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Outcomes After Anatomic Labral Repair With All-Suture Knotless Tensionable Anchors in Primary Hip Arthroscopic
David R Maldonado1, Rachel E Bruning2, Julio Nerys-Figueroa2
1Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA.
Background:
Anatomic labral repair is paramount when restoring the hip suction sealing mechanism in femoroacetabular impingement syndrome (FAIS) surgery. All-suture knotless tensionable anchors have been recently proposed as an alternative; however, data are scarce.
Purpose:
To report patient-reported outcome measure (PROM) scores at a minimum 2-year follow-up for patients who underwent primary hip arthroscopic surgery with labral repair using an all-suture knotless tensionable anchor with the controlled-tension anatomic technique in the setting of FAIS.
Study Design:
Case series; Level of evidence, 4.
Methods:
Data were prospectively collected, and patients who underwent primary hip arthroscopic surgery for the treatment of FAIS and labral tears using an all-suture knotless tensionable anchor with the controlled-tension anatomic technique between April 2019 and February 2021 were included. Patients were excluded if they had previous ipsilateral hip conditions or surgery, Tönnis grade >1, or workers' compensation insurance. Baseline and minimum 2-year follow-up scores for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), visual analog scale (VAS) for pain, International Hip Outcome Tool-12 (iHOT-12), and patient satisfaction were collected. Rates of achieving the minimal clinically important difference (MCID), the Patient Acceptable Symptomatic State (PASS), and the maximum outcome improvement (MOI) as well as the rate of secondary procedures were reported. Survivorship was defined as no conversion to total hip arthroplasty.
Results:
A total of 200 patients (200 hips) were included for analysis with a minimum 2-year follow-up. There were 141 female (70.5%) and 59 male (29.5%) patients with a mean age and mean body mass index of 33.3 ± 13.5 years and 24.5 ± 4.8 kg/m2, respectively. A significant improvement on all PROMs from baseline to a minimum 2-year follow-up was reported (P < .05). The cohort demonstrated high rates of achieving the MCID for the mHHS (91.0%), NAHS (92.0%), HOS-SSS (93.5%), and VAS (92.5%); high rates of achieving the PASS for the mHHS (80.5%), NAHS (73.0%), and HOS-SSS (77.0%); and high rates of achieving the MOI for the NAHS (74.5%) and HOS-SSS (76.5%), with 95.5% of patients achieving the MCID or PASS for at least 1 metric. The survivorship rate at a minimum 2-year follow-up was 97.5%, and 4.0% of patients underwent subsequent revision hip arthroscopic surgery at a mean of 31.4 months.
Conclusion:
At a minimum 2-year follow-up, patients who underwent primary hip arthroscopic surgery for FAIS with labral tears using an all-suture knotless tensionable anchor demonstrated a significant improvement on all the PROMs examined. Moreover, high achievement rates of the MCID, PASS, and MOI were reported. Based on this prospective analysis, labral repair using an all-suture knotless tensionable anchor seems to be a safe and valid option.
