American Hip Institute Research Foundation, Chicago, Illinois, USA.
American Hip Institute, Chicago, Illinois, USA.
Am J Sports Med. 2022 May;50(6):1571-1581. doi: 10.1177/03635465221085030. Epub 2022 Apr 19.
The incidence of revision hip arthroscopy with labral reconstruction in athletes is increasing. However, the outcomes of revision hip arthroscopy with labral reconstruction in athletes have not been well established.
(1) To report minimum 2-year patient-reported outcome (PRO) scores and return to sports (RTS) characteristics for high-level athletes undergoing revision hip arthroscopy with labral reconstruction and (2) to compare clinical results with those of a propensity-matched control group of high-level athletes undergoing revision hip arthroscopy with labral repair.
Cohort study; Level of evidence, 3.
Data were prospectively collected and retrospectively reviewed for athletes at any level who underwent a revision hip arthroscopy and a labral reconstruction between April 2010 and March 2019. Minimum 2-year PROs were reported for the modified Harris Hip Score (mHHS), the Nonarthritic Hip Score (NAHS), the Hip Outcome Score-Sport Specific Subscale (HOS-SSS), the visual analog scale (VAS) for pain, and RTS. The percentages of athletes achieving the minimal clinically important difference (MCID) and the maximum outcome improvement satisfaction threshold (MOIST) were also recorded. These patients were propensity matched in a 1: 1 ratio to athletes undergoing revision hip arthroscopy with labral repair for comparison.
A total of 46 athletes (N = 47 hips) were reported from 50 (n = 51 hips) athletes who underwent revision with labral reconstruction. A subanalysis of 30 propensity-matched athletes undergoing revision labral reconstruction was performed, with a mean follow-up time of 26.3 ± 2.4 months and an age of 28.5 ± 10.1 years, and compared with a revision labral repair group. Significant improvements were obtained for the mHHS, the NAHS, the HOS-SSS, and the VAS from preoperative to the latest follow-up ( < .001), with an achievement MCID rate of 61.5%, 72%, 62.5%, and 76.9% for the mHHS, the NAHS, the HOS-SSS, and the VAS, respectively. The rate for re-revision surgery (2 tertiary arthroscopy and 1 conversion to total hip arthroplasty) was 10%, and 14 patients (63.6%) were able to RTS. Improvements in PROs, rates of achieving MCID/MOIST, rate of re-revision surgery (re-revision hip arthroscopy, = .671; conversion to total hip arthroplasty, > .999), and RTS rate ( = .337) were similar when compared with those of the propensity-matched control labral repair group ( > .05).
Revision hip arthroscopy with labral reconstruction, in the context of an irreparable labral tear, seems to be a valid treatment option in the athletic population, demonstrating significant improvements in all PROs and low rates of undergoing revision surgery. Athletes experienced a similar magnitude of improvement in PROs, RTS rate, and revision surgery rate to that of a propensity-matched control group of athletes undergoing revision hip arthroscopy with labral repair.
接受髋关节镜下翻修手术联合盂唇重建的运动员发病率不断增加。然而，运动员接受髋关节镜下翻修手术联合盂唇重建的效果尚未得到充分证实。
（1）报告接受髋关节镜下翻修手术联合盂唇重建的高水平运动员的最低 2 年患者报告结局（PRO）评分和重返运动（RTS）特征；（2）并与接受髋关节镜下翻修手术联合盂唇修复的高水平运动员的匹配倾向对照组的临床结果进行比较。
队列研究；证据等级，3 级。
前瞻性收集数据，并对 2010 年 4 月至 2019 年 3 月期间接受髋关节镜下翻修手术和盂唇重建的任何级别的运动员进行回顾性分析。报告改良 Harris 髋关节评分（mHHS）、非关节炎髋关节评分（NAHS）、髋关节特异性结局评分-运动亚量表（HOS-SSS）、疼痛视觉模拟量表（VAS）和 RTS 的最低 2 年 PRO。还记录了达到最小临床重要差异（MCID）和最大结局改善满意度阈值（MOIST）的运动员比例。这些患者按 1:1 的比例与接受髋关节镜下翻修手术联合盂唇修复的运动员进行匹配，以进行比较。
共报告了 50 名（n = 51 髋）运动员中有 46 名（n = 47 髋）接受髋关节镜下翻修手术联合盂唇重建。对 30 名接受髋关节镜下翻修手术联合盂唇重建的匹配倾向运动员进行了亚分析，平均随访时间为 26.3 ± 2.4 个月，年龄为 28.5 ± 10.1 岁，并与接受髋关节镜下翻修手术联合盂唇修复的对照组进行比较。mHHS、NAHS、HOS-SSS 和 VAS 从术前到末次随访均有显著改善（<.001），mHHS、NAHS、HOS-SSS 和 VAS 的 MCID 率分别为 61.5%、72%、62.5%和 76.9%。再次手术率（2 次三级关节镜检查和 1 次转为全髋关节置换术）为 10%，14 名患者（63.6%）能够重返运动。PRO 的改善、MCID/MOIST 达到率、再次手术率（再次髋关节镜检查，=.671；全髋关节置换术，>.999）和 RTS 率（=.337）与匹配倾向的盂唇修复对照组相似（>.05）。
在不可修复的盂唇撕裂的情况下，髋关节镜下翻修手术联合盂唇重建似乎是运动人群的一种有效治疗选择，所有 PRO 均有显著改善，且再次手术率较低。与接受髋关节镜下翻修手术联合盂唇修复的匹配倾向对照组相比，运动员的 PRO 改善、RTS 率和再次手术率相似。
