Allograft Labral Reconstruction of the Hip: Expanding Evidence Supporting Greater Utilization in Hip Arthroscopy

Abstract

Purpose of Review The current review investigates outcomes and failure rates associated with arthroscopic circumferential allograft labral reconstruction of the hip, both as a revision and primary procedure in treating femoroacetabular hip impingement and labral-related pathology. Recent Findings Numerous studies within the last decade have demonstrated excellent patient-reported outcomes, high rates of return-to-play in athletes, and low failure rates in patients having undergone arthroscopic circumferential allograft labral reconstruction of the hip. Removal of chronically diseased and injured labral tissue can eliminate a significant pain-generator from the hip joint. Additionally, circumferential reconstruction of the labrum restores the hoop fiber strength and fluid seal akin to what would be seen with native, healthy labral tissue. Recent research has shown that arthroscopic circumferential allograft labral reconstruction may be used not only in the revision setting, but as a primary procedure. Circumferential labral reconstruction should be considered when a surgeon feels that the labrum is irreparable or has failed previous repair. Summary Arthroscopic circumferential allograft labral reconstruction of the hip can be utilized as treatment option not only in revision settings, but also in primary treatment for femoroacetabular impingement and labral pathology

Treatment of Severe Pincer-Type Femoroacetabular Impingement With Arthroscopic Significant Acetabular Rim Correction and Circumferential Labral Reconstruction Improves Patient-Reported Outcome Measures

“…As has been described previously, it has been the surgical practice of the lead author since 2013 to perform arthroscopic circumferential allograft labral reconstruction of the hip both as primary and revision procedures, rather than labral repair, in any instance when the labrum is deemed irreparable. 3,16,18,37 Preoperative radiographs were obtained, including standing and corrected anteroposterior (AP) pelvis, false-profile, and cross-table lateral views. Properly rotated and centered AP pelvis radiographs with 2 to 4 cm distance between the sacrococcygeal joint and the pubic symphysis were used to plan the amount and degree of correction required to create an acetabulum with more normal coverage.…”

“…Patient reported outcomes, including the Modified Hip Harris Score (mHHS), Lower Extremity Functional Scale (LEFS), visual analog scale (VAS) at rest, VAS with activities of daily living (ADLs), and VAS with sports were collected preoperatively, and at the most recent follow-up greater than 2 years from the date of surgery. [16][17][18]38,63 Patient satisfaction levels, rated on a scale of 1 to 10, where 10 was extremely satisfied, also were collected at the most recent follow-up. Intraoperative fluoroscopic images in the AP and lateral planes were used to assess the significant acetabular correction required to treat severe pincer-type morphology.…”

“…3,[7][8][9][10][11][12][13][14][15] Regarding nonarthritic chondrolabral pathology, a growing body of evidence is supporting labral reconstruction as a viable option not only in the revision setting but as a primary treatment for symptomatic femoroacetabular impingement (FAI) wherein the surgeon has deemed the labral tissue to be irreparable, including labral tissue that is ossified, degenerative, diminutive, or otherwise concluded to be of poor tissue quality. 3,[16][17][18] Within the last few years, 6 systematic reviews and meta-analyses and more than 2 dozen studies have been published pointing to superior results of labral reconstruction as both primary and revision procedures in terms replicating the function of native, healthy hip tissue by re-establishing the fluid seal and thereby restoring joint pressurization, stability, and normal biomechanics. [4][5][6] However, despite considerable advances in the techniques of hip-preservation surgery, significant acetabular overcoverage, such as severe pincer deformity (center edge angle [CEA] >45 ), protrusio acetabuli, coxa profunda, and acetabular retroversion, continues to be recognized as a challenging problem in terms of arthroscopic treatment.…”

Editorial Commentary: Surgeons Planning Hip Labral Arthroscopic Repair Should Have a Backup Plan of Labral Reconstruction or Augmentation Based on Intraoperative Labral Degeneration, Hypoplasia, or Ossification

“…While solid indications based on preoperative workup may result in a planned primary arthroscopic hip labral repair, some intraoperative factors previously not recognized may make a patient more suitable for a reconstruction or augmentation. 5 Considering that only one-half of the cases requiring these interventions can be predicted preoperatively, what happens to the others who are discovered intraoperatively? 6 This study narrows the focus to a unique population of patients with labral pathology of the hip who are found intraoperatively to have labral degeneration greater than 50%.…”