Bilateral Hip Arthroscopy: Direct Comparison of Primary Acetabular Labral Repair and Primary Acetabular Labral Reconstruction

Purpose: Directly compare primary acetabular labral repair versus primary acetabular labral reconstruction using a self-controlled cohort study design. Methods: Patients who underwent primary labral repair in one hip and primary labral reconstruction using iliotibial band allograft in the other hip by a single surgeon between August 2009 and November 2014 were identified. One patient with inflammatory arthritis was excluded. Patient-reported outcome data included change in Modified Harris Hip Score (MHHS), Lower Extremity Functional Scale (LEFS), average pain using a 10-point visual analog scale (VAS), and patient satisfaction (1: very dissatisfied, 10: very satisfied). Failure was defined as subsequent intra-articular hip surgery. Data were analyzed using McNemar's and Wilcoxon Signed Rank tests. Results: Overall, 29 patients (58 hips) were included in the analysis. There were 23 females and 6 males. The average age at time of surgery was 32.6 years (range: 14.9-51.6 years). Follow-up was obtained from all 29 patients (100%) at a mean of 56 months (range = 27-85 months) postoperative for repaired hips and 40 months (range = 22-61 months) postoperative for reconstructed hips. No labral reconstruction hips failed, and 9 (31%) labral repair hips failed (P < .01). Among those that did not fail treatment, there was no difference in MHHS change (32.2 +/- 15.4 vs 29.6 +/- 15.4; P = .63), LEFS change (26.6 +/- 16.5 vs 23.9 +/- 17.8; P = .61), VAS pain change (-3.2 +/- 2.4 vs -3.6 +/- 2.1; P = .47), or satisfaction (8.6 +/- 2.0 vs 8.7 +/- 2.4; P = .59) between the repair and reconstruction groups, respectively. Conclusions: In this cohort of patients, hips that underwent primary labral repair were more likely to fail treatment than hips that underwent labral reconstruction (31% vs 0%, respectively). Among hips that did not fail treatment, patient-reported outcome scores were similar between groups. Excellent clinical results can be obtained with both forms of labral-preserving treatment but were more predictably observed with primary labral reconstruction in this cohort.