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Infographic| Volume 37, ISSUE 10, P3013-3015, October 01, 2021

Restoration of Labral Function in Primary Hip Arthroscopy From Labral Repair to Labral Reconstruction

DOI:https://doi.org/10.1016/j.arthro.2021.08.003
Restoration of Labral Function in Primary Hip Arthroscopy From Labral Repair to Labral Reconstruction
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      Abstract

      The function and importance of the labrum in hip biomechanics has been established. A labral tear is the most common pathology in patients undergoing hip arthroscopy, and adequate management is critical for favorable outcomes. Although labral debridement was initially performed for arthroscopic labral tear management, there has been a shift toward labral restoration techniques. Currently, restoration with labral repair remains the gold standard for labral tear treatment, particularly in the primary setting. When compared to labral debridement, the literature has shown that labral repair has more favorable outcomes.
      Irreparable labral tears, although unusual in the primary setting, present a challenge. Labral reconstruction and augmentation are recent advancements in this scenario of hip arthroscopy that can help restore labral function.
      Two alternatives of labral reconstruction have been described: segmental and circumferential. Clinical data for segmental labral reconstruction has reported good outcomes at short-, mid-, and long-term follow-up. Similarly, arthroscopic circumferential reconstruction has shown good to excellent results at short-term follow-up. As the name suggests, only a segment of the labrum is reconstructed during segmental reconstruction. In a circumferential reconstruction, the entire labrum is taken down from the most anterior to the most posterior aspect of the transverse acetabular ligament and is reconstructed using an auto or allograft. A benefit of circumferential labral reconstruction is the removal of the entire damaged labral tissue, a potential source of pain. However, there is no clear evidence that demonstrates the superiority of one method over the other.
      Labral graft reinforcement via tissue augmentation or labral augmentation is an interesting option because it preserves the native chondrolabral junction. Labral augmentation can also be used for hypoplastic labrum that intraoperatively demonstrates a deficient suction-seal.
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      Article Info

      Footnotes

      The authors report the following potential conflicts of interest or sources of funding: B.G.D. reports grants from the American Orthopedic Foundation, Arthrex, Kaufman Foundation, Medacta, Pacira Pharmaceuticals, Stryker, Breg, Mako Surgical Corp., Medwest Associates, ATI Physical Therapy, St. Alexius Medical Center; other from the American Orthopedic Foundation, Pacira Pharmaceuticals, Stryker, Mako Surgical Corp.; personal fees from Adventist Hinsdale Hospital, Amplitude, Arthrex, DJO Global, Medacta, Pacira Pharmaceuticals, Stryker, Orthomerica, Mako Surgical Corp., St. Alexius Medical Center; non-financial support from Amplitude, Arthrex, DJO Global, Medacta, Pacira Pharmaceuticals, Stryker, Mako Surgical Corp., Medwest Associates, St. Alexius Medical Center; patents B920497, 8708941, and 9737292. He is the medical director of Hip Preservation at St. Alexius Medical Center, clinical instructor at the University of Illinois College of Medicine, a board member for the American Hip Institute Research Foundation, AANA Learning Center Committee, the Journal of Hip Preservation Surgery, Arthroscopy; has had ownership interests in the American Hip Institute, Hinsdale Orthopedic Associate, Hinsdale Orthopedic Imaging, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center. D.R.M. reports non-financial support from Arthrex, Stryker, Smith & Nephew, and Ossur; and is an editorial board member of Arthroscopy. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

      Identification

      DOI: https://doi.org/10.1016/j.arthro.2021.08.003

      Copyright

      © 2021 by the Arthroscopy Association of North America

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