So, here are our disclosures. So as you know, labral volume as well as the chondrolabral junction are critical factors in the hip suction seal mechanism. Augmentation of the labrum is a procedure that optimizes both labral volume but also maintains the native chondrolabral junction. In the revision setting, clinical outcomes following both labral repair and labrum reconstruction have been reported to be successful. There isn't as much evidence in the realm of augmentation, and this alternative is considered when the remaining labrum is inadequate in size but circumferential fibers are still present. This comparative study that I've shown here was out of our institution, and it compared in the revision setting augments versus labral reconstructions, and although it showed no difference in revision rates or conversions to total liparthroplasty between groups, the augmentation group scored higher on many of the patient-reported outcome measures obtained. So the purpose of the current study was to determine the patient-reported outcome measures and survivorship of the labral augmentation procedure using ileotilioband, autograft, or allograft for labral deficiency with a minimum of three years follow-up. We used our prospective data registry and queried for all patients who underwent the augmentation procedure by Mark Dolopon between 2011 and 2017, again with a minimum of three year follow-up. We included patients who had prior hip arthroscopy, those without dysplasia greater than 18 years old and who had continued pain and disability despite conservative treatments with positive intra-articular exam findings, excluded people under the age of 18, those with prior fractures or AVN, dysplasia, and advanced tonus grades. All patients underwent labral augmentation for insufficient labral tissue as deemed at the time of surgery by the senior author. So getting to our results, this included 88 patients with an average age of 32 and a mean follow-up of five years. Again, this was 100% revision surgeries, not used in the primary setting. So some limitations of the study was that in a revision cohort, there was some heterogeneity of the other pathologies present, but also some of the procedures performed. As you can see, there was a high amount of chondral damage, both on the acetabular and femoral side, accounting for about 50% of patients. And about a quarter to a third of these underwent microfracture, which is a treatment of choice for chondral defects that are high grade. Looking at the patient-reported outcome measures, one of the primary goals, you can see from pre-op to post-op, there was a significant increase in improvement. And looking at the MCID and patient acceptable symptomatic states, these numbers were pretty high at the average five-year follow-up. Survivorship at five years, and defined as conversion to total HIP, was 93%. But there was a relatively high rate of revision surgery, about 14% underwent a arthroscopic revision. These occurred at about 2.6 years from the primary. And at the time of revision, all of the cases were found to have adhesions, in addition to other pathologies, including some capsular defects that went on to a capsular reconstruction. Looking at just this small subgroup, about two of those were in autographs, and nine were in allographs. So this actually prompted a secondary study, which is unpublished, but being presented. Looking back at all of his autograph versus allographs in the setting of both either reconstructions or augmentations, and in that cohort, we did find that the allographs did have a higher rate, about three times higher, of needing revision arthroscopic surgery for adhesions. So this is, again, just early data, but it's sort of changed the practice towards using autographs for augmentations. So some other limitations, as I mentioned previously. All patients included were revision surgeries, many with additional pathologies, including residual impingement, cartilage damage, and capsular lesions, as well as they all underwent a heterogeneous concomitant intervention. So it's hard to tease out how much of these results are actually just based upon the augmentation alone. And another limitation is that the MCID and PASS scores reported were not validated for this specific patient population. And in conclusion, labral augmentation provides a valuable labral preserving option when addressing hip labral pathology when viable native labral fibers are present. Augmentation in the revision setting, as we've shown here, leads to improved patient-reported outcome measures that still hold up after a minimum of three years. One concerning point is that 14% arthroscopic revision rate, and so we've taken steps, as I mentioned, to try to refine on what's leading to adhesions. And so moving more towards autograft has sort of been his choice, but also some other things, including antifibrinolytics, like using Losartan and some other measures to try to reduce fibrosis have been used. Thanks. Thank you.

labral augmentation

chondrolabral junction

hip suction seal mechanism

patient-reported outcome measures

revision surgery