Revision Arthroscopic Acetabular Labral Treatment: Repair or Reconstruct?

Purpose: To compare the outcome of labral repair versus labral reconstruction in patients presenting to a single surgeon for revision hip arthroscopy following previous labral treatment. Methods: Patients who underwent revision labral repair or labral reconstruction using iliotibial band allograft, after previous labral debridement or repair, between 2009 and 2013 were identified. Hips that underwent revision labral reconstruction were further stratified into 2 graft groups (freeze-dried vs frozen allograft). Exclusion criteria were age <16 years, previous open hip surgery, or previous labral reconstruction. Failure was defined by subsequent intra-articular hip surgery. Results: 113 hips (15 repair, 98 reconstruction) met the inclusion criteria. Patients who underwent revision labral repair were younger than patients who underwent revision labral reconstruction (27.8 years vs 34.6 years; P = .02). Follow-up was obtained from 14 (93%) labral repairs at an average of 4.7 years postoperation (range: 2.0-6.0 years) and 90 (92%) labral reconstructions at an average of 2.4 years postoperation (range: 2.0-4.0 years). Seven of 14 (50%) labral repair hips failed compared with 11/90 (12%) labral reconstruction hips (P<.01). Six of 61 (10%) frozen allografts failed compared with 5/29 (17%) freeze-dried allografts (P = .32). Patients who underwent revision labral repair were 4.1 (95% confidence interval 1.9, 8.8) times more likely to fail than patients who underwent revision labral reconstruction. Conclusions: Patients who underwent revision labral repair following previous repair or debridement were 2.6 times more likely to fail than patients who underwent revision labral reconstruction, controlling for calendar time. In addition, revision labral reconstruction with frozen allograft had lower propensity of failure than freeze-dried allograft. However, there was no statistically significant difference in patient-reported outcome scores between the 2 groups. Based on these results, complete labral reconstruction with longer, nonsegmental graft led to a lower failure rate in this study population and can be considered for treatment of patients presenting for revision labral treatment. Level of Evidence: Level III, retrospective comparative study.