EP2.1 Revision Strategies for Failed Primary Arthroscopic Labral Reconstruction

Abstract Introduction Labral reconstruction replaces damaged labral tissue in cases of irreparable, deficient, and non-salvageable native tissue. This technique is often used in revision cases following failure of primary labral repair; however, it may be indicated as the primary treatment in severe cases. Although failure of primary labral reconstruction is uncommon, it does occur, and limited guidance on revision strategies exists. Methods This multicenter retrospective case series included patients who underwent revision hip arthroscopy for failed primary arthroscopic labral reconstruction between 2019-2026. Patients indicated for revision hip arthroscopy after failed primary labral reconstruction were included. Patients with history of multiple prior ipsilateral hip surgeries were excluded. Patient demographics, intraoperative findings, and details of revision procedures were collected from the medical record. Results The cohort (n=25) was predominately female (80%) with mean age of 31.6±9.9 years, height of 1.694±0.102 m, weight of 69.1±16.7 kg, and BMI of 24.0±4.2kg/m^2 . Time to revision surgery ranged from 4 months to 9 years with a mean of 2.8±2.0 years. Intraoperative findings included capsular adhesions (77.8%), residual cam deformity (77.8%), ossified labrum (22.2%) and diminutive labrum (11.1%). Revision labral treatment included arthroscopic labral repair (28%), and labral reconstruction (72%). Concomitant arthroscopic procedures included femoroplasty (84%), acetabuloplasty (40%), lysis of adhesions (84%), capsular plication (36%), and capsulorrhaphy (20%). Combined periacetabular osteotomy was indicated in 40% of revision cases. The most common intraoperative findings included residual cam (88%), residual pincer (36%), capsular defect (16.7%), and ossified labrum (16%). Conclusions Underlying structural abnormalities are common in revision arthroscopy, including residual cam morphology and instability requiring PAO. Adhesions are highly prevalent with thick bands of scar tissue forming between the capsule and allograft frequently requiring lysis of adhesions. Revision labral reconstruction was performed more often than repair, suggesting failed allograft tissue is often irreparable. Total hip arthroplasty (THA), although not captured in this cohort, is often indicated in cases of failed labral reconstruction due to ease of recovery. Labral reconstruction is not a benign procedure, and adherence to strict indications is vital to successful outcomes. Future studies should investigate outcomes following THA and revision arthroscopy for failed primary labral reconstruction.