Comparative Outcomes of Autograft and Allograft in Hip Labral Reconstruction: A Systematic Review and Meta-analysis

Abstract

Background:

There is currently no consensus regarding the superiority of allografts or autografts in labral hip reconstruction.

Purpose:

To compare patient outcomes after arthroscopic labral reconstruction using autografts versus allografts.

Study Design:

Meta-analysis; Level of evidence, 4.

Methods:

A systematic review and meta-analysis were conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Embase, and Scopus databases were queried on February 2, 2025. Original outcome studies on arthroscopic hip labral reconstruction with clearly delineated graft type and a mean follow-up of at least 1 year were included. Studies with a mean follow-up <1 year, nonarthroscopic labral reconstruction, or unclear graft-specific outcomes were excluded. Data were extracted from 30 studies (1968 hips: 1071 autograft, 897 allograft). A random-effects meta-analysis was performed using RStudio to assess patient-reported outcomes, revision surgery, and complication rates.

Results:

There were no significant differences in most patient-reported outcomes: Harris Hip Score (allograft: 27.5 vs autograft: 24.6; P = .17), Hip Outcome Score (HOS) Activities of Daily Living (20.9 vs 22.8; P = .59), HOS Sports (33.2 vs 34.0; P = .65), SF-12 Physical score (10.0 vs 7.0; P = .19), and visual analog scale pain score (−3.5 vs −4.2; P = .34). The SF-12 Mental score improvement was significantly higher in the allograft group (5.2 vs 0.0; P = .03), although sample size was limited. Complication rates approached significance favoring allografts (<1% vs 3%; P = .06). No significant differences were observed in revision arthroscopy (1% allograft vs 5% autograft; P = .07) or conversion to total hip arthroplasty (3% vs 7%; P = .20). Considerable heterogeneity existed in surgical technique and concomitant procedures.

Conclusion:

Labral reconstruction using autograft or allograft tissue produces comparable improvements in most functional and pain outcomes. Use of allograft was associated with significantly higher mental health improvements, and further investigation is warranted to understand if it may carry a lower complication burden.