FP3.2 Comparative Outcomes of Arthroscopic Labral Repair Versus Labral Reconstruction for Femoroacetabular Impingement: A Systematic Review and Meta-Analysis

Abstract ICLB03 - The Labral Reconstruction Masterclass: Autografts, Allografts, and Technical Frontiers, Session Room 12 (BMCC Level 3), October 8, 2026, 10:30 - 12:30 Introduction Arthroscopic management of femoroacetabular impingement (FAI) syndrome frequently requires treatment of labral pathology. While labral repair remains the preferred technique, reconstruction has emerged as an alternative when tissue quality is inadequate. Comparative outcomes between these techniques remain debated, with conflicting results reported in the literature. This systematic review and meta-analysis aimed to compare patient-reported outcomes, clinically meaningful improvement, and failure rates following labral repair versus reconstruction for FAI-related labral tears. Methods A systematic literature search was performed in PubMed, Embase, and Google Scholar from inception through November 14, 2025, identifying comparative studies evaluating arthroscopic labral repair versus reconstruction with minimum 2-year follow-up per PRISMA guidelines. Outcomes included patient-reported outcome measures (PROMs), achievement of minimal clinically important difference (MCID) and patient acceptable symptom state (PASS), revision arthroscopy rates, and conversion to total hip arthroplasty (THA). Random-effects meta-analyses were performed. Results Twelve studies comprising 2,664 patients met inclusion criteria (1,828 repair; 778 reconstruction). Meta-analysis demonstrated no significant between-group differences in preoperative, postoperative, or change scores for mHHS, NAHS, VAS pain, HOS-SS, iHOT-12, or SF-12 physical and mental component scores. Reconstruction demonstrated significantly greater improvement in Lower Extremity Functional Scale scores (SMD 7.90 ± 3.19; P = 0.01), while patient satisfaction showed a non-significant trend favoring repair. Rates of achieving MCID and PASS for mHHS and iHOT-12 were comparable between groups. Overall failure and revision arthroscopy rates did not differ; however, labral reconstruction was associated with significantly higher odds of conversion to THA (OR 2.19; 95% CI, 1.29–3.73; P < 0.01). Conclusion Arthroscopic labral repair and reconstruction yield comparable improvements in PROMs, clinically meaningful thresholds, and revision rates for FAI-related labral pathology. Despite worse baseline pathology in reconstruction cohorts, similar functional outcomes suggest reconstruction may effectively restore hip function in more advanced disease. Future randomized studies are needed to clarify whether observed equivalence reflects true technique parity or improvements primarily driven by correction of underlying osseous morphology. Keywords Femoroacetabular impingement; labral repair; labral reconstruction; hip arthroscopy; patient-reported outcomes; MCID; PASS; meta-analysis.