Labral Base Refixation in the Hip: Rationale and Technique for an Anatomic Approach to Labral Repair

Arthroscopic labral repair with simple looped suture technique of left hip viewed from anterolateral portal in supine position. Although the repair achieves approximation of the labrum (L) to the acetabular rim (A), it is bunched into a cylindrical shape, failing to reproduce the native triangular cross-sectional shape. (FH, femoral head.)

(A) Labral repair with a simple looped stitch that passes over the free edge of the labrum (L), causing bunching of the labrum and distortion of the normal triangular cross-sectional anatomy of the labrum. The labrum is bunched and everted away from the femoral head (FH), disrupting the contact seal (arrow). The first 3 modes of failure of nonanatomic labral refixation are illustrated here. (A, acetabulum.) (B) In LBR the labral base stitch involves a single passage of suture through the base of the labrum (L). This achieves secure fixation of the labral base while preserving the triangular cross-sectional anatomy of the labrum. The contact of the labrum with the femoral head (FH) is preserved, allowing the labrum to serve its function as a suction seal and in regulating fluid ingress and egress from the joint. (A, acetabulum.) (C) LBR with vertical mattress technique. The vertical mattress labral base stitch involves 2 passes of the suture through the base of the labrum (L). This technique is recommended when the width of the labrum is at least 5 mm. In addition to providing secure fixation of the labral base, this technique is ideal in preserving the triangular shape of the labrum and its fit against the femoral head (FH). (A, acetabulum.)

Labral repair with a simple stitch looped over the labrum in a left hip viewed from the anterolateral portal from the peripheral compartment. It should be noted that the repair achieves approximation of the labrum (L) to the acetabular rim but bunches the labrum and disrupts the contact seal (arrows) with the femoral head (FH). This figure also shows the first 3 modes of failure of nonanatomic simple stitch repair.

Splitting or intrasubstance tearing of the labrum (L) by a penetrating instrument in a right hip viewed from the anterolateral portal. The use of a larger penetrating instrument, as shown here, is likely to cause injury to the labrum by virtue of its larger diameter. To avoid such injury, a smaller-diameter penetrating device is preferred. (FH, femoral head; A, acetabulum.)

Labral detachment during acetabuloplasty of a left hip viewed from the anterolateral portal in the central compartment. Labral detachment is performed before acetabuloplasty so as to preserve the labrum (L) during the rim trimming. The beaver blade is used to carefully elevate the labrum off of the acetabular rim (A), with preservation of as much labral tissue as possible. The beaver blade is seen here cutting along the chondrolabral junction. The labrum can then be retracted away from the pincer lesion as acetabuloplasty is performed. (FH, femoral head.)

Decision algorithm for labral preservation during acetabuloplasty.

Labral base stitch in a right hip viewed from the anterolateral portal. The stitch is passed through the labrum (L) with the Suture Lasso. In this case a No. 2 FiberStick suture (Arthrex) is passed directly through the penetrating instrument, bypassing the need for the Suture Lasso to pass suture. The correct angle of passage of the suture is critical to restoring the anatomy of the labrum. (FH, femoral head; A, acetabulum.)

(A) Completed LBR in a right hip viewed from the anterolateral portal. This intra-articular view from the central compartment shows the restoration of the normal anatomy of the labrum (L). The nearly seamless transition between the articular cartilage and labrum at the chondrolabral junction (arrow) should be noted. (FH, femoral head; A, acetabulum.) (B) Completed LBR in a left hip viewed through the anterolateral portal from the peripheral compartment after release of traction. It should be noted that the tight contact (arrows) between the labrum (L) and femoral head (FH) has been restored throughout the area of labral repair. The restoration of contact with the femoral head reproduces the labral seal. This allows the labrum to function in maintenance of fluid flow, stability, and suction seal. (A, acetabulum.)