Labral Repair Versus Labral Reconstruction in Arthroscopic Treatment of Femoroacetabular Impingement: A Systematic Review and Meta-Analysis.

In the arthroscopic management of femoroacetabular impingement (FAI), labral repair and labral reconstruction are widely used, but their comparative effectiveness remains uncertain. This systematic review and meta-analysis compared functional outcomes, pain scores, revision hip arthroscopy, and conversion to total hip arthroplasty (THA) between labral repair and labral reconstruction in patients undergoing hip arthroscopy for FAI. In November 2025, a systematic search of PubMed, Scopus, Web of Science, Excerpta Medica database (Embase), and the Cochrane Library identified comparative studies reporting extractable postoperative outcomes. Fourteen non-randomized comparative cohorts, including 2,290 hips (1,530 labral repairs and 760 labral reconstructions), met the inclusion criteria. Data were extracted in duplicate, and methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). A fixed-effect model was used to calculate standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs). Labral reconstruction showed a small but statistically significant advantage in postoperative modified Harris Hip Score (mHHS), whereas other functional outcomes, including the Nonarthritic Hip Score (NAHS), Hip Outcome Score Sports Subscale (HOS-SS), and 12-item International Hip Outcome Tool (iHOT 12), were comparable between techniques. Pain improvement measured using the Visual Analog Scale (VAS) was also similar, and revision hip arthroscopy rates did not differ meaningfully between groups. In contrast, labral repair was associated with a significantly lower risk of conversion to THA than labral reconstruction. Heterogeneity across pooled analyses was low, and no relevant publication bias was detected. These findings indicate that both labral repair and labral reconstruction provide clinically important improvement after hip arthroscopy for FAI, with reconstruction performing reliably in irreparable labral pathology, while the lower arthroplasty conversion rate seen with repair likely reflects more favorable baseline joint status in hips where the native labrum can be preserved rather than a direct causal effect of the technique.