Labral Reconstruction is Unnecessary and No Evidence to Support - - PowerPoint PPT Presentation

Labral Reconstruction is Unnecessary and No Evidence to Support Primary Reconstruction

• J. W

. W. . Thomas By Byrd, MD MD

Min Mini-De Deba bate: Aceta etabular L Labral Rec econstruct ction

Orthop hopae aedic S c Summit 2 t 2017 17 - Evolving ng T Techni hniques ues Las Las Vegas as, N Nevad ada Decem cember er 8th

th, 201

2017

• Labrum h

m has e exc xcellent h healin ing capacity acity

– Animal al s studies es – Clinical al e exper erien ence ces

Arthroscopic Repair of the Acetabular Labrum: A Histologic Assessment of Healing in an Ovine Model

Philippon MJ, Arnoczky SP, Torrie A

• Arthroscopy. 2007 Apr;23(4):376-80

Revision Hip Arthroscopy. A Systematic Review of Diagnoses, Operative Findings, and Outcomes

Cvetanovich GL, Harris JD, Erickson BJ, et al

• Arthroscopy. 2015 Jul;31(7):1382-90

Revision Hip Arthroscopy Indications and Outcomes: A Systematic Review

Sardana C, Philippon MJ, de Sa D, et al

• Arthroscopy. 2015 Oct;31(10):2047-55

• Revis

isio ion a n arthros roscop copy:

– Infrequently tly is is failu ilure o

• f la

labral r l repair

• bser

serve ved i in abse sence o e of resi sidual FAI

Wh What do do we we kn know a abo bout primar ary y labral al reco constr structi ction?

Allograft Use in Arthroscopic Labral Reconstruction of the Hip With Front-to- Back Fixation Technique: Minimum 2-Year Follow-up

White BJ, Stapleford AB, Hawkes TK, et al

• Arthroscopy. 2016 Jan;32(1):26-32

Allograft Use in Arthroscopic Labral Reconstruction of the Hip With Front-to- Back Fixation Technique: Minimum 2-Year Follow-up

White BJ, Stapleford AB, Hawkes TK, et al

• Arthroscopy. 2016 Jan;32(1):26-32
• 99 (

99 (76%

6%) o

) of 1 131 a allo llografts ts w were prima mary r recons

• nstruc

uctions ns

Allograft Use in Arthroscopic Labral Reconstruction of the Hip With Front-to- Back Fixation Technique: Minimum 2-Year Follow-up

White BJ, Stapleford AB, Hawkes TK, et al

• Arthroscopy. 2016 Jan;32(1):26-32
• Ind

ndications we were: La Labrum um t too

• small,

l, or too big ig, , or ir irrep eparable

No da No data ta tha that size matters

La Labr brum al almos

• st a

always re repa pairabl ble

Allograft Use in Arthroscopic Labral Reconstruction of the Hip With Front-to- Back Fixation Technique: Minimum 2-Year Follow-up

White BJ, Stapleford AB, Hawkes TK, et al

• Arthroscopy. 2016 Jan;32(1):26-32
• Ind

ndications we were: La Labrum um t too

• small,

l, or too big ig, , or ir irrep eparable

Allograft Use in Arthroscopic Labral Reconstruction of the Hip With Front-to- Back Fixation Technique: Minimum 2-Year Follow-up

White BJ, Stapleford AB, Hawkes TK, et al

• Arthroscopy. 2016 Jan;32(1):26-32
• 13.7

.7% r reoper erat ation r rate

– 9.9% 9% co conver ersion to to THA

Allograft Use in Arthroscopic Labral Reconstruction of the Hip With Front-to- Back Fixation Technique: Minimum 2-Year Follow-up

White BJ, Stapleford AB, Hawkes TK, et al

• Arthroscopy. 2016 Jan;32(1):26-32
• 34 pt

pt impro provement i in mHHS HHS!

• Exc

xclu luded 1 d 13.7% o

• utri

righ ght f fail ilures

• Exc

xclu luded 1 d 13.8% lo lost t to follo llow-up up

Allograft Use in Arthroscopic Labral Reconstruction of the Hip With Front-to- Back Fixation Technique: Minimum 2-Year Follow-up

White BJ, Stapleford AB, Hawkes TK, et al

• Arthroscopy. 2016 Jan;32(1):26-32
• 34 pt

pt impro provement i in mHHS HHS!

• Resul

ults ts o

• f labral r

ral repai air v r variab iable, le, b but general erally ly f favor

• rab

able le

– 13.7 .7% r reoper erat ation ( (9. 9.9% 9% THA) assoc

• cia

iated c c recons

• nstruc

uctio ion n insuffici cien ent t to infer s super eriority o y over er repai air

_

• Arthroscopy. 2017 Oct 31. pii: S0749-8063(17)31052-6.. [Epub ahead of print]

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

White, BJ, Patterson, J, Herzog, MH

• 29.6

6 pt pt mH mHHS i S imp mprovement among ng r recons

• nstruc

uction

• ns

respectab able

• No
• failur

ures

• Arthroscopy. 2017 Oct 31. pii: S0749-8063(17)31052-6.. [Epub ahead of print]

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

White, BJ, Patterson, J, Herzog, MH

• n=2

=29 sm smal all sel select sam sample si size e comp

• mpared t

to

• tot
• tal n

numb umber of

• f

recons

• nstruc

uctions

• ns
• 31% failures

es a among r repairs? s?

• Arthroscopy. 2017 Oct 31. pii: S0749-8063(17)31052-6.. [Epub ahead of print]

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

White, BJ, Patterson, J, Herzog, MH

• Resul

ults ts o

• f labral d

ral debrid idemen ent n t not alw lways b bad

Conclusions

Concl clusions

• Is t

there a a ro role fo for r labr bral gra grafting?

– De Definite tely

• Is t

there a a ro role fo for r labr bral grafting as an as an index ex p proce cedure?

– Maybe

• Is t

Is there a ro role fo for l r labr bral grafting as as the he procedur ure of

• f c

choi hoice f for

• r a

a primary

• peratio

tion?

– No Not in in my opinion

• Commen

ended o

• n his tran

ansp sparency cy and convictio tion in in his is s strate tegy

Concl clusions