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Outcomes After Anatomic Labral Repair With All-Suture Knotless Tensionable Anchors in Primary Hip Arthroscopic Surgery: A Prospective Analysis of 200 Consecutive Patients

Author(s): Maldonado DR, Bruning RE, Nerys-Figueroa J, Domb BG

DOI: 10.1016/j.arthro.2020.10.001

Background

Restoration of the labral suction seal is a critical objective in hip arthroscopy for femoroacetabular impingement syndrome (FAIS). The use of all-suture knotless tensionable anchors represents an evolution in anatomic labral repair techniques, offering the potential benefits of reduced hardware profile, minimized soft tissue irritation, and controlled repair tension. However, outcome data on this technique remain limited.

Methods

This prospective case series included 200 consecutive primary hip arthroscopies performed for FAIS and labral tears between April 2019 and February 2021. All procedures utilized all-suture knotless tensionable anchors and a controlled-tension anatomic labral repair approach.

  • Inclusion: Primary cases only; FAIS with labral pathology
  • Exclusion: Prior ipsilateral hip conditions, Tönnis grade >1, workers' compensation cases
  • Patient-reported outcomes (PROs) collected at baseline and ≥2 years post-op:
    • mHHS, NAHS, HOS-SSS, iHOT-12, VAS for pain, and satisfaction
  • Metrics: MCID, PASS, MOI, revision rate, and survivorship free from total hip arthroplasty (THA)

Key Findings

  • Significant improvements in all PROs at ≥2-year follow-up (p < 0.05)
  • High MCID achievement:
    • mHHS: 91.0%
    • NAHS: 92.0%
    • HOS-SSS: 93.5%
    • VAS: 92.5%
  • PASS achievement:
    • mHHS: 80.5%
    • NAHS: 73.0%
    • HOS-SSS: 77.0%
  • MOI achievement:
    • NAHS: 74.5%
    • HOS-SSS: 76.5%
  • Overall clinical success (MCID or PASS in ≥1 metric): 95.5%
  • Revision rate: 4.0% (mean time to revision: 31.4 months)
  • Survivorship free from THA: 97.5%

Conclusion

Anatomic labral repair using all-suture knotless tensionable anchors in the setting of primary hip arthroscopy for FAIS results in high rates of clinical success, low revision rates, and strong short-term durability. These findings support the technique as an effective and reproducible option in hip preservation surgery.

What Does This Mean for Providers?

  • The use of knotless, tensionable all-suture anchors offers a minimally invasive and highly effective alternative to traditional labral repair constructs.
  • Controlled tensioning enables precise anatomic restoration, which may improve the integrity of the suction seal and contribute to patient satisfaction and functional gains.
  • The low revision (4%) and THA conversion (2.5%) rates reinforce the approach’s early durability in appropriately selected patients.
  • Given the high MCID and PASS achievement across multiple PROs, this technique may represent a best-practice option in FAIS labral repair protocols.
  • Continued follow-up is warranted to evaluate long-term survivorship and durability beyond the 2-year mark.
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