Labral Reconstruction Research Articles

Statistical fragility analysis of reported outcomes associated with surgical management of acetabular labral pathology.

The purpose of this study was to analyse the robustness of comparative research that evaluated arthroscopic labral reconstruction versus other surgical management of labral pathology. Key measures of statistical fragility include the fragility index and fragility quotient.ß. 12 comparative studies that evaluated the use of arthroscopic labral reconstruction were included in this study. Particular attention was placed on evaluating trends, either statistically significant or not, of functional improvement, complication rates, need for total hip arthroplasty (THA) and revision rates with associated p-values. The analysis involved in this study was the Fragility Index, which is the median number of events required to change the statistical significance of a particular outcome, thus changing the study conclusions. Fragility quotient was calculated for each study as the fragility index divided by sample size. Of the 12 studies that were included for analysis, there were a total of 25 reported outcomes, 8 of which were statistically significant (p < 0.05). The statistical fragility for the significant outcomes were 2.5 (interquartile range [IQR]: 1.5-3.5), whereas the median statistical fragility for insignificant results was 6 (IQR 4-9). The overall fragility index was 4 (IQR 3-7). The median of fragility quotients was 0.04 (IQR 0.01-0.07). This study demonstrated that comparative research regarding arthroscopic techniques of labral reconstruction may not be as statistically stable as previously hoped. In many of the reported outcomes, particularly the ones that were statistically significant, only a small percentage of event changes was required to change the significance of the study conclusions. This fragility is worrisome, since clinical decisions that rely on these reported outcomes may have a significant impact on long-term patient outcomes. It is, therefore, crucial to optimise patient outcomes by incorporating past literature and reported outcomes.

Arthroscopic Labral Reconstruction With a Modified Inferior Capsular Shift Allows Return to Sport and Excellent Outcomes in Contact and Noncontact Athletes With Anterior Shoulder Instability at Minimum 5-Year Follow-Up

PurposeTo compare return to sport, functional outcomes, recurrence of instability, and osteoarthritis(OA) between collision/contact and limited/non-contact athletes following arthroscopic labral reconstruction with a modified inferior capsular shift for anterior shoulder instability. MethodsAthletes underwent an arthroscopic labral reconstruction with a modified inferior capsular shift, by the senior author between 1999 and 2017. Inclusion criteria were labral stripping from 12(just beyond the biceps anchor) to 6 o’clock, less than 20% glenoid bone loss, active sports participation, and no prior surgery. Athletes were divided into collision/contact and limited/non-contact groups. Outcome measures, physical examination, and radiographic evaluation were collected at a minimum 5-year follow-up. Re-operations or any subjective laxity were considered failures. Radiographs were analyzed for OA utilizing Samilson-Prieto Radiological Classification. ResultsNinety-two patients underwent arthroscopic labral reconstruction with a modified inferior capsular shift. Sixty-four met the inclusion criteria. Thirty-eight(age=26.0±8.0 years) participated in at least one collision/contact sport, and 26(age=38.0±9.0 years) participated in limited/non-contact sports. Two(5%) collision/contact and 3(12%) limited/non-contact athletes had traumatic re-injury requiring revision surgery. Of the remaining athletes (59/64), minimum 5-year follow-up was obtained on 54(92%) with a mean follow-up of 12±4 years(range 5 to 23 years). All athletes returned to their original sport at the same level. There was no significant difference between collision/contact and limited/non-contact athletes in timing of return to sports (5.2±1.9 and 6.0±3.1 months, respectively; p=0.389). There were no significant differences between groups on any outcomes scores. ConclusionArthroscopic labral reconstruction with a modified inferior capsular shift addressed anterior instability with return to sport for both collision/contact and limited/non-contact athletes with excellent functional and clinical outcomes, full shoulder ROM, and a low prevalence of advanced OA at minimum 5-year follow-up. This modified technique resulted in a low failure rate in both limited/non-contact and collision/contact athletes.

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

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. 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. 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. 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). 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. 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.

The revision hip arthroscopy complex: capsular deficiency, labral deficiency, femoral over-resection andadhesions can result ingood survivorship with revision hip arthroscopy.

To evaluate the patient-reported outcomes (PROs) and survivorship of combined arthroscopic hip labral reconstruction/augmentation, capsular reconstruction, femoral neck remplissage and lysis of adhesions. Patients ≥18 years old who underwent this combination of procedures during revision hip arthroscopy and were eligible for minimum 2-year follow-up were identified. PRO scores including Hip Outcome Score (HOS)-Activities of Daily Living scale, HOS-Sports scale, modified Harris Hip Score, Short Form 12, and Western Ontario & McMaster Universities Osteoarthritis Index, patient satisfaction and failure rates were analyzed. Seven patients (5 females and 2 males) with average age of 45.0 ± 5.2 (range: 40-54 years) met inclusion criteria. Patients had a median of 1 (range: 1-3) prior hip surgery at an outside institution. All patients had previously undergone femoral osteoplasty, and 85% (6/7) of patients had a labral repair performed. Four patients had no capsule closure performed in their prior procedures. Six patients were available for minimum 2-year follow-up. Two patients converted to total hip arthroplasty: one patient with four prior hip arthroscopies and the other had advanced osteoarthritis with outerbridge grade 3/4 defects requiring microfracture. Mean patient satisfaction was 7 (range: 2-9). At mean follow-up of 3 years, most patients who underwent the combination of labral reconstruction, capsular reconstruction, femoral neck remplissage and lysis of adhesions during revision hip arthroscopy demonstrated improved PROs. This salvage procedure has the potential to restore hip function in patients who have failed an initial hip arthroscopy procedure. In patients with these pathologies present and concomitant joint space narrowing, a total hip arthroplasty may be a more appropriate salvage option.

Modified Technique for Labral Reconstruction of Hip Joint Using Autologous Iliotibial Band (ITB)—Make Labral Reconstruction Stress-Free

Current treatments for labral tear include surgical debridement, arthroscopic repair, and labral reconstruction. Although labral debridement and labral suture repair are suitable for most patients, labral reconstruction is the first treatment option when there is extensive labral degeneration or defect. Often, however, the labral degeneration or defect is only detected intraoperatively; therefore, the surgeon should always have a backup plan. The current labral reconstruction technique has shortcomings such as long operation time, difficult autograft harvesting, cumbersome graft preparation, and the need for a large surgical incision and re-sterilization and draping. To address these problems, we developed a modified technique for draping and surgery. This technique ensures preparedness for labral reconstruction during each hip arthroscopic surgery. The method also simplifies the steps for autologous iliotibial band graft harvesting and shortens operative time. We have achieved satisfactory clinical results with use of this technique over the past 2 years. In this Technical Note, we describe our technique. This modified labral reconstruction technique greatly improves surgical efficiency and could be a promising surgical technique for hip labral reconstruction.

Modified Loop Suture Technique in Arthroscopic Labral Repair of the Hip

Hip arthroscopy is rapidly increasing in case volume annually in the United States. However, it remains a challenging surgery with a steep learning curve. Labral repair is commonly performed to preserve the labrum rather than labral debridement or reconstruction. Many techniques have been described for labral repair. In this technical note, we describe our technique for a modified loop suture technique for arthroscopic labral repair of the hip.

Acetabular Labral Reconstruction: Review of Techniques and Outcomes.

To analyze advances in labral reconstruction, and to discuss the literature relating to efficacy, outcomes, and technical considerations of labral reconstruction. The available evidence suggests that labral reconstruction is a safe and effective procedure that can improve pain and function in patients with severe and/or complex labral tears. The superiority of labral reconstruction over labral repair is uncertain, and it remains unclear what graft type and technique should be used in labral reconstructions. Labral reconstruction assists in restoring the function of the labrum of the hip. It consistently restores stability of the hip joint and demonstrates good clinical outcomes at follow-up. The optimal graft type, technique, and extent are still debated, and more research is needed. Ultimately, despite this uncertainty, labral reconstruction is proving to be a valuable tool for hip preservation specialists.

Poster 225: Acetabular Labral Blood Flow Using Laser Doppler Flowmetry Before &amp; After All- Arthroscopic Capsular Autograft Labral Reconstruction

Objectives: All-arthroscopic capsular autograft labral reconstruction has been proposed to repair complex or irreparable tears without the downside of autograft related donor-site morbidity. Cadaveric studies have suggested that the acetabular labrum receives its blood supply from radial branches of the periacetabular periosteal vascular ring that penetrate the hip capsule, with perfusion remaining intact in most hips exhibiting labral tears. Despite this, little is known about the exact course of blood flow to labral tissue or how surgical reconstruction of this region affects microvasculature during hip arthroscopy. The purpose of this study was to examine the effects of all-arthroscopic capsular autograft labral reconstruction on labral blood flow in vivo using laser doppler flowmetry (LDF) to measure microvascular perfusion. Methods: After obtaining institutional review board approval, patients ≥18 years old undergoing arthroscopic repair of the acetabular labrum by a single surgeon were consented between 2018-2022. Labral repair was performed via a previously published capsular autograft labral reconstruction technique. An LDF probe (Moor Instruments) continuously measured microvascular blood flow flux (perfusion units [PU]) within 1mm3 of surrounding labral tissue (Figure 1). LDF measurements were taken medial and lateral to the region of the tear before/after labral reconstruction and before/after labral elevation from the acetabular rim. The mean of flux measurements was expressed as a percent change from each patient’s baseline measurements. The percent change in labral perfusion was analyzed using student t-tests and one-way ANOVA using Tukey’s method for multiple comparisons. Associations between preoperative demographics and labral perfusion were analyzed using multiple regression analyses. Lending from previous literature, flux decreases ≥50% were considered clinically significant. Results: This study included 41 patients [24 males (58.5%) and 17 females (41.5%)] undergoing arthroscopic labral repair with capsular autograft reconstruction with mean [SD] age 31.3 [8.4] years, BMI 24.8 [3.3] kg/m2, lateral center edge angle (LCEA) 35.3 [4.9] degrees, Tönnis angle 5.8 [5.8] degrees, and mean arterial pressure 96.0 [10.9] mmHg. The mean [95% CI] percent change in blood flow following labral elevation was -9.24% [(-0.04) to (-18.1)]. Following labral reconstruction, the mean [95% CI] percent change in blood flow medially was -22.3% [(-11.9) to (-32.7)] and laterally -32.5% [(-23.6) to (-41.5)]. There was no significant difference between the changes in medial versus lateral perfusion (p=0.136) following repair. Unadjusted analyses stratifying for age, BMI, sex, type of impingement, Tönnis/Outerbridge class, amount of capsule used for augmentation, and suture technique revealed that none of these factors were correlated with significant differences in labral perfusion medially or laterally (p&gt;0.05; Table 1). Multiple regression analyses controlling for demographic and intra-operative variables demonstrated that BMI, LCEA, suture technique, age, mean arterial pressure were not significantly associated with changes in medial or lateral labral perfusion (p&gt;0.05; Table 2). Finally, all changes in flux were found to be significantly less than the 50% threshold, when comparing decreases following labral elevation (p&lt;0.001) and labral reconstruction medially (p&lt;0.001) and laterally (p&lt;0.001). Conclusions: While the vascular nature of the acetabular labrum has been described in literature, preservation of labral blood flow following arthroscopic labral repair has not yet been objectively reported. This study found that techniques to preserve native hip anatomy and vascular supply may adequately maintain perfusion to labral tissue and promote healing. While laser doppler flowmetry may be affected by secondary operative factors, careful measures were taken to standardize the in vivo environment during each measurement. Additionally, blood flow measurements are only limited time assessments with no ability to speculate if observed changes are permanent or temporary. Although this study cannot be generalized to all variations of labral repair/reconstruction, these results suggest that surgeons can employ techniques that preserve microvascular tissue perfusion. The use of capsular augmentation enables preservation of the donor-tissue blood supply with local tissue transfer, suggesting that current labral repair techniques can preserve labral perfusion. [Table: see text] [Table: see text]

Paper 03: The Anterior Labral Circumferential Onlay Technique (ALCOT) serves to reconstruct the anterior labrum and biomechanically restores anterior glenohumeral joint stability

Objectives: The standard of care for treating anterior shoulder instability caused by a labral detachment is the Bankart repair. In the case of a deficient labrum with significant antero-inferior glenoid bone loss, the latarjet technique can be used instead. However, when the labrum is deficient and the bone loss is minimal, labral reconstruction has been recently proposed as an alternative. A new technique called Anterior Labral Circumferential Onlay Technique (ALCOT) was developed, which reconstructs the labrum using the long head of the biceps tendon. The purpose of this study was to biomechanically evaluate the efficacy of the ALCOT to stabilize the shoulder joint against anterior dislocation in the setting of a deficient labrum with no glenoid bone loss. Methods: Ten fresh-frozen cadaveric shoulders were tested in 5 consecutive states using a 6-degrees-of-freedom robotic arm: (1) Native, (2) Capsular Repair, (3) Labral Tear (4) ALCOT (5) Latarjet. The capsule repair state used as a control because the joint capsule needed to be opened and repaired to perform the other states. This state ensured that any differences were due to the surgical procedure being tested, and not because of any iatrogenic damage to the capsule. The Labral Tear was performed by detaching the labrum from the glenoid between 3-6 o’clock and removing it from the joint. For the ALCOT, the biceps tendon was shortened at the distal portion and pulled into the joint. Three knotless all suture anchors were placed at 3, 4:30 and 6 o’clock position on the glenoid rim, and the biceps tendon was secured to the suture anchors using mattress stitches. For the latarjet, a coracoid autograft was cut 25 mm from the tip, keeping the conjoint tendons intact, and secured to the glenoid using two screws. In the native state, each specimen underwent an initial test to determine the appropriate amount of anterior and inferior displacement for future tests. In this test, a 50N compressive load was maintained while an 80N force was applied in the sagittal plane at a 45° angle between the anterior and inferior axes. The corresponding anterior and inferior displacements were recorded. Then, in each state including native, a dislocation test was performed. In this test, a 50N compressive load was maintained while the joint was driven in position control to the previously recorded positions on the anterior and inferior axes. The amount of force needed to displace the shoulder and the lateral displacement of the humeral head were recorded throughout the motion. Higher lateral translation was considered more stable, because it corresponded to a larger obstacle to overcome during the dislocation. To account for variation in the amount of compressive load during the test, antero-inferior dislocation load was normalized by compressive load to create a force ratio. This metric accounts for the fact that the amount of force required to dislocate depends on the amount of stabilizing compressive load provided by the robot in vitro, and by muscle tension in vivo. Results: No significant differences were found between the native and capsular repair states. Compared to native, the labral tear significantly decreased the lateral translation of the humeral head during dislocation from 6.5mm to 5.4mm (p&lt;0.001) and decreased the force ratio from 1.8 to 1.1 (p=0.002), corresponding to a decrease from 90N to 55N at 50N of compressive load. The ALCOT restored these values to 6.4 mm and 1.4, respectively, showing no significant difference from native. The latarjet restored the force ratio to 1.3 (not significant from native) but failed to restore lateral translation with a value of 5.6 mm (p=0.003 from Native, not significantly different from the labral tear). The force ratio is shown on figure 1 and the lateral translation is shown on figure 2. Conclusions: The ALCOT is a novel technique for labral reconstruction that can be considered as a treatment option for anterior instability in the setting of a deficient labrum. Compared to the latarjet technique, the ALCOT involves less morbidity and represents a more anatomic glenoid surface by replacing the labrum without changing the bony morphology. In this study, the ALCOT also showed superior stabilization by restoring native force ratio and lateral humerus translation. Further research is necessary to clinically validate this technique, and possibly to expand indications to small degrees of glenoid bone loss. [Table: see text]

Poster 371: A Comparison of Fresh-frozen Tendon versus Fresh Meniscus Allograft Transplantation for Acetabular Labrum Reconstruction

Objectives: To document indications, surgical technique, and outcomes for acetabular labrum reconstruction in the initial series of cases using fresh meniscus allograft transplantation in comparison to a contemporaneous cohort of cases using fresh-frozen tendon allografts. The study was designed to test the hypothesis that patients undergoing labral reconstructions using fresh meniscus allograft transplantation would have better short-term outcomes compared to those using fresh-frozen tendon allografts based on patient-reported measures of pain and function. Methods: With IRB approval and documented informed consent, patients were prospectively enrolled into a dedicated registry designed to follow outcomes after allograft transplant surgeries in the hip. Included patients underwent acetabular labral reconstruction for irreparable acetabular labral insufficiency between November 2015 and June of 2021 with at least 1-year of follow-up available. Cohort assignment was defined based on type of allograft used for acetabular labrum reconstruction, as follows: Fresh meniscus allograft transplant (MAT) utilized to reconstruct the acetabular labrum; Frozen tendon allograft transplant (TAT) utilized to reconstruct the acetabular labrum. Patient reported outcome measures were collected pre-operatively and at regular intervals after surgery (6 weeks, 3 months, 6 months, and then yearly). Visual analog scale for pain (VAS), Hip disability and Osteoarthritis (HOOS) junior, and Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function scores were collected via electronic data capture. Patient electronic medical records were used to obtain patient demographic, operative, complications, and re-operations data. Treatment failures were defined as any revision surgery involving the hip joint or total hip arthroplasty (THA). Patients were considered successful when they were recorded as having returned to functional activities without revision or arthroplasty at final follow-up at least one year post-operatively. Initial success rate was calculated using the formula: 100% - (%revision + %THA). Final follow up was defined at 1 year (Range = 12-81 mos; mean 34.5 mos). Fisher exact tests were used to assess for significant differences in proportions. t-Tests or rank sum tests were used to assess for significant differences between cohorts at each time point. Repeated measures analysis of variance was used to assess for significant differences within cohorts over time. Significance was set at P&lt;0.05. Results: A total of 27 patients (12 male, 15 female) were included for analysis. Mean age was 30.7 ± 9.2 years (range: 18-48) and mean body mass index (BMI) was 27.1 ± 5.4 kg/m2 (range: 20.1-44.0). Initial success rate for the entire group of 27 patients was 88.9%. Initial success rate in the TAT cohort was 80% with one patient undergoing THA at 4 months after transplantation. Initial success rate in the MAT cohort was 90.1% with two patients undergoing THA at 9 and 38 months after transplantation. Initial treatment success rates were not significantly different between cohorts (p=0.47). Treatment failure was significantly associated with concurrent femoral head OCA transplantation (p=.029, OR = 19.9). For the MAT cohort, clinically meaningful and statistically significant improvements in HOOS JR (p=.004, p=.023), VAS pain (p&lt;.001, p=.&lt;.001), and PROMIS PF (p=.044, p=.035) scores were noted at 1-year and final follow-up. For the TAT cohort, clinically meaningful improvements in HOOS JR and VAS pain scores were noted at 1-year but were not sustained at final follow-up. Conclusions: These data support consideration for use of fresh meniscus allografts as an option for acetabular labrum reconstruction when indicated. MAT for acetabular labrum reconstruction was associated with better short-term patient reported scores and success rate when compared to TAT, which may be related to biologic and biomechanical differences in graft types and transplantation techniques. However, only concurrent femoral head OCA transplantation was associated with a significantly higher treatment failure rate.

Magnetic Resonance Imaging Approximates Labral Width at the 9-, 12-, and 3-O’Clock Positions in the Setting of Revision Hip Arthroscopy

To compare preoperative magnetic resonance imaging (MRI) and intraoperative measurements of labral width and determine whether MRI can reliably predict labral width in the setting of revision surgery. Patients who underwent revision hip arthroscopy with labral repair performed by a single surgeon from January 2008 to December 2015 were identified retrospectively from a prospectively collected database. The width of the labrum was measured intraoperatively at the time of surgery. Two orthopaedic surgeons performed labral width measurements on MRI scans at 3 standardized locations using the clock-face method. Interobserver and intraobserver reliabilities were calculated, and comparisons between intraoperatively measured labral widths and MRI measurements were performed. Fifty-eight patients who underwent revision hip arthroscopy were enrolled in the study. The average labral width measurements at the 3-, 12-, and 9-o'clock positions were 7.4 mm (standard deviation [SD], 1.2 mm), 7.5 mm (SD, 1.4 mm), and 6.6 mm (SD, 1.2 mm), respectively, on MRI compared with 6.7 mm (SD, 2.1 mm), 6.5 mm (SD, 2.5 mm), and 7.0 mm (SD, 1.9 mm), respectively, when measured intraoperatively. The average intraoperative measurements were smaller than the MRI measurements at the 3-o'clock (P= .03) and 12-o'clock (P= .01) positions. The inter-rater intraclass correlation coefficients between the 2 surgeons exhibited good agreement (0.612) at the 3-o'clock position, fair agreement (0.498) at the 12-o'clock position, and poor agreement (0.171) at the 9-o'clock position. The positive predictive values of the MRI measurements were 72% at the 3-o'clock position, 68% at the 12-o'clock position, and 88% at the 9-o'clock position for identifying a labral width of 6 mm or greater. The results of this study show that MRI-measured labral width and actual labral width measured at the time of revision arthroscopy are usually within 1 mm of each other. Level II, diagnostic study investigating diagnostic test.

Labral Tear Management in Patients Aged 40 Years And Older Undergoing Primary Hip Arthroscopy: A Propensity-Matched Case-Control Study Comparing Labral Reconstruction to Labral Repair With Minimum Two-Year Follow-Up

Labral Tear Management in Patients Aged 40 Years And Older Undergoing Primary Hip Arthroscopy: A Propensity-Matched Case-Control Study Comparing Labral Reconstruction to Labral Repair With Minimum Two-Year Follow-Up

Long-Term Outcomes Following Arthroscopic Labral Reconstruction with a Modified Inferior Capsular Shift for Anterior Shoulder Instability

Long-Term Outcomes Following Arthroscopic Labral Reconstruction with a Modified Inferior Capsular Shift for Anterior Shoulder Instability

Primary Labral Reconstruction Versus Labral Repair In Patients With Femoroacetabular Impingement: An Inverse Propensity Score Weighted Analysis of Patient Reported Outcomes and Subsequent Surgery Risk

Primary Labral Reconstruction Versus Labral Repair In Patients With Femoroacetabular Impingement: An Inverse Propensity Score Weighted Analysis of Patient Reported Outcomes and Subsequent Surgery Risk

Primary Acetabular Labral Reconstruction In Adolescents, In the Rare Scenario of Irreparable Labral Tears, Resulted In Comparable Improvement, Clinical Benefit, and Revision Surgeries Rate to a Primary Labral Repair Benchmark Group

Primary Acetabular Labral Reconstruction In Adolescents, In the Rare Scenario of Irreparable Labral Tears, Resulted In Comparable Improvement, Clinical Benefit, and Revision Surgeries Rate to a Primary Labral Repair Benchmark Group

Assessment of Acetabular Labral Blood Flow Using Laser Doppler Flowmetry Before and After All-Arthroscopic Capsular Autograft Labral Reconstruction

Assessment of Acetabular Labral Blood Flow Using Laser Doppler Flowmetry Before and After All-Arthroscopic Capsular Autograft Labral Reconstruction

Arthroscopic Hip Labral Reconstruction With Fresh Meniscal Allograft

The acetabular labrum is essential to maintaining the functional health of the hip joint through contributions to joint congruity, stability, and the negative pressure suction seal. Injury, overuse, long-standing developmental disorders, or failed primary labral repair can eventually lead to functional labral insufficiency requiring management via labral reconstruction. While numerous graft options exist for hip labral reconstruction, there is no current gold standard. The optimal graft should best mimic the native labrum with regard to geometry, structure, mechanical properties, and durability. This has led to the development of an arthroscopic technique for labral reconstruction with fresh meniscal allograft tissue.

Labral Pull-Through Technique for Arthroscopic Labral Reconstruction of the Hip

Background: The goal of hip labral reconstruction is to restore the suction seal, requiring the labral graft to be precisely secured along the acetabular rim. When performed arthroscopically, controlling the graft as it is suspended in the hip joint between 2 cannulas can be challenging, making fixation in the optimal position to restore the suction seal difficult to achieve. Indications: Labral reconstruction/augmentation is indicated for patients with a deficient/dysfunctional labrum when repair alone cannot restore/maintain the suction seal. Technique Description: Following diagnostic arthroscopy, debridement, and measurement of the labral deficiency (30 mm), 70 mm tibialis anterior allograft was tubularized with a whipstitch and prepared with long suture tails at both ends and a single mattress stitch placed through the graft at the medial end. Holes for the anchors were pre-drilled. Viewing from the anterolateral portal, the graft was introduced down a sled through the modified anterior portal, pulled through the joint, and guided into the posterolateral portal cannula via instrumentation through the distal anterolateral accessory portal. With initial fixation achieved medially with the mattress stitch, directing the graft into position while achieving optimal coverage of the deficient area was facilitated by the excess graft length pulled into the posterolateral portal cannula. Results: Labral reconstruction can restore the suction seal of the hip joint when repair alone is not sufficient. Comparative studies with matched repair cohorts have demonstrated comparable survivorship and patient-reported outcomes between groups, with similar rates of patient acceptable symptomatic state and minimal clinically important difference between groups, and similar rates of return to sport in high-level athletes. Recent systematic reviews have largely corroborated these findings. Discussion/Conclusions: Arthroscopic labral reconstruction is an effective treatment option when repair alone cannot restore the suction seal when the graft is secured in an optimal position, but controlling the graft during passage and fixation while achieving a final length spanning the segmental deficiency in continuity with native tissue at both ends can present technical challenges. The labral pull-through technique greatly facilitates this process. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Single Portal Segmental Labral Reconstruction of the Hip

Many techniques have been described for reconstruction of the acetabular labrum, but the procedure is known to be technically rigorous leading to lengthy procedure times and traction times. Increasing efficiency of the procedure with respect to graft preparation and delivery remain areas for potential improvement. We describe a simplified procedure for arthroscopic segmental labral reconstruction using peroneus longus allograft and a single working portal to shuttle the graft into the joint via suture anchors placed at the terminal extents of the graft defect. This method allows for efficient preparation, placement and fixation of the graft that can be completed in under 15 minutes.

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To systematically review and report the mid- to long-term patient reported outcomes (PROs) following hip labral reconstruction.A literature search of the Pubmed, Embase, and Cochrane Library databases was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for clinical studies reporting mid- to long-term PROs at minimum five year follow-up following arthroscopic hip labral reconstruction. A quality assessment was performed using the Methodological Index of Non-Randomized Studies (MINORS) grading system. Data collection included study characteristics, demographics, indications, radiographic metrics, perioperative findings, surgical technique, baseline and most recent PROs, and subsequent surgeries.Four studies met inclusion criteria, with 182 hips (age range, 27.9 to 38.7 years) undergoing labral reconstruction in primary and revision hip surgery with minimum five year follow-up. There were three level III studies and one level IV study, with an average MINORS score of 16.6. All studies cited labral tissue characteristics as a factor for surgical indications, including the quality and/or size of the labrum. Three studies performed segmental labral reconstructions, while another study utilized a circumferential technique. Varying grafts were selected, including hamstring autograft/allograft, ligamentum teres autograft, iliotibial band autograft, and tensor fascia lata autograft. All studies demonstrated improved PROs from baseline to most recent follow-up, with four studies reporting modified Harris Hip Score (mHHS) values that increased from baseline (range, 58.9 to 66.8) to most recent follow-up (range, 80.1 to 86.3). After labral reconstruction, rates of revision arthroscopy ranged from 4.8% to 13.3% and conversion to total hip arthroplasty ranged from 1.6% to 27%.Improved PROs were observed in all studies at minimum 5-year follow-up, suggesting that labral reconstruction can offer durable results beyond short-term follow-up. While surgical indications for all studies included labral tissue characteristics, differing graft selection and surgical techniques were utilized across studies, limiting the ability to determine an optimal treatment approach.