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 Mini-De Min 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 Vegas Las as, N Nevad ada Decem cember er 8 th 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

Arthroscopy. 2007 Apr;23(4):376-80 Arthroscopic Repair of the Acetabular Labrum: A Histologic Assessment of Healing in an Ovine Model Philippon MJ, Arnoczky SP, Torrie A

Arthroscopy. 2015 Jul;31(7):1382-90 Revision Hip Arthroscopy. A Systematic Review of Diagnoses, Operative Findings, and Outcomes Cvetanovich GL, Harris JD, Erickson BJ, et al

Arthroscopy. 2015 Oct;31(10):2047-55 Revision Hip Arthroscopy Indications and Outcomes: A Systematic Review Sardana C, Philippon MJ, de Sa D, et al

• Revis isio ion a n arthros roscop copy: – Infrequently tly is is failu ilure o of la labral r l repair obser 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?

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 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 • 99 ( 99 ( 76% 6% ) o ) of 1 131 a allo llografts ts w were prima mary r recons onstruc uctions ns

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 • Ind ndications we were: La Labrum um t too oo small, l, or too big ig, , or ir irrep eparable

No da No data ta tha that size matters

La Labr brum al almos ost a always re repa pairabl ble

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 • Ind ndications we were: La Labrum um t too oo small, l, or too big ig, , or ir irrep eparable

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 • 13.7 .7% r reoper erat ation r rate – 9.9% 9% co conver ersion to to THA

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 • 34 pt pt impro provement i in mHHS HHS!

• Exc xclu luded 1 d 13.7% o outri righ ght f fail ilures • Exc xclu luded 1 d 13.8% lo lost t to follo llow-up up

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 • 34 pt pt impro provement i in mHHS HHS!

• Resul ults ts o of labral r ral repai air v r variab iable, le, b but general erally ly f favor orab able le – 13.7 .7% r reoper erat ation ( (9. 9.9% 9% THA) _ assoc ocia iated c c recons onstruc 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

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 onstruc uction ons respectab able • No o 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 ompared t to o tot otal n numb umber of of recons onstruc uctions ons • 31% failures es a among r repairs? s?

• Resul ults ts o of 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 of c choi hoice f for or a a primary operatio tion? – No Not in in my opinion

Concl clusions • Commen ended o on his tran ansp sparency cy and convictio tion in in his is s strate tegy