Arthroscopic Technique for Acetabular Labral Reconstruction Using Iliotibial Band Autograft

Abstract

The dynamic function of the acetabular labrum makes it an important structure for both hip stability and motion. Because of this, injuries to the labrum can cause significant dysfunction, leading to altered hip kinematics. Labral repair is the gold standard for symptomatic labral tears to keep as much labral tissue as possible; however, in cases where the labrum has been injured to such a degree that it is either deficient or repair is not possible, arthroscopic labral reconstruction is preferred. This article describes our preferred approach for reconstruction of the acetabular labrum using iliotibial band autograft.

Hip labral reconstruction: consensus study on indications, graft type and technique among high-volume surgeons

“…However, the ideal technique, the optimal graft and even proper indications for procedure remain subjects of debate [22, 27–31]. Both, autograft and allograft have been used for labral reconstruction [22], going from iliotibial band [32, 33], indirect head of the rectus femoris [21] and hamstring autografts [26], to iliotibial band [25, 30, 34] and hamstring allografts [31, 35]. Technically demanding, labral reconstructions currently can only be accomplished reproducibly by a handful of orthopaedic hip surgeons around the world [22, 30, 36–39] .…”

“…Technically demanding, labral reconstructions currently can only be accomplished reproducibly by a handful of orthopaedic hip surgeons around the world [22, 30, 36–39] . The purpose of this study was to survey these high-volume hip arthroscopists to document their current indications for labral reconstruction, technique and graft preference (allograft versus autograft) [31, 32, 35, 38]. It was hypothesized that labral reconstruction in the setting of irreparable tears would be an important resource of treatment among high-volume hip specialist orthopaedic surgeons.…”

Kite Measurement Technique for Enhanced Accuracy and Technical Proficiency of Graft Preparation in Segmental Labral Reconstruction of the Hip

“…To date, 2 methods of hip labral reconstruction used clinically have been described: (1) segmental labral reconstruction, in which the torn or poor-quality segment of native labral tissue is excised and replaced with autograft or allograft, maintaining as much healthy native labral tissue as possible,8, 10 or (2) front-to-back labral reconstruction,9, 11 in which the entire native labrum is removed and replaced with graft tissue. Although both methods have inherent technical difficulties,6, 7, 9 both have the capability of restoring the native suction seal and improving native hip stability.…”

“…This learning curve is estimated at approximately 3 to 5 cases, which is a relatively high number for a rare procedure. Second, this technique is intended for use during segmental labral reconstruction only 8, 10. For patients with a completely deficient labrum requiring a front-to-back, 270° labral reconstruction, a technique has been previously described that allows for reconstitution of labral hoop stresses with an entirely new labrum 9 .…”

Arthroscopic Hip Labral Augmentation Technique With Iliotibial Band Graft

“…9 However, the use of autograft necessitates a separate incision and harvesting of the ITB. 18 This could potentially induce soft-tissue complications in the harvest area described for labral reconstruction that can also occur in cases of labral augmentation. Labral augmentation cannot be indicated in cases of segmental and circumferential labral defects, in which a labral reconstruction is the most appropriate choice (Table 3).…”