Advertisement

Arthroscopic Repair of the Acetabular Labrum: A Histologic Assessment of Healing in an Ovine Model

      Purpose: Recently, arthroscopic repair has been advocated for the treatment of labral tears. The purpose of this study was to document the histologic healing process in an arthroscopically repaired acetabular-labral detachment in an ovine model. Methods: A total of 10 skeletally mature female sheep underwent unilateral arthroscopic labral repair. A 1.5-cm-long incision was made at the junction of the labrum and acetabulum. The labral detachment was then repaired arthroscopically with a single suture anchor. Postoperatively, the animals were confined to small indoor pens, and no form of immobilization was used. After 12 weeks, the animals were killed and the labral repair evaluated via routine histology. Normal labra from 3 nonoperative animals were also processed for histology. Results: The acetabular labrum of the sheep is an avascular, fibrocartilaginous structure similar in anatomic design to that of human beings. All arthroscopically repaired labra appeared stable and grossly healed at 12 weeks. Histologically, labral healing appeared to occur via fibrovascular scar tissue originating from the joint capsule or the exposed bony attachment of the labrum (or both). However, the labral healing was incomplete in all specimens, with a shallow, superficial cleft remaining at the junction of the labrum and the articular surface of the acetabulum. Conclusions: Arthroscopically repaired acetabular-labral lesions in sheep are capable of healing via fibrovascular repair tissue or direct reattachment via new bone formation (or both). Clinical Relevance: The ability of labral detachments to heal in this animal model provides the rationale for additional investigations into the clinical efficacy of arthroscopic labral repair in human beings.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Altenberg A.P.
        Acetabular labrum tears: A cause of hip pain and degenerative arthritis.
        South Med J. 1977; 70: 174-175
        • Byrd J.W.
        Labral lesions: An elusive source of hip pain case reports and literature review.
        Arthroscopy. 1996; 12: 603-612
        • Kelly B.T.
        • Weiland D.E.
        • Schenker M.L.
        • Philippon M.J.
        Arthroscopic labral repair in the hip: Surgical technique and review of the literature.
        Arthroscopy. 2005; 21: 1496-1504
        • Philippon M.J.
        • Schenker M.L.
        A new method for acetabular rim trimming and labral repair.
        Clin Sports Med. 2006; 25: 293-297
        • Ganz R.
        • Parvizi J.
        • Beck M.
        • Leunig M.
        • Notzli H.
        • Siebenrock K.A.
        Femoroacetabular impingement: A cause for osteoarthritis of the hip.
        Clin Orthop Relat Res. 2003; : 112-120
        • Philippon M.J.
        Arthroscopic capsulorrhaphy of the hip: A review of 12 cases.
        Arthroscopy. 2000; 16 (abstr): 416
        • Philippon M.J.
        The role of arthroscopic thermal capsulorrhaphy in the hip.
        Clin Sports Med. 2001; 20: 817-829
        • Byrd J.W.
        • Jones K.S.
        Hip arthroscopy in the presence of dysplasia.
        Arthroscopy. 2003; 19: 1055-1060
        • Dorell J.H.
        • Catterall A.
        The torn acetabular labrum.
        J Bone Joint Surg Br. 1986; 68: 400-403
        • McCarthy J.C.
        • Noble P.C.
        • Schuck M.R.
        • Wright J.
        • Lee J.
        The role of labral lesions to development of early degenerative hip disease.
        Clin Orthop Relat Res. 2001; : 25-37
        • McCarthy J.C.
        • Noble P.C.
        • Schuck M.R.
        • Wright J.
        • Lee J.
        The watershed labral lesion: Its relationship to early arthritis of the hip.
        J Arthroplasty. 2001; 16: S81-S87
        • Farjo L.A.
        • Glick J.M.
        • Sampson T.G.
        Hip arthroscopy for acetabular labral tears.
        Arthroscopy. 1999; 15: 132-137
        • Fitzgerald Jr, R.H.
        Acetabular labrum tears.
        Clin Orthop Relat Res. 1995; : 60-68
        • Konrath G.A.
        • Hamel A.J.
        • Olson S.A.
        • Bay B.
        • Sharkey N.A.
        The role of the acetabular labrum and the transverse acetabular ligament in load transmission in the hip.
        J Bone Joint Surg Am. 1998; 80: 1781-1788
        • Ferguson S.J.
        • Bryant J.T.
        • Ganz R.
        • Ito K.
        The acetabular labrum seal: A poroelastic finite element model.
        Clin Biomech. 2000; 15: 463-468
        • Ferguson S.J.
        • Bryant J.T.
        • Ganz R.
        • Ito K.
        The influence of the acetabular labrum on hip joint cartilage consolidation: A poroelastic finite element model.
        J Biomech. 2000; 33: 953-960
        • Ferguson S.J.
        • Bryant J.T.
        • Ganz R.
        • Ito K.
        An in vitro investigation of the acetabular labral seal in hip joint mechanics.
        J Biomech. 2003; 36: 171-178
        • Espinosa N.
        • Rothenfluh D.A.
        • Beck M.
        • Ganz R.
        • Leunig M.
        Treatment of femoro-acetabular impingement: Preliminary results of labral refixation.
        J Bone Joint Surg Am. 2006; 88: 925-935
        • Murphy K.P.
        • Ross A.E.
        • Javernick M.A.
        • Lehman Jr, R.A.
        Repair of the adult acetabular labrum.
        Arthroscopy. 2006; 22 (567.e1-567.3. Available online at www.arthroscopyjournal.org)
        • Seldes R.M.
        • Tan V.
        • Hunt J.
        • Katz M.
        • Winiarsky R.
        • Fitzgerald Jr, R.H.
        Anatomy, histologic features, and vascularity of the adult acetabular labrum.
        Clin Orthop Relat Res. 2001; : 232-240
        • Petersen W.
        • Petersen F.
        • Tillmann B.
        Structure and vascularization of the acetabular labrum with regard to the pathogenesis and healing of labral lesions.
        Arch Orthop Trauma Surg. 2003; 123: 283-288
        • Kelly B.T.
        • Shapiro G.S.
        • Digiovanni C.W.
        • Buly R.L.
        • Potter H.G.
        • Hannafin J.A.
        The vascularity of the hip labrum: A cadaveric investigation.
        Arthroscopy. 2005; 21: 3-11
        • Arnoczky S.P.
        • Warren R.F.
        Microvasculature of the human meniscus.
        Am J Sports Med. 1982; 10: 90-95
        • Arnoczky S.P.
        • Warren R.F.
        The microvasculature of the meniscus and its response to injury.
        Am J Sports Med. 1983; 11: 131-141
        • Miozzari H.H.
        • Clark J.M.
        • Jacob H.A.
        • von Rechenberg B.
        • Notzli H.P.
        Effects of removal of the acetabular labrum in a sheep hip.
        Osteoarthritis Cartilage. 2004; 12: 419-430
        • Rodeo S.A.
        • Arnoczky S.P.
        • Torzilli P.A.
        • Hidaka C.
        • Warren R.F.
        Tendon healing in a bone tunnel: A biomechanical and histological study in the dog.
        J Bone Joint Surg Am. 1993; 75: 1795-1803