BACKGROUND Labral repair has become the preferred method for the arthroscopic treatment of acetabular labral tears that are associated with femoroacetabular impingement (FAI) resulting in pain and dysfunction. Labral reconstruction is performed mainly in revision hip arthroscopy but can be utilized in the primary setting for absent or calcified labra. The purpose of this study was to compare the minimum 2-year patient-reported outcomes (PROs) and risk of revision or conversion to arthroplasty between primary labral reconstruction and primary labral repair. METHODS Patients with FAI who underwent primary hip arthroscopy with labral repair or reconstruction performed by the senior author between 2006 and 2018 were identified from a prospectively enrolled patient outcome registry. Exclusion criteria included confounding injuries, dysplasia, prior ipsilateral hip surgery, or a joint space of <2 mm. Patients who were 18 to 80 years old were eligible for inclusion. Multiple regression with inverse propensity score weighting was conducted to estimate the average treatment effect in the treated (ATT) for labral reconstruction versus labral repair with respect to postoperative PROs and the likelihood of subsequent surgery (revision hip arthroscopy or conversion to arthroplasty). PRO end points included the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL), modified Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index total score (WOMAC), 12-Item Short Form Health Survey Physical Component Summary score (SF-12 PCS), and patient satisfaction. RESULTS A total of 150 hips undergoing primary labral reconstruction and 998 hips undergoing primary labral repair were included. The median follow-up time was 5.3 years in the reconstruction group and 5.8 years in the repair group. Compared with labral repair, labral reconstruction was associated with a higher risk of conversion to total hip arthroplasty (THA) (20% versus 7%; adjusted odds ratio, 3.2; 95% confidence interval [CI], 1.2 to 8.8; p = 0.024). Inverse propensity score-weighted multiple regression estimated a significant negative effect of labral reconstruction, relative to labral repair, on the postoperative values for the HOS-ADL (ATT, -3.3; 95% CI, -5.8 to -0.7; p = 0.012) and WOMAC (ATT, 2.6; 95% CI, 0.1 to 5.2; p = 0.044). CONCLUSIONS Compared with primary labral reconstruction, primary labral repair resulted in better postoperative HOS-ADL and WOMAC values and decreased conversion to THA. These findings were demonstrated in both the unadjusted group comparisons and multivariable modeling. These data support the use of labral repair in the primary setting of labral tears and the reservation of labral reconstruction for more advanced labral pathology or for revision cases. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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股骨髋臼撞击患者初次关节镜手术的两年结果：盂唇修复和盂唇重建的比较研究。


背景技术盂唇修复已成为关节镜治疗髋臼盂唇撕裂的首选方法，髋臼盂唇撕裂与股骨髋臼撞击(FAI)相关，导致疼痛和功能障碍。盂唇重建主要在髋关节翻修术中进行，但也可用于盂唇缺如或钙化的主要情况。本研究的目的是比较初次盂唇重建和初次盂唇修复之间的至少 2 年患者报告结果 (PRO) 以及翻修或转为关节置换术的风险。方法 从前瞻性登记的患者结果登记中筛选出 2006 年至 2018 年间接受初级髋关节镜检查并由资深作者进行盂唇修复或重建的 FAI 患者。排除标准包括混杂损伤、发育不良、既往同侧髋关节手术或关节间隙为 <2 mm。 18 至 80 岁的患者有资格纳入。采用逆倾向评分加权的多元回归来估计盂唇重建与盂唇修复治疗组 (ATT) 的平均治疗效果，即术后 PRO 和后续手术的可能性（修正髋关节镜检查或转为关节成形术）。 PRO 终点包括髋部结果评分日常生活活动量表 (HOS-ADL)、改良的 Harris 髋部评分、西安大略大学和麦克马斯特大学骨关节炎指数总分 (WOMAC)、12 项简短健康调查身体成分总结评分 (SF) -12 PCS）和患者满意度。结果 总共纳入了150个接受初次盂唇重建的髋关节和998个接受初次盂唇修复的髋关节。中位随访时间为 5。重建组为3年，修复组为5.8年。与盂唇修复相比，盂唇重建与转为全髋关节置换术 (THA) 的风险较高相关（20% 对比 7%；调整后优势比，3.2；95% 置信区间 [CI]，1.2 至 8.8；p = 0.024 ）。逆倾向评分加权多元回归估计，相对于盂唇修复，盂唇重建对术后 HOS-ADL 值有显着的负面影响（ATT，-3.3；95% CI，-5.8 至 -0.7；p = 0.012）和 WOMAC（ATT，2.6；95% CI，0.1 至 5.2；p = 0.044）。结论 与初次盂唇重建相比，初次盂唇修复术后 HOS-ADL 和 WOMAC 值更好，并减少向 THA 的转化。这些发现在未调整的组比较和多变量模型中得到了证明。这些数据支持在盂唇撕裂的主要情况下使用盂唇修复术，并为更高级的盂唇病理学或修复病例保留盂唇重建术。证据级别 治疗级别 III。有关证据级别的完整描述，请参阅作者须知。