Arthroscopic Labral Repair Versus Debridement for Femoroacetabular Impingement: A Systematic Review and Meta-analysis of 2730 Hips.

BACKGROUND: Arthroscopic management of acetabular labral pathology in femoroacetabular impingement (FAI) has progressively shifted toward labrum preservation; however, the effectiveness of labral repair over debridement remains unsettled.

PURPOSE: To compare arthroscopic labral repair versus debridement for FAI regarding patient-reported outcomes, pain, and risk of conversion to total hip arthroplasty (THA).

METHODS: The study protocol was registered on PROSPERO (CRD420251062063). A systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials was performed through October 21, 2025. Randomized controlled trials (RCTs) and comparative cohort studies evaluating arthroscopic labral repair versus arthroscopic labral debridement for FAI were included. Open procedures and labral reconstruction were excluded to minimize clinical heterogeneity. Outcomes included the Modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), visual analog scale (VAS) pain score, and conversion to THA. Random-effects models were applied, with prespecified subgroup analyses by study design and follow-up duration (<5 vs ≥5 years).

RESULTS: Ten studies consisting of 2730 hips (1580 repairs, 1150 debridements) were included. No significant difference was observed in pooled mHHS (mean difference [MD], 1.92; 95% CI, -2.33 to 6.16). HOS outcomes varied by study design: observational cohorts demonstrated no significant between-group differences for HOS-ADL (MD, 0.69) or HOS-SSS (MD, 0.11), whereas the RCT demonstrated significantly higher scores favoring labral repair for both HOS-ADL (MD, 10.30) and HOS-SSS (MD, 12.40). VAS pain scores were comparable at short-term follow-up but favored repair at ≥5 years (MD, -1.37). Conversion to THA occurred in 3.5% of repaired hips versus 7.4% of debrided hips, with labral repair associated with a significantly lower risk of THA (risk ratio, 0.56; 95% CI, 0.37 to 0.84; P = .006), driven by long-term follow-up.

CONCLUSION: Labral repair confers a significant protective benefit against conversion to THA and superior pain relief at mid- to long-term follow-up. While functional outcomes appear equivalent in observational cohorts, randomized evidence demonstrates superior activity-related scores favoring repair.

STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 3.