Hip Labral Reconstruction: Techniques and Outcomes

Abstract

Purpose of Review With increased understanding of the biomechanical function of the acetabular labrum, more attention has been directed towards surgical techniques that preserve or restore normal joint anatomy. While labral repair has been shown to produce superior outcomes to labral debridement, repair is not always possible in the setting of severe labral intrasubstance tearing or deficiency. These patients were previously left without suitable arthroscopic treatment options. Recent Findings Labral reconstruction is an emerging procedure that has been shown to offer promising outcomes for traditionally difficult-to-treat hip pathology. Short-and mid-term follow-up studies have consistently demonstrated significant improvement in patient-reported outcomes, function, and patient satisfaction postoperatively, often despite less favorable preoperative characteristics. Summary Labral reconstruction is a viable arthroscopic treatment option that has been shown to reliably produce clinically meaningful results in patients with severe labral pathology that is not amenable to repair/refixation or augmentation.

Primary Arthroscopic Labral Management: Labral Repair and Complete Labral Reconstruction Both Offer Durable, Promising Results at Minimum 5-Year Follow-up

“…Our preferred technique for reconstruction has been well-documented previously. [32][33][34] In our practice, frozen tensor fascia lata allograft (Allosource; Centennial) is available and used for all reconstruction cases. All reconstructions performed were circumferential in nature, and no augmentations were performed.…”

Graft Options for Hip Labral Reconstruction

“…Damage to the labrum results in altered joint physiology and biomechanics and loss of hip joint stability and function 1,3 . It is believed that if left untreated, labral damage can progress to symptomatic joint degeneration and osteoarthritis 1,3 .…”

“…A key consideration for the choice of technique and graft involves the need for segmental vs. circumferential reconstruction 1,7,24,25 . Both segmental and circumferential labral reconstructions have been reported to produce good outcomes 11 .…”

“…Segmental techniques reconstruct only the irreparable segment of the labrum, whereas circumferential reconstructions proceed in a “front-to-back” fashion to restore the entire labrum 1,11,24,25 . Circumferential reconstruction has been endorsed as the preferred technique when segmental reconstruction will be unable to remove all pain-generating tissues and when it is felt that the junction points between graft and native tissue may confer less stability 1,11 . As such, best current evidence suggests that the choice of labral reconstruction technique and consequently graft type can be made based on indication, degree of pathology, patient variables, tissue availability, and surgeon capabilities and preferences.…”

“…Labral tears are the most common pathology documented in patients undergoing hip arthroscopy 7 . Although operative management of labral tears has been largely focused on arthroscopic labral debridement, the desire to improve treatment outcomes has driven a paradigm shift toward labral restoration techniques such as repair and reconstruction 1,3,[8][9][10][11] . Recent studies investigating these labral preserva-tion techniques have consistently demonstrated superior outcomes compared with debridement 3,9,12,13 .…”