Results of Arthroscopic Labral Reconstruction of the Hip in Elite Athletes
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1 Results of Arthroscopic Labral Reconstruction of the Hip in Elite Athletes Robert E. Boykin, MD; Karen K. Briggs, MPH; Diana Patterson, BA; Ashley Dee, MS, ATC; Marc J. Philippon, MD The Steadman Philippon Research Institute Vail, CO
2 Disclosures Research and Educational Support Smith & Nephew Endoscopy, Ossur, Arthrex, Siemens Royalties (MJP) Smith & Nephew Endoscopy, Arthrosurface, Bledsoe, DonJoy, SLACK Inc., Elsevier Stockholder (MJP) Arthrosurface, HIPCO, MIS Consultant (MJP) Smith & Nephew Endoscopy, MIS Ownership (MJP) HIPCO
3 Background Clinical studies have demonstrated better results with labral repair than labral debridement (Philippon JBJS 2009, Espinosa JBJS 2006) Biomechanical studies have shown that the labrum provides a seal creating a hydrostatic fluid pressure Enhances lubrication and limits the rate of cartilage layer consolidation (Ferguson, J Biomech 2003) The patient with an irreparable labrum presents a difficult clinical challenge
4 Background To address labral deficiency, reconstruction has been reported 1. Open technique utilizing ligamentum teres autograft (Sierra, CORR 2009) 2. Arthroscopic technique using iliotibial (IT) band autograft (Philippon, Arthroscopy 2010) 47 patients with a min 1 year follow-up Improvement in mean modified Harris hip score (MHHS) (62 -> 85) Mean patient satisfaction of 8/10 3. Arthroscopic technique using gracilis autograft (Matsuda, AANA 2010)
5 Purpose To report the clinical outcomes of arthroscopic labral reconstruction of the hip in elite athletes in addition to return to sport Hypothesis: Arthroscopic IT band labral reconstruction of the hip in high level athletes yields good clinical outcomes, allowing patients to return to a similar level of play
6 Methods Retrospective review of a prospective registry Inclusion criteria: an elite athlete having undergone an IT band arthroscopic labral reconstruction from 8/2005 to 11/2010 (with min 1 year follow-up) Elite defined as Olympic-level, on a recognized professional team, or whose sport is their primary job and source of income Exclusion criteria: < 18 years old Dysplasia (Center edge angle< 20 or Sharp s >42 ) Previous acetabular or femoral osteotomy Return to play: Defined as return to participation in a patient s individual sport Further analysis based on sport specific statistics compared to pre-injury stats
7 Results 25 elite athletes on initial query 1 excluded for previous peri-acetabular osteotomy, 3 excluded for dysplasia: 21 total included (all male) 7 soccer 5 hockey 4 football 2 skiing 1 baseball 1 basketball 1 ice skating 2 bilateral reconstructions = 23 hips Average age 28 years (range 19-41)
8 Results Clinical Outcomes Pre-op Post-op Mean 95% CI p-value MHHS to HOS ADL to HOS Sport to SF-PCS to SF-MCS to
9 Results Clinical Outcomes Overall mean patient satisfaction 8/10 (range 1-10) No significant difference in patients with vs. without microfracture No significant difference in patients with vs. without previous surgery
10 Return to play Results 18/21 (86%) returned to sports 15/21 (76%) returned to previous level of play based on sport specific statistics 1/21 (5%) returned to professional level play, but with lower statistics than pre-injury 1/21 (5%) returned to practice or minor league play but did not have any confirmable return to previous level of play 3/21 (14%) did not return to sports 2/21 (9.5%) progressed to arthroplasty 1/21 (4.8) retired from professional sports shortly after surgery
11 Results Graft Integration: MRI 25 months post reconstruction: Pathology: 25 months post reconstruction 1. Histologically viable fibrovascular connective tissue with focal benign synovial type lining 2. No infection or foreign body reaction
12 Conclusions 1. Arthroscopic labral reconstruction of the hip using an ipsilateral iliotibial band autograft yields good short term clinical outcomes, high patient satisfaction, and a satisfactory level of return to play in a select group of elite athletes 2. Graft integration is seen arthroscopically, on MRI, and histologically 3. The procedure should be considered for athletes presenting with a hypoplastic or irreparable labrum Patients with < 2mm joint space have a high failure rate
13 References Espinosa N, Rothenfluh DA, Beck M, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am. 2006;88: Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;36: Larson CM, Giveans MR. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement. Arthroscopy. 2009;25: Philippon MJ, Briggs KK, Hay CJ, Kuppersmith DA, Dewing CB, Huang MJ. Arthroscopic labral reconstruction in the hip using iliotibial band autograft: technique and early outcomes. Arthroscopy. 2010;26: Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br. 2009;91: Sierra RJ, Trousdale RT. Labral reconstruction using the ligamentum teres capitis: report of a new technique. Clin Orthop Relat Res. 2009;467:
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