Purpose
The purpose of this study was to histologically examine the human healing response
of arthroscopically repaired acetabular labrum tears.
Methods
Biopsy specimens were retrieved from 6 patients during total hip arthroplasty after
clinical failure of the index arthroscopic procedure. All patients were diagnosed
as having femoroacetabular impingement with a concomitant labral tear. In all cases
severe chondral damage was observed during arthroscopy (Beck grades 3 to 4). Despite
successful technical repair of the labral tear, chondral damage in these patients
was so advanced that the clinical progress after the procedure was unsatisfactory
and arthroplasty of the joint was required. Biopsy specimens of the repaired acetabular
labra were harvested during the arthroplasty surgery and processed for standard histologic
evaluation.
Results
Macroscopically and histologically, all repaired labra kept their triangular shape
more or less and appeared to have healed. All harvested biopsy specimens displayed
a typical fibrocartilaginous appearance with limited vascular supply. Calcifications
were present in only 1 biopsy specimen. In 3 cases neovascularization of the labral
tissue was noticed in the proximity of the sutures. In the superficial and deep parts
of the labral body, small clefts were observed in all cases.
Conclusions
In this study the histologic aspects of arthroscopically repaired human labral tears
were addressed. It was shown that human labral tears show healing potential after
surgical repair. The surfaces of the labral tissues were intact, and neither remnants
of the tear nor the presence of fibrovascular scar tissue was observed. However, some
small clefts in the superior and deep parts of the repaired structures were noticed
in all cases.
Level of Evidence
Level IV, therapeutic case series.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic and PersonalCorporate R&D ProfessionalsOne-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 ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- On the shoulders of giants.Am J Sports Med. 2011; 39: 5-6
- The acetabular labrum: Anatomic and functional characteristics and rationale for surgical intervention.J Am Acad Orthop Surg. 2010; 18: 338-345
- Anatomy of the labro-capsular complex.Orthopade. 1998; 27 (in German): 675-680
- Histological study on the type and distribution of the sensory nerve endings in human hip joint capsule and ligament.Nippon Seikeigeka Gakkai Zasshi. 1964; 38 (in Japanese): 887-901
- The nerve endings of the acetabular labrum.Clin Orthop Relat Res. 1995; 320: 176-181
- Acetabular labral tears rarely occur in the absence of bony abnormalities.Clin Orthop Relat Res. 2004; 426: 145-150
- The torn acetabular labrum; a block to reduction of a dislocated hip.J Bone Joint Surg Br. 1957; 39: 306-309
- Hip arthroscopy for acetabular labral tears.Arthroscopy. 1999; 15: 132-137
- Acetabular labral tears.Arthroscopy. 2000; 16: 11-15
- Acetabular labrum tears: Diagnosis and treatment.Clin Orthop Relat Res. 1995; : 60-68
- Arthroscopic treatment of labral tears in femoroacetabular impingement: A comparative study of refixation and resection with a minimum two-year follow-up.J Bone Joint Surg Br. 2011; 93: 1027-1032
- Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement.Arthroscopy. 2009; 25: 369-376
- The 2007 Frank Stinchfield Award.Clin Orthop Relat Res. 2007; 465: 16-22
- 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
- The acetabular labrum seal: A poroelastic finite element model.Clin Biomech (Bristol, Avon). 2000; 15: 463-468
- The influence of the acetabular labrum on hip joint cartilage consolidation: A poroelastic finite element model.J Biomech. 2000; 33: 953-960
- An in vitro investigation of the acetabular labral seal in hip joint mechanics.J Biomech. 2003; 36: 171-178
- Arthroscopic repair of the acetabular labrum: A histologic assessment of healing in an ovine model.Arthroscopy. 2007; 23: 376-380
- Labral base refixation in the hip: Rationale and technique for an anatomic approach to labral repair.Arthroscopy. 2010; 26: 81-89
- Hip morphology influences the pattern of damage to the acetabular cartilage: Femoroacetabular impingement as a cause of early osteoarthritis of the hip.J Bone Joint Surg Br. 2005; 87: 1012-1018
- Anterior femoroacetabular impingement: Part II.Clin Orthop Relat Res. 2004; : 67-73
- Validation of the classification system for acetabular chondral lesions identified at arthroscopy in patients with femoroacetabular impingement.J Bone Joint Surg Br. 2011; 93: 332-336
- Can microfracture produce repair tissue in acetabular chondral defects?.Arthroscopy. 2008; 24: 46-50
- Intra-articular pressure of the hip joint outside and inside the limbus.Nippon Seikeigeka Gakkai Zasshi. 1982; 56: 529-536
- Joint space of the human knee and hip joint under a static load.Eng Med. 1980; 9: 66-74
- Effects of removal of the acetabular labrum in a sheep.Osteoarthritis Cartilage. 2004; 12: 419-430
Article Info
Publication History
Published online: October 19, 2012
Accepted:
June 4,
2012
Received:
November 30,
2011
Footnotes
E.A.A. and A.A.M.D. have contributed equally to this article and share first authorship. The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
