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.
Project description:The importance of the acetabular labrum has been well documented for the function and overall health of the hip joint. Several biomechanical studies have shown the sealing effect of the acetabular labrum. In the past decade, labral repair procedures have gained increased attention, with the literature suggesting that the outcomes after hip arthroscopy are directly related to labral preservation. However, a primary labral repair can be challenging in cases of hypoplastic, ossified, or complex and irreparable labral tears in which there is insufficient tissue to perform a primary repair. For these cases, labral reconstruction becomes a viable option with good outcomes at short-term and midterm follow-up. A subset of these patients may show viable remnants of the labral circumferential fibers but, because of the low tissue volume, these remnant fibers are unable to maintain the suction seal. In this situation, a labral augmentation may be a viable alternative to labral reconstruction while preserving as much native labral tissue as possible. The purpose of this Technical Note is to describe an arthroscopic hip labral augmentation technique using iliotibial band autograft or allograft.
Project description:The labrum is essential for stability, movement, and prevention of arthritis in the hip. In cases of labral damage where repair of a labral tear is not possible, reconstruction can be a useful alternative. Several different autografts have been used, including the iliotibial band (ITB), the ligamentum teres capitis, and the gracilis tendon. Authors have reported both open and arthroscopic techniques for reconstruction with good preliminary results. However, an all-arthroscopic labral reconstruction technique including the graft harvest and reconstruction portions of a labral reconstruction procedure using an ITB autograft has not been previously described. We describe a technique for an all-arthroscopic labral reconstruction performed using a novel method for arthroscopic harvest of the ITB. The decreased invasiveness of our described technique for labral reconstruction may potentially minimize scarring, bodily disfigurement, infection, and postoperative pain associated with the graft harvesting incision.
Project description:Despite growing interest in hip arthroscopy and labral preservation, some patients have severely damaged, degenerative, or deficient labrums and may be candidates for arthroscopic labral reconstruction. The ligamentum teres has been used as a graft source for open hip labral grafting, and the iliotibial band has been used in the arthroscopic setting. We present an alternative method of hip labral reconstruction using the gracilis autograft, which does not require post-harvest manipulation. Arthroscopic techniques for graft tensioning and labrum-graft overlap are introduced that may facilitate restoration of labral function in patients with otherwise non-salvageable labrums.
Project description:The acetabular labrum serves many integral functions within the hip joint. As a result, novel surgical techniques that aim to preserve or reconstruct the labrum have entered the spotlight. We have performed labral reconstruction using the quadriceps tendon as an autograft for a patient with a moderate labral defect. The purpose of this report is to propose this novel donor site as a viable alternative for labral reconstruction using an autograft; the potential benefits over currently popular methods are discussed.
Project description:Labral tears in the hip may cause painful clicking or locking of the hip, reduced range of motion, and disruption to sports and daily activities. The acetabular labrum aids stabilization of the hip joint, particularly during hip motion. The fibrocartilaginous structure extends the acetabular rim and provides a suction seal around the femoroacetabular interface. Treatment options for labral tears include debridement, repair, and reconstruction. Repair of the labrum has been shown to have better results than debridement. Labral refixation is achieved with sutures anchored into the acetabular rim. The acetabular rim is trimmed either to correct pincer impingement or to provide a bleeding bed to improve healing. Labral repair has shown excellent short-term to midterm outcomes and allows patients to return to activities and sports. Arthroscopic rim trimming and labral refixation comprise an effective treatment for labral tears with an underlying diagnosis of femoroacetabular impingement and are supported by the peer-reviewed literature.
Project description:Biomechanical stability is the primary function of the acetabular labrum. It provides a hip suction seal and optimal joint function. Labral tears are a common reason for hip arthroscopy, to improve patient function and to prevent long-term degenerative arthropathy. Arthroscopic labral repair has shown significantly better outcomes in return to premorbid activity levels when compared with labral debridement. Injury to the acetabular labrum is a challenge and can lead to long-term complications. In this scenario, arthroscopic labral reconstruction has shown good results regarding patient subjective and objective outcomes. We describe a technique for complete arthroscopic labral reconstruction using tensor fascia lata allograft.
Project description:The acetabular labrum is a dynamic structure important for both hip stability and functional motion. Given its importance, injuries to the labrum result in significant symptomatic dysfunction caused by altered hip kinematics. Although labral repair represents the standard for symptomatic labral tears with underlying bony deformity, complex labral tears or those with significant degeneration may not be amenable to repair and require labral reconstruction. Labral reconstruction has been shown to restore intra-articular fluid pressurization to levels similar to those in the intact state, and cohort studies have increasingly demonstrated significant improvement in patient-reported outcomes at midterm follow-up. A critical component of successful labral reconstruction is accurate measurement of the graft length to restore native anatomy and kinematics of the hip. The purpose of this Technical Note is to describe a way to accurately measure graft length required for labral reconstruction.
Project description:Acetabular labral tears are common in patients presenting with hip or groin pain. When the labrum is irreparable, labral reconstruction procedures are warranted. A circumferentially intact labrum is essential for joint health, whereas labral deficiency may predispose hip joints to osteoarthritis (OA). We aimed to determine whether labral reconstruction provides a benefit in terms of reduced OA development compared with labral resection. We performed labral reconstructions, labral resections, and sham operations in a porcine model. We assessed subsequent OA development by macroscopic observation, scanning electron microscopy, nanoindentation, histology, magnetic resonance imaging of cartilage in the acetabulum and femoral head, and enzyme-linked immunosorbent assays for inflammatory cytokines in the synovial fluid. We subjected the postoperative implants to biomechanical, histological, and mRNA expression analyses. At 24 weeks after surgery, the resected joints displayed apparent degenerative changes, in which the labral defects were filled with tiny amounts of loose, fibrous scar tissue. Compared with the resected joints, the reconstructed joints showed smooth and homogeneous geomorphology of cartilage surfaces; increased cartilage extracellular matrix (type II collagen and proteoglycans) content, elastic modulus, and hardness; and decreased type X collagen content, macroscopic and histological pathology scores, and inflammatory cytokines in the synovial fluid. The postoperative implants had compression, tensile, and histological features similar to those of the native labrum, which may have helped to attenuate OA development following labral reconstruction. Labral reconstruction using autografts greatly reduced OA progression compared with labral resection. The autologous implants used for reconstruction effectively restored the biomechanical and histological features of the labrum, contributing to hip joint homeostasis.
Project description:Labral tears are a significant cause of hip pain and are currently the most common indication for hip arthroscopy. Compared with labral debridement, labral repair has significantly better outcomes in terms of both daily activities and athletic pursuits in the setting of femoral acetabular impingement. The classic techniques described in the literature for labral repair all use loop or pass-through intrasubstance labral sutures to achieve a functional hip seal. This hip seal is important for hip stability and optimal joint biomechanics, as well as in the prevention of long-term osteoarthritis. We describe a novel eversion-inversion intrasubstance suturing technique for labral repair and reconstruction that can assist in restoration of the native labrum position by re-creating an optimal seal around the femoral head.
Project description:The integrity of the acetabular labrum is crucial to normal biomechanics of the hip joint. Disruption of the labral seal could be detrimental to the overall nutrition of the cartilage, leading to its premature degeneration.The aim of this study is to determine the clinical effectiveness of arthroscopic hip labral reconstruction using fascia lata allograft. The hypothesis is that labral reconstruction would provide good clinical outcomes.We retrospectively reviewed all 10 patients who underwent labral reconstruction with fascia lata allograft from January 2013 to October 2015. We assessed improvement in pain and function, complications, and subsequent surgery. The minimum follow-up was 12 months (average, 22.9 months; range, 16-36 months).All patients reported subjective improvement in preoperative pain and function. The mean modified Harris hip score improved significantly from 58 (55-60) to 95 (91-98). The mean change of modified Harris hip score was 36 (31-41) and mean post-operative patient satisfaction score was 9.5(8-10). We observed no radiological progression of arthritis as well as no patient had revision procedure including total hip replacement.Arthroscopic labral reconstruction using a fascia lata tendon allograft is an effective and safe procedure that not only provides excellent clinical outcomes in short term but also potentially prevent continued cartilage degeneration by restoring acetabular labral seal in patients with deficient or resected labrums.