Abstract
Purpose
To perform a systematic review comparing clinical outcomes of patients undergoing primary hip arthroscopy with labral repair versus labral reconstruction.
Methods
A systematic review was conducted in March 2025 according to the PRISMA guidelines by searching PubMed, the Cochrane Library, and Embase to identify studies that directly compared clinical outcomes of labral repair versus labral reconstruction during primary hip arthroscopy. Additional outcomes included rate of revision hip arthroscopy and conversion to total hip arthroplasty (THA). The search phrase used was: hip arthroscopy labral repair reconstruction. Articles were included if they directly compared patient-reported outcomes (PROs) between cohorts undergoing labral repair versus reconstruction during primary hip arthroscopy. Studies on revision hip arthroscopy were excluded.
Results
Six studies (all Level III) met the inclusion and exclusion criteria with a total of 1,628 labral repairs and 679 labral reconstructions. Mean patient age ranged from 29.9 to 48.6 years and from 34.6 to 48.1 years in the repair and reconstruction groups, respectively. Mean follow-up ranged from 2.0 years to 5.8 years and from 2.0 years to 5.6 years in the repair and reconstruction groups, respectively. All studies demonstrated significant improvements in PROs from preoperatively to final follow-up in both groups. Two studies reported superior postoperative outcomes in the labral repair groups in terms of the modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Four studies reported no significant differences in postoperative PROs between cohorts. Four studies reported no significant differences in revision hip arthroscopy rates between groups. One study reported a significantly lower likelihood of conversion to THA in the labral repair group (p = 0.024). In studies involving patients aged ≥40 years, primary labral reconstruction demonstrated significantly lower failure rates and similar or lower conversion rates to THA compared to labral repair.
Conclusion
Both labral repair and reconstruction demonstrate significant improvements in PROs at mid-term follow-up. Labral repair generally yields equivalent or superior clinical outcomes and lower rates of conversion to THA, while reconstruction may offer lower failure rates in patients aged ≥40 years.