Acetabular Labral Reconstruction Research Articles

Primary Circumferential Acetabular Labral Reconstruction: Achieving Outcomes Similar to Primary Labral Repair Despite More Challenging Patient Characteristics

Background: Treatment of acetabular labral tears with moderate or severe intrasubstance damage or segmental defects remains a substantial challenge. Circumferential labral reconstruction with iliotibial band allograft is a relatively new technique that has been proposed to restore stability and eliminate high-stress junction points. Purpose: To compare outcomes between hips treated with primary allograft circumferential labral reconstruction and primary labral repair. Study Design: Cohort study; Level of evidence, 3. Methods: All consecutive hips between 2014 and 2015 that underwent primary reconstruction or primary repair by the senior surgeon were included and compared. Hips that had a prior intra-articular procedure were excluded. Patient-reported outcome (PRO) scores and visual analog scales were completed by patients within 1 week before surgery and between 22 and 26 months postoperatively. PROs included the modified Harris Hip Score, the International Hip Outcome Tool, and the 12-Item Short Form Health Survey for physical health. Pain and satisfaction were assessed with visual analog scales. Crude and inverse probability of treatment weighting comparisons of PROs between groups were performed. Results: A total of 162 hips met the inclusion criteria for this study, including 99 labral repairs and 63 complete labral reconstructions. Patients who underwent labral reconstruction were, on average, older (43.4 vs 29.5 years; P < .01), had a slightly higher body mass index (24.6 vs 23.0; P < .01), had hips with a higher Tönnis grade (grade 1 or 2: 25% vs 9%; P < .01), had higher preoperative pain scores (49.9 vs 41.5; P = .01), and had hips with more severe pathology (68% vs 5%; P < .01) as compared with patients with labral repair hips. Five (5%) labral repair hips and 5 (8%) labral reconstruction hips failed treatment (P = .48). Among hips that did not fail (n = 94 repairs, n = 58 reconstructions), all demonstrated statistically significant improvements in PROs, and there was no statistical difference in PROs between groups after weighting (P > .05). Conclusion: Primary circumferential labral reconstruction is a viable treatment option with promising short-term outcomes for hips that demonstrate moderate or severe labral damage. Despite less favorable preoperative characteristics, labral reconstruction offers similar outcomes when compared with labral repair in hips with less severe pathology.

Bilateral Hip Arthroscopy: Direct Comparison of Primary Acetabular Labral Repair and Primary Acetabular Labral Reconstruction

Directly compare primary acetabular labral repair versus primary acetabular labral reconstruction using a self-controlled cohort study design. Patients who underwent primary labral repair in one hip and primary labral reconstruction using iliotibial band allograft in the other hip by a single surgeon between August 2009 and November 2014 were identified. One patient with inflammatory arthritis was excluded. Patient-reported outcome data included change in Modified Harris Hip Score (MHHS), Lower Extremity Functional Scale (LEFS), average pain using a 10-point visual analog scale (VAS), and patient satisfaction (1: very dissatisfied, 10: very satisfied). Failure was defined as subsequent intra-articular hip surgery. Data were analyzed using McNemar's and Wilcoxon Signed Rank tests. Overall, 29 patients (58 hips) were included in the analysis. There were 23 females and 6 males. The average age at time of surgery was 32.6years (range: 14.9-51.6years). Follow-up was obtained from all 29 patients (100%) at a mean of 56months (range= 27-85months) postoperative for repaired hips and 40months (range= 22-61months) postoperative for reconstructed hips. No labral reconstruction hips failed, and 9 (31%) labral repair hips failed (P < .01). Among those that did not fail treatment, there was no difference in MHHS change (32.2 ± 15.4 vs 29.6 ± 15.4; P= .63), LEFS change (26.6 ± 16.5 vs 23.9 ± 17.8; P= .61), VAS pain change (-3.2 ± 2.4 vs-3.6 ± 2.1; P= .47), or satisfaction (8.6 ± 2.0 vs 8.7 ± 2.4; P= .59) between the repair and reconstruction groups, respectively. In this cohort of patients, hips that underwent primary labral repair were more likely to fail treatment than hips that underwent labral reconstruction (31% vs 0%, respectively). Among hips that did not fail treatment, patient-reported outcome scores were similar between groups. Excellent clinical results can be obtained with both forms of labral-preserving treatment but were more predictably observed with primary labral reconstruction in this cohort. LEVELOF EVIDENCE: Level III, retrospective comparative study.

Arthroscopic Acetabular Labral Reconstruction with Fascia Lata Allograft: Clinical Outcomes at Minimum One-Year Follow-Up.

Background: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.Purpose: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.Methods: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).Results: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.Conclusion: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.

Acetabular labral reconstruction using the indirect head of the rectus femoris tendon significantly improves patient reported outcomes.

The aim of this study was to evaluate outcomes after acetabular labral reconstruction using the indirect head of the rectus femoris tendon. The study hypothesis stated that arthroscopic acetabular labral reconstruction may improve patient reported outcomes in patients with labral tears that were not amenable to repair. Between 2009 and 2015, the senior author performed 31 acetabular labral reconstructions using the indirect head of the rectus femoris tendon. The graft is harvested through the same arthroscopic portals established for the procedure. The graft was gradually secured to the acetabular rim starting at its origin to the myotendinous junction, reestablishing the suction seal of the joint. Medical records and surgical reports were reviewed for demographic data, and outcome measures were assessed with pre- and postoperative modified Harris Hip Scores (mHHS). Twenty-two patients with follow-up of more than 2years were evaluated. Fourteen procedures were revision hip arthroscopy and 8 were primary labral reconstruction in 13 males and 9 females. The median age was 43 (range 22-68years old). The median follow-up time was 36.2months with a range from 24 to 72months. The median preoperative mHHS was 67.1. Postoperatively, patients improved to a median mHHS of 97.8 (range 73.7-100) (p<0.0001). Acetabular labral reconstruction using the indirect head of the rectus femoris tendon is a minimally invasive surgical procedure. The technique was applicable in all patients in this study with good outcomes. This procedure is clinically relevant for patients with large labral tears not amendable to labral repair as it offers good results using a local allograft. The local allograft is clinically advantageous as there is no additional donor-site morbidity and no risk of disease transmission. IV.

Circumferential Acetabular Labral Reconstruction Provides Equivalent Improvement to Labral Repair Despite Greater Initial Severity of Damage at Two-Year Follow-Up

Circumferential Acetabular Labral Reconstruction Provides Equivalent Improvement to Labral Repair Despite Greater Initial Severity of Damage at Two-Year Follow-Up

Acetabular Labral Reconstruction With Autologous Tendon Tissue in a Porcine Model

Background: Acetabular labral reconstruction with autologous tendons is the preferred method for treating a severely damaged labrum. However, the healing process of implants remains unknown. Similar to the human acetabular labrum, the porcine acetabular labrum is a fibrocartilage-like tissue. Purpose: This study aimed to characterize the histological healing process and gene expression profile of implants in a porcine model of acetabular labral reconstruction. Study Design: Descriptive laboratory study. Methods: Eighteen pigs were included in this study. The pigs underwent unilateral acetabular labral reconstruction. A 1.0 cm–long defect was made at the site of the anterior (cranial) dorsal labrum, which was repaired using an autologous mesogluteus tendon. The pigs were sacrificed at 12 and 24 weeks postoperatively. The implants were subjected to histological assessment and gene expression analysis. The cell phenotype of the implants was visualized using paraffin-embedded sections. Results: Macroscopic observations revealed that at 12 weeks, 8 of 9 implants partially filled the labral defect; by contrast, at 24 weeks, 6 of 9 implants fully filled and 3 implants partially filled the labral defects. Oval- or round-shaped fibrochondrocytes were found in the implants at 12 and 24 weeks. The matrix staining results showed that proteoglycan and collagen types 1 and 2 were more evident in the implants at 24 weeks than at 12 weeks. Gene expression analysis results revealed that COL2A1 and COL3A1 were expressed by the implants to a higher extent at 24 weeks than at 12 weeks; COL2A1 and COL3A1 were also expressed to a higher extent in the implants than in the native tendon. Conclusion: On the basis of the results of histological assessment and gene expression analysis, autologous tendon tissue for acetabular labral reconstruction can fully or partially fill labral defects and converts to fibrocartilage, which is rich in proteoglycan and collagen types 1 and 2, at 24 weeks in a porcine model. Clinical Relevance: Autologous tendon tissue can be considered as a viable option for acetabular labral reconstruction.

The Effect of an Acetabular Labral Tear, Repair, Resection, and Reconstruction on the Hip Fluid Seal

Objectives:The acetabular labrum is theorized to have an important role in the normal function of the hip through the hip fluid seal. The hip fluid seal functions to create intra-articular fluid pressurization and stability to distractive forces. Yet, the effect of a labral tear or partial labral resection, and interventions including labral repair and labral reconstruction, on the hip fluid seal remain to be defined. The purpose of the current study was to characterize the hip fluid seal, including intra-articular fluid pressurization and stability to distraction, in six different labral conditions: (1) intact, (2) labral tear, (3) labral repair, (4) partial resection, (5) labral reconstruction with iliotibial band, and (6) complete resection. Additionally, the current study investigates the effect of looped (3a) and through (3b) type labral suture repairs on the hip fluid seal.Methods:Eight cadaveric hips with a mean age of 47 (range 41-51) years were included in the study. Hips were compressed using an Instron testing device with a force of 2.7 times body weight (2118 N), simulating the single leg stance phase of gait, while intra-articular pressure was continuously measured with three miniature 1.0 x 0.3 mm pressure transducers. Additionally, the distractive strength of the hip fluid seal was recorded after each loading cycle. Three loading trials were performed for each labral condition. Specimens were randomized to looped or through type labral suture repairs within matched hips. Peak intra-articular pressures and distractive strength measurements for each condition were normalized relative to the intact state of each hip (percentage of intact state). Statistical analyses were performed utilizing a general linear model with repeated measures analysis for several predetermined comparisons of labral conditions.Results:Intra-articular fluid pressurization of the intact state varied from 78 to 422 kPa, while the distractive strength of the hip fluid seal ranged from 124 to 150 N. Labral tear, partial resection, and complete resection resulted in average decreases in pressurization of 25%, 47%, and 76%, and decreases in distractive strength of 24%, 71%, and 73% respectively, compared to the intact state. Through type labral suture repair resulted in significantly greater improvement in fluid pressurization, compared to the labral tear state, than the looped type repair (+66.4% vs. -12.5%, p 0.029). Labral reconstruction resulted in a mean normalized pressurization of 110% and distraction of 66%, with an improvement in pressurization of 53% and distraction of 37% compared to a partial labral resection (p=0.012 and p=0.021, respectively). A moderate positive correlation between peak fluid pressurization and distractive strength was present (Pearson correlation coefficient 0.435, p=0.016).Conclusion:The presence of a labral tear or partial labral resection results in decreases in intra-articular fluid pressurization and stability to a distractive force. Through type labral suture repair restores the hip fluid seal significantly better than a looped type repair at time zero. Labral reconstruction with an iliotibial band graft significantly improves pressurization (to levels similar to the intact state) and stability to distractive force, compared to a partial labral resection.

The hip fluid seal—Part I: the effect of an acetabular labral tear, repair, resection, and reconstruction on hip fluid pressurization

The acetabular labrum is theorized to be important to normal hip function by creating intra-articular fluid pressurization through the hip fluid seal. However, the effect of a labral tear or partial labral resection, and interventions including labral repair and labral reconstruction, on the hip fluid seal remains to be defined. The purpose of this study was to characterize intra-articular fluid pressurization in six labral conditions: intact, tear, repair (looped vs. through sutures), partial resection, reconstruction with iliotibial band, and complete resection. Eight cadaveric hips with a mean age of 47.8 years (SD 4.3, range 41-51) were included in the study. For each labral condition, the hip was compressed with a force of 2.7 times body weight (2,118 N) while intra-articular pressure was continuously measured with 1.0 × 0.3 mm pressure transducers. Peak intra-articular pressure measurements for each condition were normalized relative to the intact state. Statistical analyses were performed utilizing linear mixed-effects models with repeated measures analysis. Intra-articular fluid pressurization of the intact state varied from 78 to 422 kPa (mean 188 kPa ± SD 120). Labral tear, partial resection, and complete resection resulted in average pressurization of 75 ± 33, 53 ± 37, and 24 ± 18 %, respectively compared with the intact state. Through type labral repair resulted in significantly greater increases in pressurization from the labral tear state, compared with the looped type repair (median increase; +46 vs. -12 %, p = 0.029). Labral reconstruction resulted in a mean pressurization of 110 ± 38 % relative to intact state, with a significant 56 ± 47 % improvement in pressurization compared with partial labral resection (p = 0.009). Partial labral resection caused significant decreases in intra-articular fluid pressurization. Through type labral suture repair restored the fluid pressurization better than looped type repairs. Labral reconstruction significantly improved pressurization to levels similar to the intact state. This study demonstrated the effect of labral tears and partial resections on intra-articular fluid pressurization via the hip fluid seal, and it also demonstrated improvements in pressurization seen with through type labral repairs and labral reconstructions.

The hip fluid seal—Part II: The effect of an acetabular labral tear, repair, resection, and reconstruction on hip stability to distraction

The acetabular labrum is theorized to be important to normal hip function by providing stability to distraction forces through the suction effect of the hip fluid seal. The purpose of this study was to determine the relative contributions of the hip capsule and labrum to the distractive stability of the hip, and to characterize hip stability to distraction forces in six labral conditions: intact labrum, labral tear, labral repair (looped vs. through sutures), partial resection, labral reconstruction with iliotibial band, and complete resection. Eight cadaveric hips with a mean age of 47.8 years (SD 4.3, range 41-51 years) were included. For each condition, the hip seal was broken by distracting the hip at a rate of 0.33 mm/s while the required force, energy, and negative intra-articular pressure were measured. For comparisons between labral conditions, measurements were normalized to the intact labral state (percent of intact). The relative contribution of the labrum to distractive stability was greatest at 1 and 2 mm of displacement, where it was significantly greater than the role of the capsule and accounted for 77 % (SD 27 %, p = 0.006) and 70 % (SD 7 %, p = 0.009) of total distractive stability, respectively. The relative contribution of the capsule to distractive stability increased with progressive displacement, providing 41 % (SD 49 %) and 52 % (SD 53 %) of distractive stability at 3 and 5 mm of distraction, respectively. The maximal distraction force required to break the hip seal in the intact labral state (capsule removed) varied from 124 to 150 N. Labral tear, partial resection, and complete resection resulted in average maximal distraction forces of 76 % (SD 34 %), 29 % (SD 26 %), and 27 % (SD 22 %), respectively, compared to the intact state. Through type labral repairs resulted in significantly greater improvements (from the labral tear state) in maximal negative pressure generated, compared to looped type repairs (median increase; +32 vs. -9 %, p = 0.029). Labral reconstruction resulted in a mean maximal distraction force of 66 % (SD 35 %), with a significant improvement of 37 % compared to partial labral resection (p < 0.001). The acetabular labrum was the primary hip stabilizer to distraction forces at small displacements (1-2 mm). Partial labral resection significantly decreased the distractive strength of the hip fluid seal. Labral reconstruction significantly improved distractive stability, compared to partial labral resection. The results of this study may provide insight into the relative importance of the capsule and labrum to distractive stability of the hip and may help to explain hip microinstability in the setting of labral disease.

The Effect of an Acetabular Labral Tear, Repair, Resection, and Reconstruction on the Hip Fluid Seal

The Effect of an Acetabular Labral Tear, Repair, Resection, and Reconstruction on the Hip Fluid Seal

Arthroscopic Labral Reconstruction Is Superior to Segmental Resection for Irreparable Labral Tears in the Hip

Background: The acetabular labrum is an important structure that plays a significant role in proper biomechanical function of the hip joint. When the labrum is significantly deficient, arthroscopic reconstruction could provide a potential solution for the nonfunctional labrum. Purpose: To compare the clinical outcomes of arthroscopic labral reconstruction (RECON) with those of arthroscopic segmental labral resection (RESEC) in patients with femoroacetabular impingement (FAI) of the hip. Study Design: Cohort study; Level of evidence, 3. Methods: Between April 2010 and March 2011, all prospectively gathered data for patients with FAI who underwent arthroscopic acetabular labral reconstruction or segmental resection with a minimum 2-year follow-up were reviewed. Eleven cases in the RECON group were matched to 22 cases in the RESEC group according to the preoperative Non-Arthritic Hip Score (NAHS) and sex. The patient-reported outcome scores (PROs) used included the NAHS, the Hip Outcome Score (HOS), and the modified Harris Hip Score (mHHS). Statistical analyses were performed to compare the change in PROs in both groups. Results: There was no statistically significant difference between groups regarding the preoperative NAHS (P = .697), any of the other preoperative PROs, or demographic and radiographic data. The mean change in the NAHS was 24.8 ± 16.0 in the RECON group and 12.5 ± 16.0 in the RESEC group. The mean change in the HOS–activities of daily living (HOS-ADL) was 21.7 ± 16.5 in the RECON group and 9.5 ± 15.5 in the RESEC group. Comparison of the amount of change between groups showed greater improvement in the NAHS and HOS-ADL for the RECON group (P = .046 and .045, respectively). There was no statistically significant difference in the mean changes in the rest of the PROs, although there were trends in all in favor of the RECON group. All PROs in both groups showed a statistically significant improvement at follow-up compared with preoperative levels. Conclusion: Arthroscopic labral reconstruction is an effective and safe procedure that provides good short-term clinical outcomes in hips with insufficient and nonfunctional labra in the setting of FAI.

Use of the Quadriceps Tendon in Arthroscopic Acetabular Labral Reconstruction: Potential and Benefits as an Autograft Option

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.

Acetabular Labral Reconstruction With an Iliotibial Band Autograft

Background: Injury to the acetabular labrum results from multiple causes including femoroacetabular impingement, dysplasia, and acute trauma. The patient’s labrum can be reconstructed utilizing an iliotibial band autograft that is tubularized and fixed to the acetabular rim, substituting for the patient’s own labrum. Purpose/Hypothesis: The purpose of this study was to evaluate the midterm results of this technique with a follow-up from 3 to 6 years after reconstruction. The hypothesis was that midterm results would show excellent patient-reported outcomes and high patient satisfaction with outcome. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of a prospectively collected registry was undertaken that identified 75 patients (76 hips) who underwent arthroscopic labral reconstruction using an iliotibial band autograft by a single surgeon from February 2005 to August 2008. Modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), and patient satisfaction level (on a scale of 1-10) were recorded preoperatively and postoperatively annually. Survivorship analysis curves were created to evaluate the effectiveness of this technique. Results: Among 76 hips, 19 progressed to total hip arthroplasty at an average of 28 months from the procedure. Mean survivor time (no arthroplasty) was 59.1 months (95% CI, 53.9-64.4). Follow-up on the surviving hips was available for 49 patients (86%) with a mean follow-up time of 49 months (range, 36-70 months). The mHHS significantly increased from a preoperative mean of 58.9 to the most recent follow-up score averaging 83 (P = .0001); HOS values in the sports and the activities of daily living subscales also increased significantly (P = .0001 and P = .001, respectively). Median patient satisfaction with outcome was 8. A joint space of ≤2 mm was found to be a poor prognostic factor for survival of the hip. Conclusion: Arthroscopic labral reconstruction using an iliotibial band autograft resulted in a survivorship of 56 months. Of the 76% of patients who did not require total hip arthroplasty, improvement in function and high satisfaction with outcome were reported. Joint space of ≤2 mm is a contraindication for acetabular labral reconstruction.

Arthroscopic Labral Reconstruction in the Hip Using Iliotibial Band Autograft: Technique and Early Outcomes

The purpose of this study was to investigate the indications for and outcomes of arthroscopic labral reconstruction in the hip by use of iliotibial band (ITB) autograft. Between August 2005 and May 2008, the senior author (M.J.P.) performed 95 arthroscopic labral reconstructions using an ITB autograft in patients with advanced labral degeneration or deficiency. There were 47 patients who had undergone surgery at a minimum of 1 year previously and met the inclusion criteria. The modified Harris Hip Score (MHHS) and patient satisfaction were used to measure outcomes postoperatively. The labral autograft was harvested from the ITB through a separate incision. The graft was sutured to the intact labral remnant in the region of labral deficiency, re-establishing the suction seal of the hip joint. There were 32 men and 15 women. The mean age at the time of surgery was 37 years (range, 18 to 55 years). The mean time from the onset of symptoms to labral reconstruction was 36 months (range, 1 month to 12 years). Subsequent total hip arthroplasty was performed in 4 patients (9%). Follow-up was obtained in 37 of the remaining 43 patients. The mean time to follow-up was 18 months (range, 12 to 32 months). The mean MHHS improved from 62 (range, 35 to 92) preoperatively to 85 (range, 53 to 100) postoperatively (P = .001). Median patient satisfaction was 8 out of 10 (range, 1 to 10). Patients who were treated within 1 year of injury had higher MHHSs than patients who waited longer than 1 year (93 v 81, P = .03). The independent predictor of patient satisfaction with outcome after labral reconstruction was age. This study showed that patients who have labral deficiency or advanced labral degeneration had good outcomes and high patient satisfaction after arthroscopic intervention with acetabular labral reconstruction. Lower satisfaction was associated with joint space narrowing and increased age. Patients who waited longer than 1 year from the time of injury to surgery had lower function at follow-up than those treated in the first year. Level IV, therapeutic case series.

Outcomes of Arthroscopic Acetabular Labral Reconstruction in the Hip (SS-34)

Outcomes of Arthroscopic Acetabular Labral Reconstruction in the Hip (SS-34)