Background
Favorable short-term outcomes of arthroscopic labral reconstruction for femoroacetabular impingement syndrome (FAIS) have been reported. However, mid-term outcomes are of arthroscopic labral reconstruction for FAIS limited.
Purpose
The purpose of this study was to evaluate the mid-term outcomes of arthroscopic labral reconstruction using an iliotibial band and compare the clinical outcomes of labral reconstruction with those of labral refixation in the mid-term.
Methods
From March 2009 to December 2015, patients with FAIS undergoing primary hip arthroscopy with a minimum 5-year follow-up were reviewed. Patient-reported outcome scores (PROs), including the Nonarthritis Hip Score (NAHS), modified Harris Hip Score (mHHS), Vail Hip Score, International Hip Outcome Tool 12 (iHOT12) score, postoperative revision rates and radiographic osteoarthritis (OA) progression, were assessed. The NAHS and mHHS were evaluated preoperatively, at 2 years, at 5 years, and at the final follow-up. The Vail Hip Score and iHOT12 score were evaluated at the final follow-up. In addition, patient-matched analysis was performed according to age (±4 years), sex, body mass index (BMI) (±3.0 kg/m2) and Tönnis grade.
Results
Twenty-eight patients met the inclusion criteria, and 23 patients (16 male, 7 female) were followed up for more than 5 years (follow-up rate 82.1%). The mean follow-up period was 77.1 ± 18.6 months. The mean age at surgery was 54.2 ± 13.6 years old, and the BMI was 24.6 ± 2.9 kg/m2. The mean NAHS was significantly improved after surgery (from 64.6 ± 17.9 preoperatively to 87.1 ± 14.1 at 2 years, 85.3 ± 14.1 at 5 years and 83.5 ± 13.7 at the final follow-up). The mean mHHS was significantly improved after surgery (from 69.7 ± 12.8 preoperatively to 92.4 ± 12.3 at 2 years, 94.3 ± 9.2 at 5 years and 95.5 ± 5.6 at the final follow-up). At the final follow-up, the mean Vail Hip Score was 87.8 ± 13.9, and the iHOT12 score was 86.9 ± 18.5. Radiographic OA progression was observed in 6 patients (26.1%). Revision arthroscopy was performed for 3 patients (13.0%) at a mean of 6.3 ± 4.5 months. Of the 6 patients with radiographic OA progression, 4 (17.4%) were converted to THA at a mean of 58.5 ± 42.2 months after hip arthroscopy. Of 23 patients in the reconstruction group, 14 patients were matched to 28 patients in the refixation groups. In the patient-matched analysis, there were no significant differences in age, sex, BMI, follow-up duration or preoperative PROs. After surgery, the NAHS and mHHS significantly improved (Wilcoxon signed-rank test, p < 0.001), and there were no significant differences in the NAHS, mHHS, Vail Hip Score or iHOT12 score between the groups. There were no significant differences between the groups regarding radiographic OA progression (Fisher’s exact test, p=0.440) or additional surgery (Fisher’s exact test, revision arthroscopy p=0.571, THA p=0.407).
Conclusions
Arthroscopic labral reconstruction provides comparable mid-term clinical outcomes with labral refixation for the treatment of patients in the setting of FAIS.