.001).

Conclusion: The findings of this review suggest that treatment of irreparable labra with reconstruction or augmentation results in improved patient reported outcome measures (PROMs). For the hypoplastic labrum, primary repair also results in improvement in PROMs. Future studies focusing on the hypoplastic labra alone with an appropriate control group, rather than irreparable labral tears are needed to properly assess patient outcomes and guide surgical indications.

Keywords: Arthroscopy; Hip; Hypoplastic; Irreparable; Labral; Reconstruction.

Publication types

Review