Arthroscopic acetabular labral reconstruction: a review

Maldonado, David R.; Glein, Rachel M.; Domb, Benjamin G.

doi:10.1093/jhps/hnab003

Cited by 14 publications

(2 citation statements)

References 64 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A previous study associated labral repair with a lower risk of conversion to arthroplasty than debridement [25]. However, labral repair is not always successful [15]. The situation is compounded by the fact that resection of a nonrepairable acetabular labrum down to a bleeding bony surface does not stimulate tissue regrowth [18].…”

Section: Introductionmentioning

confidence: 99%

Can the Acetabular Labrum Be Reconstructed With a Meniscal Allograft? An In Vivo Pig Model

Maimaitimin,

Yang,

Huang

et al. 2023

Clin Orthop Relat Res

View full text Add to dashboard Cite

Background No single graft type has been shown to have a benefit in acetabular labral reconstruction. The native labrum and lateral meniscus share many similarities, suggesting that the meniscus may be a promising source of graft material in labral reconstruction. Questions/purposes Using a pig model, we sought to evaluate the healing process of fresh-frozen meniscus allograft for acetabular reconstruction by assessing (1) MRI and macroscopic observations of the meniscus allograft; (2) histologic appearance and immunohistologic evaluation of the meniscus allograft, native meniscus, and labrum; (3) microscopic assessment of the native labrum and meniscus via scanning electron microscopy; and (4) biomechanical assessment of tensile properties. Methods Twelve skeletally mature male miniature Bama pigs (24 hips) were randomly divided into two groups: labral defect group (control) and lateral meniscus allograft group. The selection of Bama pig specimens was based on the similarity of their acetabular labrum to that of the human acetabular labrum, characterized by the presence of fibrocartilage-like tissue lacking blood vessels. The pigs underwent bilateral hip surgery. Briefly, a 1.5-cm-long section was resected in the anterior dorsal labrum, which was left untreated or reconstructed using an allogeneic lateral meniscus. The pigs were euthanized at 12 and 24 weeks postoperatively, and then evaluated by macroscopic observations and MRI measurement to assess the extent of coverage of the labral defect. We also performed a histologic analysis and immunohistologic evaluation to assess the composition and structure of meniscus allograft, native labrum, and meniscus, as well as scanning electron microscopy assessment of the microstructure of the native labrum and meniscus and biomechanical assessment of tensile properties. Results Imaging measurement and macroscopic observations revealed that the resected area of the labrum was fully filled in the lateral meniscus allograft group, whereas in the control group, the labral defect remained at 24 weeks. The macroscopic scores of the meniscus allograft group (8.2 ± 0.8) were higher than those of the control groups (4.8 ± 1.0) (mean difference 3.3 [95% CI 1.6 to 5.0]; p < 0.001). Moreover, in the meniscus allograft group, histologic assessment identified fibrocartilage-like cell cluster formation at the interface between the graft and acetabulum; cells and fibers arranged perpendicularly to the acetabulum and tideline structure that were similar to those of native labrum could be observed at 24 weeks. Immunohistochemical results showed that the average optical density value of Type II collagen at the graft-acetabulum interface was increased in the meniscus allograft group at 24 weeks compared with at 12 weeks (0.259 ± 0.031 versus 0.228 ± 0.023, mean difference 0.032 [95% CI 0.003 to 0.061]; p = 0.013). Furthermore, the tensile modulus of the lateral meniscus allograft was near that of the native labrum at 24 weeks (54.7 ± 9.9 MPa versus 63.2 ± 11.3 MPa, mean difference -8.4 MPa [95% CI -38.3 to 21.4]; p = 0.212). Conclusion In a pig model, lateral meniscus allografts fully filled labral defects in labral reconstruction. Regeneration of a fibrocartilage transition zone at the graft-acetabulum interface was observed at 24 weeks. Clinical Relevance The use of an autograft meniscus for labral reconstruction may be a viable option when labral tears are deemed irreparable. Before its clinical implementation, it is imperative to conduct a comparative study involving tendon grafts, which are extensively used in current clinical practice.

show abstract

Section: Introductionmentioning

confidence: 99%

Can the Acetabular Labrum Be Reconstructed With a Meniscal Allograft? An In Vivo Pig Model

Maimaitimin,

Yang,

Huang

et al. 2023

Clin Orthop Relat Res

View full text Add to dashboard Cite

show abstract

“…Labral reconstruction is a well-described procedure used to restore labral function when facing an irreparable labral tear. 18 Compared with labral debridement, superior patient-reported outcomes have been reported with labral reconstruction. 6,14,19 Overall, 2 options for labral reconstruction have been described: segmental labral reconstruction (SLR) and circumferential labral reconstruction (CLR).…”

mentioning

confidence: 99%

An Increased Allograft Width for Circumferential Labral Reconstruction Better Restores Distractive Stability of the Hip: A Cadaveric Biomechanical Analysis

et al. 2022

View full text Add to dashboard Cite

Background: Questions remain about whether circumferential labral reconstruction (CLR) using an iliotibial band (ITB) allograft can effectively restore the labral suction seal of the hip. Hypotheses: (1) CLR with an ITB allograft >6.5 mm would restore distractive stability force to that of the intact labrum. (2) CLR with an ITB allograft >6.5 mm would achieve significantly superior distractive stability force compared with CLR with an ITB allograft <6.5 mm. Study Design: Controlled laboratory study. Methods: A total of 6 fresh-frozen pelves with attached femurs (n = 12 matched hemipelves) from male donors were procured and dissected free of all soft tissue, including the hip capsule but preserving the native labrum, transverse acetabular ligament, and ligamentum teres. Potted hemipelves were placed in a saline bath and securely fixed to the frame of a hydraulic testing system. A 500-N compressive load was applied, followed by femoral distraction at a rate of 5.0 mm/s until the suction seal ruptured. Force and femoral displacement were continually recorded. Force versus displacement curves were plotted, the maximum force was recorded, and the amount of femoral distraction to rupture the suction seal was determined. After intact testing, the labrum was excised, and specimens were retested using the same protocol. CLR was subsequently performed twice in a randomized fashion using (1) an ITB allograft with a width >6.5 mm (7.5-9.0 mm) and (2) an ITB allograft with a width <6.5 mm (4.5-6.0 mm). Specimens were retested after each CLR procedure. Force (in Newtons) and femoral distraction (in millimeters) required to rupture the suction seal were measured and compared between the 4 testing states (intact, deficient, CLR <6.5 mm, and CLR >6.5 mm) using repeated-measures analysis of variance. Results: On average, intact specimens required 148.4 ± 33.1 N of force to rupture the hip suction seal, which significantly decreased to 44.3 N in the deficient state ( P < .001). CLR with ITB allografts <6.5 mm did not improve the maximum force (63 ± 62 N) from the deficient state ( P = .42) and remained significantly lower than the intact state ( P < .01). CLR with ITB allografts >6.5 mm recorded significantly greater force to rupture the suction seal (135.8 ± 44.6 N) compared with both the deficient and CLR <6.5 mm states ( P < .01), with a mean force comparable with the intact labrum ( P = .59). The amount of femoral distraction to rupture the suction seal demonstrated similar findings. Conclusion: In a cadaveric model, CLR using ITB allografts >6.5 mm restored the distractive force and distance to the suction seal rupture to values comparable with hips with an intact labrum. CLR using ITB allografts >6.5 mm outperformed CLR with ITB allografts <6.5 mm, demonstrated by a significantly higher force to rupture the suction seal and increased distraction before the rupture. Clinical Relevance: The results of this cadaveric investigation suggest that using wider labral allografts during CLR will provide the distractive force required to rupture the suction seal and immediate postoperative stability of the hip, although further studies are required to determine if these results translate to improved clinical outcomes.

show abstract

Arthroscopic Hip Surgery for the Management of Acetabular Labral Tears and Femoroacetabular Impingement in Athletes: Recent Advances in Surgical Techniques and a Brief Review of Outcomes

Fasulo,

Sarna,

Kraeutler

et al. 2024

Dissecting Sports Injuries of the Hip

View full text Add to dashboard Cite

Arthroscopic acetabular labral reconstruction: a review

Cited by 14 publications

References 64 publications

Can the Acetabular Labrum Be Reconstructed With a Meniscal Allograft? An In Vivo Pig Model

Can the Acetabular Labrum Be Reconstructed With a Meniscal Allograft? An In Vivo Pig Model

An Increased Allograft Width for Circumferential Labral Reconstruction Better Restores Distractive Stability of the Hip: A Cadaveric Biomechanical Analysis

Arthroscopic Hip Surgery for the Management of Acetabular Labral Tears and Femoroacetabular Impingement in Athletes: Recent Advances in Surgical Techniques and a Brief Review of Outcomes

Contact Info

Product

Resources

About