Arthroscopic Labral Reconstruction in the Hip Using Iliotibial Band Autograft: Technique and Early Outcomes

• Published in: Arthroscopy Vol. 26; no. 6; pp. 750 - 756
• Main Authors: Philippon, Marc J., M.D, Briggs, Karen K., M.P.H, Hay, Connor J., B.A, Kuppersmith, David A., B.S, Dewing, Christopher B., M.D, Huang, Michael J., M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-06-2010; Elsevier
• Subjects: Acetabulum - surgery; Adolescent; Adult; Arthroscopy; Biological and medical sciences; Cartilage, Articular - injuries; Endoscopy; Fascia - transplantation; Female; Follow-Up Studies; Fractures, Cartilage - rehabilitation; Fractures, Cartilage - surgery; Hip Joint - surgery; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Orthopedic surgery; Orthopedics; Patient Satisfaction; Patient Selection; Prospective Studies; Reconstructive Surgical Procedures; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surveys and Questionnaires; Transplantation, Autologous; Treatment Outcome; Young Adult; Autograft; Arthroscopy; Orthopedic surgery; Prognosis; Treatment; Diseases of the osteoarticular system; Iliotibial band; Graft; Endoscopy; Technique; Hip
• ISSN: 0749-8063; 1526-3231
• DOI: 10.1016/j.arthro.2009.10.016

Purpose The purpose of this study was to investigate the indications for and outcomes of arthroscopic labral reconstruction in the hip by use of iliotibial band (ITB) autograft. Methods Between August 2005 and May 2008, the senior author (M.J.P.) performed 95 arthroscopic labral reconstructions using an ITB autograft in patients with advanced labral degeneration or deficiency. There were 47 patients who had undergone surgery at a minimum of 1 year previously and met the inclusion criteria. The modified Harris Hip Score (MHHS) and patient satisfaction were used to measure outcomes postoperatively. The labral autograft was harvested from the ITB through a separate incision. The graft was sutured to the intact labral remnant in the region of labral deficiency, re-establishing the suction seal of the hip joint. Results There were 32 men and 15 women. The mean age at the time of surgery was 37 years (range, 18 to 55 years). The mean time from the onset of symptoms to labral reconstruction was 36 months (range, 1 month to 12 years). Subsequent total hip arthroplasty was performed in 4 patients (9%). Follow-up was obtained in 37 of the remaining 43 patients. The mean time to follow-up was 18 months (range, 12 to 32 months). The mean MHHS improved from 62 (range, 35 to 92) preoperatively to 85 (range, 53 to 100) postoperatively ( P = .001). Median patient satisfaction was 8 out of 10 (range, 1 to 10). Patients who were treated within 1 year of injury had higher MHHSs than patients who waited longer than 1 year (93 v 81, P = .03). The independent predictor of patient satisfaction with outcome after labral reconstruction was age. Conclusions This study showed that patients who have labral deficiency or advanced labral degeneration had good outcomes and high patient satisfaction after arthroscopic intervention with acetabular labral reconstruction. Lower satisfaction was associated with joint space narrowing and increased age. Patients who waited longer than 1 year from the time of injury to surgery had lower function at follow-up than those treated in the first year. Level of Evidence Level IV, therapeutic case series.