Both Labral Debridement and Labral Repair Result in >90% Total Hip Arthroplasty-free Survival at 5-Year Follow-Up: An Analysis of the German Cartilage Registry (KnorpelRegister DGOU)

Editorial Commentary: Arthroscopic Hip Labral Preservation Combined With Bony Correction and Capsular Closure Results in Improved Patient Outcomes

Hip labral reconstruction aims to replace an irreparable or insufficient labrum with the goal of restoring the native function of the labrum and thus contribute to hip preservation. Multiple studies have reported success and improved outcomes with labral reconstruction, both in primary and revision settings. The function of the labrum includes providing additional soft-tissue coverage of the femoral head and contributing to regulation of fluid dynamics within the hip joint through the "suction seal." Labral tears and insufficiency alter hip joint biomechanics, which could result in hip microinstability and joint degeneration. Yet, although labral reconstruction is better than a labral-deficient state, labral reconstruction does not restore native hip biomechanics when compared with the native intact labrum. However, concomitant procedures to address bony morphology, hip capsule, cartilage, and adhesions in the revision setting frequently are performed at the time of labral reconstruction, making the true effect of labral reconstruction unknown. Therefore, the labrum should be considered as one of many variables when evaluating individuals with hip pain, and surgeons who perform hip arthroscopy should ensure that appropriate patient selection and additional pathology are adequately addressed in the primary and revision settings.

Acetabular Labral Repair and Selective Labral Debridement Show No Significant Difference in Clinical Outcomes at a Minimum 2-Year Follow-Up

PURPOSE

To compare the outcomes of arthroscopic labral repair using looped type suture with a matched-pair selective labral debridement with a minimum 2-years follow-up.

METHODS

We identified 378 patients undergoing primary arthroscopic labral repair using loop-suture and selective labral debridement from January 2, 2018, to December 28, 2020. The labral repair group was matched 1:1 to a selective labral debridement control group by age, sex, body mass index, follow-up period, lateral center-edge angle, Tönnis grade, and preoperative joint space. Before surgery, 3-Tesla radial magnetic resonance imaging with a 3-dimensional double-echo steady-state sequence was obtained following failed nonoperative treatment lasting more than 3 months. Follow-up imaging was conducted at a minimum of 2 years. In both groups, the ratio of positive slices in which a disrupted chondrolabral junction was observed between the 2 o'clock and 11 o'clock positions was measured. Patient-reported outcome scores included the Harris Hip Score, visual analog score, Hip Outcome Score Activities of Daily Living Subscale, and Hip Outcome Score of Sport-Specific Subscale.

RESULTS

In total, 76 patients of the repair group were matched to 76 controls with a minimum 2-years follow-up (repair vs control: 2.6 ± 0.4 vs 2.6 ± 0.4 years, P = .775). The repair group experienced a 2-fold improvement (0.6 ± 0.1 to 0.3 ± 0.1, P＜.001). Although the selective debridement group experienced a 3-fold improvement (0.3 ± 0.1 to 0.1 ± 0.1, P＜.001). Significant improvement of the patient-reported outcome was shown in both groups at final follow-up without significant difference between the 2 groups.

CONCLUSIONS

The mid-term clinical outcomes are comparable between the labral repair using looped type suture and selective labral debridement group. Although a gap between the labrum and articular cartilage may appear in 3-dimensional double-echo steady-state magnetic resonance imaging results after labral repair, it does not correspond with clinical outcomes.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.