Labral Repair and Reconstruction Yield Comparable Patient-Reported Outcomes at Short- to Mid-Term Follow-Up During Primary Hip Arthroscopy: A Systematic Review.

Purpose

To systematically review and compare clinical outcomes and survivorship of labral repair versus labral reconstruction during primary hip arthroscopy.

Methods

A search of PubMed, the Cochrane Library, and Embase databases was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comparative clinical studies investigating labral repair versus reconstruction during primary hip arthroscopy were included. Outcomes assessed included patient-reported outcomes (PROs), rate of revision hip arthroscopy, and conversion to total hip arthroplasty.

Results

Six Level III studies met inclusion criteria (1628 labral repairs, 679 reconstructions). Mean age at surgery ranged from 29.9 to 48.6 years (repair) and 34.6 to 48.1 years (reconstruction). Mean follow-up ranged from 2.0 to 5.8 years. All studies showed significant within-group improvements in PROs with minimal clinically important difference and patient acceptable symptomatic state achievement rates exceeding 70% in both groups, with no significant between-group differences. Two studies found no significant differences in postoperative PROs or magnitude of improvement between groups. Conversely, 2 studies showed greater mean PRO improvement in the reconstruction group, including patients aged ≥40 years in 1 study, while 1 study reported higher adjusted postoperative PROs for labral repair. Four studies showed no significant differences in revision rates, but 1 reported a lower total hip arthroplasty conversion rate after labral repair, and 1 reported a lower failure rate with reconstruction in patients aged ≥40 years.

Conclusions

Both labral repair and reconstruction show significant improvements in PROs at short- to mid-term follow-up, with comparable achievement of minimal clinically important difference and patient acceptable symptomatic state thresholds. However, evidence suggests that labral repair yields lower rates of conversion to total hip arthroplasty, whereas reconstruction offers better clinical outcomes and lower failure rates in patients aged ≥40. Consequently, the optimal surgical approach should be individualized based on patient age, intraoperative assessment of tissue quality, and overall joint pathology. LEVEL OF EVIDENCE Level III, systematic review of Level III studies.