New multicenter work set out to compare arthroscopic labral reconstruction with labral repair. The study, “Arthroscopic Reconstruction of the Irreparable Acetabular Labrum: A Match-controlled Study,” appears in the January 4, 2019 edition of Arthroscopy.
Labral Repair or Labral Reconstruction? New Study
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Co-author Benjamin Domb, M.D., founder of the American Hip Institute in Chicago, Illinois, told OTW, “Arthroscopic reconstruction of the labrum has become an important tool in the treatment of labral tears.”
“Specifically, when faced with the irreparable labrum, reconstruction makes it possible to leave the hip with a viable labral seal. However, labral reconstruction remains an extremely technically challenging procedure. Newer procedures such as the ‘knotless pull-through technique for circumferential labral reconstruction,’ as published by our group, have made it possible to reconstruct the entirety of the labrum with a reproducible and efficient methodology and result.”
“The importance of the present study is to evaluate the outcomes of reconstruction, and to compare those outcomes against the benchmark of labral repair, using a matched control cohort study design.”
The study enrolled 34 reconstruction patients who were matched to 68 patients who underwent repair. The researchers found a statistically significant improvement in patient reported outcomes for both groups, and a significant decrease in Visual Analog Scale scores in both groups.”
According to the researchers, there were no significant differences between the two groups as far as of postop complications, secondary arthroscpy, or conversion to total hip arthroplasty are concerned.
Dr. Domb commented to OTW, “We have found that even when faced with the irreparable labrum, we can achieve excellent results with our technique for labor at reconstruction. Furthermore, the results show that outcomes of reconstruction, when performed well, can match up well against the benchmark of labral repair. At our institution we continue to perform repair for the repairable labrum, but advocate reconstruction for the irreparable labrum.”
“Labral reconstruction remains a technically challenging procedure. Extensive training, cadaveric practice, and study are available and invaluable in mastering labral reconstruction.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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