Background:

Previous literature has suggested that primary acetabular labral reconstruction leads to lower secondary surgery rates than does labral repair for patients aged ≥40 years.

Purpose:

To report minimum 2-year patient-reported outcome (PRO) scores, survivorship, and secondary surgeries in patients aged ≥40 years who underwent primary hip arthroscopy with labral reconstruction compared with a propensity-matched primary labral repair group.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Data were prospectively collected and retrospectively reviewed for patients who underwent a primary hip arthroscopy for femoroacetabular impingement syndrome between January 2014 and June 2018. Patients aged ≥40 years who underwent a labral reconstruction or a labral repair and had preoperative and minimum 2-year PROs for the modified Harris Hip Score, Nonarthritic Hip Score, and visual analog scale (VAS) for pain were included. Patients with previous ipsilateral hip conditions and surgery, Tönnis grade >1, hip dysplasia, or workers’ compensation status were excluded. Patients in the reconstruction group were propensity matched 1:2 to patients in the repair group based on age, sex, and body mass index. Secondary surgeries and achievement of the minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and maximum outcome improvement (MOI) were recorded.

Results:

A total of 53 and 106 hips were included in the labral reconstruction and repair groups, respectively. The average follow-up time was 37.6 months. The average ages for the reconstruction and repair groups were 48.01 ± 5.4 years and 48.61 ± 6.0 years, respectively. Both groups achieved significant improvements in all PROs at a minimum of 2 years, with similar achievements of MCID, PASS, and MOI, and comparable secondary surgery rates.

Conclusion:

Patients aged ≥40 years who received primary labral repair and primary labral reconstruction achieved similar significant improvements in all PROs, VAS pain, and patient satisfaction at the minimum 2-year follow-up, with comparable rates of secondary surgeries and achieving MCID, PASS, and MOI. Based on these findings, labral repair remains the gold standard treatment for viable labrum in this population group, while reconstruction is a useful alternative for irreparable labrum.

中文翻译：

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40 岁及以上接受初次髋关节镜检查的患者的盂唇撕裂管理：一项至少 2 年随访的倾向匹配病例对照研究

背景：

以前的文献表明，对于 40 岁以上的患者，初次髋臼盂唇重建导致二次手术率低于盂唇修复。

目的：

报告与倾向匹配的初次盂唇修复组相比，接受初次髋关节镜下盂唇重建的 40 岁以上患者的最低 2 年患者报告结果 (PRO) 评分、存活率和二次手术。

学习规划：

病例对照研究；证据水平，3。

方法：

对 2014 年 1 月至 2018 年 6 月期间因股骨髋臼撞击综合征接受初次髋关节镜检查的患者的数据进行前瞻性收集和回顾性审查。年龄≥40 岁的患者接受了盂唇重建或盂唇修复，术前和至少 2 年的 PROs包括改良的 Harris 髋关节评分、非关节炎髋关节评分和疼痛的视觉模拟评分 (VAS)。既往有同侧髋关节疾病和手术史、Tönnis 分级>1、髋关节发育不良或工伤补偿状态的患者被排除在外。根据年龄、性别和体重指数，重建组患者与修复组患者的倾向性匹配为 1:2。二次手术和实现最小临床重要差异 (MCID)、患者可接受的症状状态 (PASS)、

结果：

盂唇重建组和修复组分别包括 53 和 106 髋。平均随访时间为37.6个月。重建组和修复组的平均年龄分别为 48.01 ± 5.4 岁和 48.61 ± 6.0 岁。两组在至少 2 年内在所有 PROs 中都取得了显着改善，在 MCID、PASS 和 MOI 方面取得了相似的成就，并且二次手术率相当。

结论：

在至少 2 年的随访中，接受初次盂唇修复和初次盂唇重建的 40 岁以上患者在所有 PRO、VAS 疼痛和患者满意度方面取得了类似的显着改善，二次手术率相当，并达到 MCID、PASS、和 MOI。基于这些发现，盂唇修复仍然是该人群中可行盂唇的金标准治疗，而重建是无法修复的盂唇的有用替代方法。