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

      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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      Bibliography

        • Bsat S.
        • Frei H.
        • Beaulé P.E.
        The acetabular labrum: A review of its function.
        Bone Jt J. 2016; 98-B: 730-735
        • Byrd J.W.T.
        • Jones K.S.
        Prospective analysis of hip arthroscopy with 10-year follow-up.
        Clin Orthop. 2010; 468: 741-746
        • Domb B.G.
        • Kyin C.
        • Rosinsky P.J.
        • et al.
        Circumferential labral reconstruction for irreparable labral tears in the primary setting: Minimum 2-year outcomes with a nested matched-pair labral repair control group.
        Arthroscopy. 2020; 36: 2583-2597
        • Krych A.J.
        • Thompson M.
        • Knutson Z.
        • Scoon J.
        • Coleman S.H.
        Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: A prospective randomized study.
        Arthroscopy. 2013; 29: 46-53
        • Menge T.J.
        • Briggs K.K.
        • Dornan G.J.
        • McNamara S.C.
        • Philippon M.J.
        Survivorship and outcomes 10 years following hip arthroscopy for femoroacetabular impingement: Labral debridement compared with labral repair.
        J Bone Joint Surg Am. 2017; 99: 997-1004
        • Perets I.
        • Hartigan D.E.
        • Chaharbakhshi E.O.
        • Walsh J.P.
        • Close M.R.
        • Domb B.G.
        Circumferential labral reconstruction using the knotless pull-through technique-surgical technique.
        Arthrosc Tech. 2017; 6: e695-e698
        • Philippon M.J.
        • Arner J.W.
        • Crawford M.D.
        • Bolia I.K.
        • Briggs K.K.
        Acetabular labral reconstruction with iliotibial band autograft: Outcome and survivorship at a minimum 10-year follow-up.
        J Bone Joint Surg Am. 2020; 102: 1581-1587
        • Philippon M.J.
        • Bolia I.K.
        • Locks R.
        • Briggs K.K.
        Labral preservation: Outcomes following labrum augmentation versus labrum reconstruction.
        Arthroscopy. 2018; 34: 2604-2611