Uppstrom, Tyler J.

Abstract Introduction Labral reconstruction has seen an increase in utilization over the last decade. As a result of the increasing number of labral reconstructions being performed, there has been a subsequent increase in the number of failed labral reconstructions requiring revision. The purpose of the present study was to report the short-term survivorship and outcomes of patients who underwent segmental acetabular labral reconstruction in the setting of a failed prior labral reconstruction. Methods A retrospective review of all labral reconstructions performed by the senior author between 01/01/2010-04/01/2022 was conducted. Patients who underwent a labral reconstruction and were over 18 at the time of surgery were included. Patients with a history of avascular necrosis, Legg-Calvé-Perthes, or with a lateral center edge angle < 18° were excluded. Demographics, radiographic parameters, and patient reported outcomes (PROs) were collected. Patients who underwent a labral reconstruction in the setting of a prior failed labral reconstruction (Group B) were matched in a 1:1 fashion to patients in a control group who underwent only one labral reconstruction (Group A) by age, sex, LCEA, minimum joint space, and the presence of an Outerbridge Grade 3 or 4 defect. Results A total of 24 hips (23 patients) were included in Group B. Mean age at the time of surgery was 36 ± 13 years, and most hips were female (n=14, 58%). Twenty-two (92%) of the hips met a study endpoint, with 3 (14%) converting to total hip arthroplasty (THA) and 3 (14%) undergoing a subsequent hip-preserving surgery. The remaining 16 hips reported 2-year minimum PROs and had a median patient satisfaction of 9.5 (Range: 6-10). Additionally, they demonstrated significant improvement from baseline in SF-12 PCS (p=0.004), WOMAC Total (p<0.001), mHHS (p=0.004), HOS-ADL (p=0.002), and HOS-Sport (p=0.002). Notably, patients in Group B demonstrated similar improvement in PROs from baseline compared to the matched-control group (Group A). Conclusion Patients who undergo revision labral reconstruction in the setting of a failed prior labral reconstruction demonstrate significant improvement in PROs post-operatively compared to baseline at a rate similar to patients who underwent only one labral reconstruction.

Abstract Anterior shoulder instability is a common cause of shoulder pain and dysfunction in young patients and may be associated with concomitant bony and soft tissue pathology. Humeral avulsion of the glenohumeral ligament (HAGL) and rotator cuff tears are often seen in the setting of traumatic anterior shoulder instability events, especially in patients over 40 years of age, and portend poor postoperative outcomes if not addressed appropriately. While arthroscopic repair of rotator cuff tears is standard of care, both arthroscopic and open approaches for HAGL repair have been described and are associated with good clinical outcomes. Open HAGL repair affords the ability to address additional pathologies, including subscapularis tears and biceps tendon tears/SLAP tears with open subpectoral tenodesis, with direct visualization of the tear, while affording protection of the neurovascular structures. In this Technical Note, the authors describe their preferred technique for combined arthroscopic rotator cuff tear and open HAGL repair. Technique Video video See video under supplementary data.