Allograft reconstruction of acetabular labrum has comparable outcomes to labral refixation

**Background:** The acetabular labrum is critical for hip stability, fluid seal maintenance, and cartilage protection. Labral tears disrupt this seal and can lead to osteoarthritis. While labral refixation is the gold standard for repairable tears, severe or previously debrided labra may be unsalvageable. Labral reconstruction using grafts has emerged as an alternative, but data on optimal graft type, surgical approach, and indications remain limited. Most reconstructions are performed arthroscopically; however, open techniques may still have a role. This study evaluates outcomes of allograft labral reconstruction via a mini-open anterior approach compared to labral refixation.

**Methods:** Data were reviewed from a prospectively maintained institutional database of patients who underwent mini-open FAI surgery (2003–2019) by a single surgeon. Inclusion criteria: symptomatic FAI, Tönnis grade ≤2, mini-open surgery with femoroplasty and/or acetabuloplasty plus either labral reconstruction or refixation, minimum 2-year follow-up. Twelve patients with irreparable labral defects underwent reconstruction using semitendinosus tendon allograft and were propensity-matched 1:3 to 36 patients who underwent labral repair with anchors. Matching variables: age, gender, BMI, year of surgery, preoperative Tönnis grade, previous hip surgery, residual hip pathology, and extent of acetabular chondral lesion. Primary outcome: survivorship (time to revision FAI surgery or THA conversion). Secondary outcomes: mHHS, SF-36 physical scores, and radiographic parameters (alpha angles, LCEA, ACEA, Tönnis angle, joint space width). Statistical analysis used independent t-tests, Mann-Whitney U tests, chi-square/Fisher exact tests.

**Key Results:** Mean follow-up was 6.40 years (reconstruction) vs 6.68 years (refixation) (p=0.608). Groups were well-matched demographically and radiographically. Intraoperatively, the reconstruction group had significantly more labral calcification (41.7% vs 0%, p<0.001) and fewer labral tears (33.3% vs 100%, p<0.001). THA conversion rates: 25% (3/12) in reconstruction vs 8.3% (3/36) in refixation (p=0.156). Time to THA conversion was significantly longer in the reconstruction group: 3.58 years (±1.04) vs 1.20 years (±0.93) (p=0.042). Both groups showed significant improvements in mHHS and SF-36 physical scores (p<0.001). Postoperative mHHS: 85.8 (±1.63) reconstruction vs 69.8 (±22.3) refixation (p=0.184). Postoperative SF-36 physical: 47.8 (±6.03) vs 38.6 (±10.5) (p=0.067). The mHHS improvement (Δ) was +29.1 points in reconstruction vs +16.0 points in refixation (not significant). No revision FAI surgeries occurred in either group.

**Clinical Implications:** Allograft labral reconstruction via the mini-open anterior approach provides comparable functional outcomes and significantly longer hip survivorship compared to labral refixation in patients with unsalvageable labral tears. The semitendinosus allograft avoids donor-site morbidity associated with autograft harvesting. Despite a higher (non-significant) THA conversion rate in the reconstruction group (likely reflecting more severe baseline pathology), the longer time to conversion suggests reconstruction may delay disease progression. These findings support labral reconstruction as a viable option for irreparable labral damage, though larger studies with longer follow-up are needed. Limitations include small sample size, retrospective design, single-surgeon series, and lack of postoperative imaging to assess graft healing.