EP1.22 Clinical Outcomes of Arthroscopic Labral Repair in Borderline Dysplastic Hips: A Case Series

Abstract

Abstract Background Surgical management of borderline hip dysplasia (BHD) presents unique challenges due to underlying instability. While arthroscopic labral repair with capsular plication has shown success in this population, the role of labral reconstruction, particularly in relation to the size of the native labrum, remains underexplored. Purpose To compare 2-year clinical outcomes of primary hip arthroscopy with labral reconstruction versus labral repair in patients with BHD (lateral center-edge angle 18–25°), and to evaluate the impact of native labral size on outcomes. We hypothesized that both techniques would lead to significant improvements, with reconstruction offering greater benefit in patients with a small native labrum. Methods BHD patients who underwent labral reconstruction or augmentation were propensity matched 1:1 to patients who underwent labral repair. Intraoperative labral size was documented at four locations, with a small native labrum (SNL) defined as <5 mm at any location. Patient-reported outcome measures (PROs) included the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sports Subscale (HOS-SSS), International Hip Outcome Tool–12 (iHOT-12), and Visual Analog Scale (VAS) for pain. Rates of achieving the Minimal Clinically Important Difference (MCID) and the Patient Acceptable Symptom State (PASS) were compared. A subanalysis examined outcomes by labral size. Results Thirty-five patients were included in each group. Both the reconstruction and repair groups demonstrated significant improvements in all PROs at 2-year follow-up (p < 0.01), with no significant differences in overall outcomes or rates of achieving MCID or PASS. There was a 2.5 relative risk of conversion to both a total hip arthroplasty, as well as revision arthroscopy for BHD patients undergoing repair versus reconstruction (95% CI: 0.52 to 12.0, p=0.25). Additionally, the 35 patients who underwent reconstruction had significantly superior outcomes in mHHS (p = 0.049), HOS-SSS (p < 0.046), and VAS (p < 0.04) compared to SNL patients who underwent repair. Within the SNL subgroup, patients treated with reconstruction showed significantly greater improvements in mHHS (p = 0.03), NAHS (p = 0.04), HOS-SSS (p < 0.01), and VAS (p < 0.01) than those treated with repair. Conclusion Labral reconstruction provides favorable outcomes in patients with BHD. When considering labral size, BHD patients with a small native labrum who undergo repair have inferior outcomes compared to those with normal-sized labra undergoing either treatment. These findings suggest that labral reconstruction may warrant consideration in BHD patients with a small labrum, potentially due to enhanced effective hip stability through a larger labral graft.