Transverse Acetabular Ligament Research Articles

Reliability of the transverse acetabular ligament as a landmark for functional cup anteversion in total hip arthroplasty.

The transverse acetabular ligament (TAL) can be a useful and reproducible landmark in the orientation of the acetabular cup in total hip arthroplasty (THA). Its role in guiding cup orientation when aiming to implant in a functional anteversion orientation is unclear. The aim of this study was to assess the relationship between the TAL and the planned acetabular cup anteversion when implanted in a function orientation. In a retrospective study the anteversion of the TAL in the contralateral un-replaced hip was measured in CT scans of patients undergoing THA and compared to the functional cup anteversion using the patient-specific spinopelvic parameters. Comparative measurements of the native acetabular version were made from the superior rim to the inferior rim and at 10 mm intervals between the 2, all in reference to the anterior pelvic plane. 96 hips were measured. The mean TAL anteversion angle was 17.2° ± 4.5°. The mean planned acetabular cup anteversion angle was 26.3° ± 4.7°. Pearson's correlation coefficient of this measurement with the TAL was -0.03 (p = 0.769). There was a significant difference between the planned acetabular cup anteversion and the measurement of the TAL (p < 0.0001). If cups are implanted parallel to the TAL, almost 80% will be >5° different to targeted functional cup version. It should be aimed to implant cups with more anteversion than the TAL indicates.

Morphological Characteristics of the Vietnamese Adult Human Acetabulum Using Multiplanar Reconstruction Computed Tomography in Total Hip Replacement Surgery.

The anatomical parameters of the acetabulum vary among races and geographical regions. Multislice Computed Tomography (CT) has proven to be a practical approach to assess morphological parameters of the acetabulum. The purpose of this study was to explore morphological characteristics of the acetabulum measured by CT scans in Vietnamese adults. Thirty-five consecutive patients aged 18 years and older received indications and eligibility for total hip replacement surgery. Sixty-three acetabulum were examined with multislice computed tomographic system (CT) with multiplanar reconstruction (MPR). Measured morphometric parameters of acetabulum included acetabular inclination angle (AIA), acetabular anteversion angle (AAA), acetabular angle of sharp (AAS), sagittal acetabular angle (SAA), acetabular horizontal offset (AHO), transverse acetabular ligament anteversion (TALA), transverse acetabular ligament inclination (TALI), acetabular depth (ADe), acetabular depth ratio (ADr) and acetabular diameter (ADi). The mean values of acetabular diameter, femoral head diameter, AIA, AAA, AAS, SAA, TALA, TALI, AHO, ADe, ADr were 50.22±3.56 mm, 43.54±3.68 mm, 40.27±5.09 mm, 13.30±5.54 mm, 39.46±5.41 mm, 26.38±9.01 mm, 9.49±3.92 mm, 47.70±6.73 mm, 3.06±0.37 mm, 18.62±2.95 mm and 309.60±41.87 mm. Our initial data has showed morphological characteristics of the acetabulum in Vietnamese adults, different from the populations from other parts of world. Also, significant correlation between the orientation of the acetabulum and the transverse acetabular ligament was documented.

Feasibility of feline coxofemoral arthroscopy using a supratrochanteric lateral portal: A cadaveric study.

To evaluate the feasibility of feline diagnostic coxofemoral arthroscopy. Ex vivo feline cadaveric descriptive study. Seven feline cadavers (14 hips). Gross dissection of two feline hips was performed to evaluate anatomic landmarks, guide arthroscopic portal development, and determine optimal limb positioning. A 1.9 mm, 0° arthroscope, inserted through a supratrochanteric lateral portal, was used to assess intraarticular structures in 12 feline cadaver hips. Arthroscopy was followed by gross dissection of periarticular soft tissues. Relative portal locations and damage to periarticular structures were recorded. Hips were disarticulated, and an India ink assay was performed to assess whether there was iatrogenic cartilage injury (ICI). Scope insertion was achieved in all hips. Articular cartilage of the femoral head and acetabulum, round ligament, joint capsule, transverse acetabular ligament, and dorsal acetabular rim were identified arthroscopically in all hips. Probe insertion and intra-articular structure palpation was achieved in all hips. Scope and instrument portals resulted in minimal periarticular muscle trauma. No sciatic nerve damage was detected. Minor partial thickness ICI was observed in all hips at the site of scope insertion. Focal full thickness ICI was noted in one hip. Arthroscopy of the feline coxofemoral joint allowed visual and probe evaluation of intra-articular structures without evidence of major periarticular neurovascular trauma. Iatrogenic cartilage injury occurred in all hips but severity of lesions was considered mild. Coxofemoral arthroscopy is feasible in cats and can be utilized as a diagnostic tool for minimally invasive joint evaluation.

Debulking of Ligamentum Teres—A Technique to Preserve the Ligamentum in Open Reduction of DDH

Debulking of Ligamentum Teres—A Technique to Preserve the Ligamentum in Open Reduction of DDH

Application of transverse acetabular ligament in total hip arthroplasty: a systematic review

IntroductionIn total hip arthroplasty (THA), the correct position of the acetabular component directly determines the outcome of the surgery, or the success of the surgery. Therefore, how to accurately locate the position of the acetabular component has become a very critical step in THA. As an important anatomical structure of the hip joint, the transverse acetabular ligament (TAL) is helpful for acetabular component orientation in THA. The aim of this systematic review was to investigate application of TAL in THA.Materials and methodsA systematic literature search of PUBMED, EMBASE, and Cochrane Library was performed (January and February 2023) using keywords “total hip arthroplasty,” “total hip replacement,” “total hip replacements,” “total hip arthroplasties,” “total hip prosthesis,” and “transverse acetabular ligament” in all possible combinations. Reference lists of included articles were reviewed. Study design, surgical approach, patient demographics, TAL identification rate, appearance of the TAL, anteversion and inclination angle and rate of dislocations were recorded.ResultsIn total, 19 studies met the screening criteria. Study designs were prospective cohorts (42%), retrospective cohorts (32%), Case series (21%), and randomized controlled trial (5%). Twelve of the 19 (63.2%) studies investigated the application of TAL as an anatomical landmark for locating acetabular component position in THA. Analysis revealed that TAL is a reliable anatomical landmark for acetabular component orientation within the safe zone in THA.ConclusionsTAL can reliably be used to align the acetabular component in the safe zone for anteversion and inclination in THA. However, TAL has individual variation influenced by some risk factors. More randomized controlled studies with larger numbers of patients are needed to investigate the precision and accuracy of TAL as an intraoperative landmark in THA.Level of evidenceIV.

Posterior Approach Total Hip Arthroplasty Utilizing a Monoblock Dual-Mobility Construct Without Posterior Hip Precautions: A Series of 580 Hips With One Dislocation

BackgroundInstability remains a devastating complication following total hip arthroplasty. Here we describe a mini-posterior approach with a monoblock dual-mobility implant without “traditional posterior hip precautions” yielding excellent results. MethodsThere were 580 consecutive hips in 575 patients who underwent total hip arthroplasty utilizing a monoblock dual-mobility implant and a mini-posterior approach. With this technique, the acetabular component positioning does not rely on tradition intra-operative radiographic abduction and anteversion goals but rather uses patient-specific anatomic landmarks (anterior acetabular rim and, when visible, the transverse acetabular ligament) to set cup position; stability is assessed with a significant, dynamic intra-operative test of range of motion. Patients’ mean age was 64 years (range, 21 to 94), and 53.7% were women. ResultsMean abduction was 48.4° (range, 29° to 68°) and mean anteversion was 24.7° (range, −1° to 51°). Patient Reported Outcomes Measurement Information System scores improved in every measured domain from preoperative to final postoperative visit. There were seven (1.2%) patients who required reoperation, with mean time to reoperation of 1.3 months (range, one to 176 days). Only one patient (0.2%) who had a preoperative history of spinal cord injury and Charcot arthropathy dislocated. ConclusionA posterior approach hip surgeon may want to consider using a monoblock dual-mobility construct and avoidance of traditional posterior hip precautions to achieve early hip stability with an extremely low dislocation rate and high patient satisfaction scores.

Comparison between magnetic resonance imaging and intraoperative arthrogram in detection of soft tissue obstacles to reduction in developmental dysplasia of the hip

Abstract Background The spectrum of abnormalities in developmental dysplasia of the hips (DDH) is not limited to osseous changes, but extends to include periarticular soft tissue changes, which could not be visualized by conventional radiographs or computed tomography (CT). Both MRI and conventional arthrogram can evaluate those soft tissue obstacles to reduction. Patients and methods In total, 16 children with DDH (21 hips), dated for surgical management by open reduction, were chosen. All patients were examined by preoperative MRI as well as intraoperative arthrogram. Both modalities were used to assess different obstacles to reduction, such as the labrum, pulvinar, ligamentum teres (LT), iliopsoas tendon interposition, and the transverse acetabular ligament (TAL). Results Both MRI and conventional arthrogram showed similar sensitivity (100%) for detection of ligamentum teres pathology, labral inversion, and hypertrophied pulvinar. MRI showed higher sensitivity than arthrogram for detection of the iliopsoas tendon interposition (100% vs. 64.5%) and for detection of the thickened transverse acetabular ligament (85.7% vs. 19%). Conclusions Both MRI and conventional arthrogram can visualize the soft tissue obstacles to reduction in dysplastic hips. MRI is a noninvasive technique, requiring sedation in the pediatric population. Conventional arthrogram is an invasive technique. However, significant complications can be readily avoided.

Ossified Transverse Acetabular Ligament of Hip Bone- A Case Study

Ossified Transverse Acetabular Ligament of Hip Bone- A Case Study

Restoration of Global Offset and Limb Length in Primary Unilateral Total Hip Arthroplasty When Preoperative Templating is not Applied

Background: Preoperative templating is an essential step before performing any total hip arthroplasty (THA). Restoration of global offset (GO) and limb length (LL) were among the templating purposes. Thus, we aimed to perform THA without preoperative templating based on clinical examination and intra-operative anatomical landmarks to restore hip biomechanics.Patients and Methods: This prospective observational study was conducted on 40 patients with primary THA through the posterior approach. The lesser trochanter was used to determine the level of femoral neck cut, the femoral component insertion depth, and version, along with adjusting the level of the center of the femoral head to the tip of the greater trochanter. The transverse acetabular ligament (TAL) was used as a reference for the acetabular component version and inclination. To optimize the LL, preoperative clinical assessment, intra-operative comparison with the normal side, soft tissue tension, and shuck test were used. GO was adjusted using the depth of acetabulum after reaming, placing the acetabular component fit or 10% overhang from the ridge and gluteus medius muscle tension. Postoperatively, computed tomography (CT) scan was used for measuring the GO (acetabular offset (AO) + femoral offset (FO)) and limb length discrepancy (LLD) and compared to the sound side. Pre and postoperatively, LL was measured using a tape measure from the anterior superior iliac spine (ASIS) to the medial malleolus.Results: Depending on postoperative CT measurements, there was no significant difference between the mean normal and operative GO (P=0.894). The mean LL difference between the two sides was 0.38 cm (P=0.007). Clinically, the mean LLD (comparing the normal side with the operated side preoperatively) was 1.001 cm, while the mean LLD was 0.722 cm (P=0.0455).Conclusions: This study demonstrated that when the preoperative templating step is omitted, depending on intraoperative landmarks, neither the GO nor the AO and FO of the operated side were significantly affected. The mean radiological and clinical postoperative LLD was almost consistent, and the mean difference was &lt; 1 cm, which is within the acceptable range. Do not use abbreviations in abstract and conclusions.

An Increased Allograft Width for Circumferential Labral Reconstruction Better Restores Distractive Stability of the Hip: A Cadaveric Biomechanical Analysis

Background: Questions remain about whether circumferential labral reconstruction (CLR) using an iliotibial band (ITB) allograft can effectively restore the labral suction seal of the hip. Hypotheses: (1) CLR with an ITB allograft >6.5 mm would restore distractive stability force to that of the intact labrum. (2) CLR with an ITB allograft >6.5 mm would achieve significantly superior distractive stability force compared with CLR with an ITB allograft <6.5 mm. Study Design: Controlled laboratory study. Methods: A total of 6 fresh-frozen pelves with attached femurs (n = 12 matched hemipelves) from male donors were procured and dissected free of all soft tissue, including the hip capsule but preserving the native labrum, transverse acetabular ligament, and ligamentum teres. Potted hemipelves were placed in a saline bath and securely fixed to the frame of a hydraulic testing system. A 500-N compressive load was applied, followed by femoral distraction at a rate of 5.0 mm/s until the suction seal ruptured. Force and femoral displacement were continually recorded. Force versus displacement curves were plotted, the maximum force was recorded, and the amount of femoral distraction to rupture the suction seal was determined. After intact testing, the labrum was excised, and specimens were retested using the same protocol. CLR was subsequently performed twice in a randomized fashion using (1) an ITB allograft with a width >6.5 mm (7.5-9.0 mm) and (2) an ITB allograft with a width <6.5 mm (4.5-6.0 mm). Specimens were retested after each CLR procedure. Force (in Newtons) and femoral distraction (in millimeters) required to rupture the suction seal were measured and compared between the 4 testing states (intact, deficient, CLR <6.5 mm, and CLR >6.5 mm) using repeated-measures analysis of variance. Results: On average, intact specimens required 148.4 ± 33.1 N of force to rupture the hip suction seal, which significantly decreased to 44.3 N in the deficient state (P < .001). CLR with ITB allografts <6.5 mm did not improve the maximum force (63 ± 62 N) from the deficient state (P = .42) and remained significantly lower than the intact state (P < .01). CLR with ITB allografts >6.5 mm recorded significantly greater force to rupture the suction seal (135.8 ± 44.6 N) compared with both the deficient and CLR <6.5 mm states (P < .01), with a mean force comparable with the intact labrum (P = .59). The amount of femoral distraction to rupture the suction seal demonstrated similar findings. Conclusion: In a cadaveric model, CLR using ITB allografts >6.5 mm restored the distractive force and distance to the suction seal rupture to values comparable with hips with an intact labrum. CLR using ITB allografts >6.5 mm outperformed CLR with ITB allografts <6.5 mm, demonstrated by a significantly higher force to rupture the suction seal and increased distraction before the rupture. Clinical Relevance: The results of this cadaveric investigation suggest that using wider labral allografts during CLR will provide the distractive force required to rupture the suction seal and immediate postoperative stability of the hip, although further studies are required to determine if these results translate to improved clinical outcomes.

Cup placement in primary total hip arthroplasty: how to get it right without navigation or robotics.

Acetabular component orientation and position are important factors in the short- and long-term outcomes of total hip arthroplasty.Different definitions of inclination and anteversion are used in the orthopaedic literature and surgeons should be aware of these differences and understand their relationships.There is no universal safe zone.Preoperative planning should be used to determine the optimum position and orientation of the cup and assess spinopelvic characteristics to adjust cup orientation accordingly.A peripheral reaming technique leads to a more accurate restoration of the centre of rotation with less variability compared with a standard reaming technique.Several intraoperative landmarks can be used to control the version of the cup, the most commonly used and studied is the transverse acetabular ligament.The use of an inclinometer reduces the variability associated with the use of freehand or mechanical alignment guides.

Three-dimensional morphological analysis of true acetabulum in Crowe type IV hip dysplasia via standard-sized cup-simulated implantation.

Acetabular reconstruction in Crowe type IV developmental dysplasia of the hip (DDH) can be a challenging procedure for surgeons. A high risk of acetabular revision has been reported to be associated with extremely small acetabular prostheses. However, to our knowledge, quantitative morphological and coverage evaluations of the true acetabulum in Crowe IV hips have been infrequently conducted. Useful bony landmarks for acetabular reconstruction can also facilitate satisfactory intraoperative implantation. The aim of the present study was to investigate the anatomical size, orientation angles, and 2/3-dimensional (2D/3D) coverage parameters of the true acetabulum in Crowe IV hips; evaluate the feasibility of standard cup (>44 mm) implantation at the true acetabulum in Crowe IV hips; and identify the optimal position and useful bony landmarks of the acetabular reaming center in Crowe IV hips. A total of 42 Crowe IV hips in 37 patients and 36 normal hips were included in this study. Based on pelvic 3D computed tomography (CT) reconstruction, anatomical size and integral volume of the true acetabulum were measured quantitatively. Through standard-size cup-simulated implantation, morphological assessments of the true acetabulum included Cup-CE, Cup-Sharp, acetabular anteversion angle, and thickness of the medial wall. Acetabular sector angles (ASAs) and the component coverage ratio were measured to provide coverage indices. Acetabular reconstruction was also performed at different vertical levels to measure medial bone stock and 3D component coverage. Bony landmarks for optimal component center location were also determined. The anatomic shape and volume of the acetabular triangle were significantly smaller in Crowe IV hips. Compared with the control group, the dysplastic acetabulum was more anteverted and abductive, with a thicker medial wall. According to the true acetabulum, bone stock was relatively sufficient in the posterior direction and prominently deficient in the anterosuperior and superior direction. The average 3D component coverage reached 79.89% by standard-sized cup implantation, with the most satisfactory coverage achieved at the true acetabulum (at the level of 13.32 mm above the transverse acetabular ligament). Regarding the component opening plane, the optimal component center was located at the midpoint between the superolateral and posteroinferior points of the true acetabulum. The most satisfactory coverage was achieved at the level of the true acetabulum, of which the most prominent deficiency was mainly located in the anterosuperior and superior directions. The optimal component center was determined to be the midpoint between the superolateral and posteroinferior points of the true acetabulum.

Extracapsular sling technique for treatment of three canine caudoventral hip luxation cases

AbstractThe objective of this study was to report surgical stabilisation of caudoventral coxofemoral luxation by an extra‐articular technique in dogs. Medical records from caudoventral coxofemoral luxations in dogs and cats presented at our institution between January 2012 and December 2020 were reviewed. Caudoventral luxations were relatively rare and were found in one cat and in 13 dogs. Three cases of surgical stabilisation using a ventral coxofemoral approach were reviewed, replacing function of the transverse acetabular ligament using a figure of eight braided suture passed around two pelvic screws and one femoral screw. Functional recovery was obtained in all three cases, without complication or re‐luxation. Extra‐articular stabilisation using a sling implant is a simple, effective method for treatment of caudoventral coxofemoral luxation in dogs.

Unilateral absence of round ligament of femur - Cadaveric case report

Round ligament of femur is a pyramidal structure with apex attached to the fovea of the femoral head and its base blends with the transverse acetabular ligament. It is an intracapsular but extrasynovial structure. It is also called ligamentum teres femoris or foveal ligament. It transmits the acetabular branch of obturator artery and also acts as a secondary stabilizer of the hip joint by supplementing the other ligaments of the hip joint in extreme range of motion. Absence of round ligament of femur is a rare variation which can be unilateral or bilateral and prevalence is 2%–3%. It presents rarely as isolated entity or in association with congenital dysplasia of the hip. This report presents a rare variation of unilateral absence of round ligament of femur with minimal evidence of developmental dysplasia of the hip. During routine dissection of a middle-aged cadaver, on opening the hip joint cavity, the round ligament of femur was absent on the left side whereas, acetabular labrum and femoral head were normal. On the right side, the lower limb was normal in position and round ligament of femur was present in normal length and thickness. Awareness and knowledge of such a rare variation are important for radiologists and orthopedicians for better diagnosis and management of hip-related problems.

CLINICAL RELEVANCE OF HETEROTOPIC OSSIFICATION OF HIP AND PELVIC BONES MUSCLES AND LIGAMENTS

Objectives: Heterotopic ossification is a formation of bone at unusual sites. The present study is aimed to observe the ossification of transverse acetabular ligament, obturator membrane and gluteus maximus muscle in hip bones and fibrous capsule of hip joints and ossification of sacrotuberous and sacrospinous ligaments, erector spinae aponeurosis in pelves, and bilateral ankylosis of sacroiliac joints. Methods: The study was performed on 128 dried human hip bones and six pelves of unidentified sex and age, in the Department of Anatomy. An ossified muscles and ligaments of hip and pelvic bones were observed and their measurements were recorded using Vernier calipers. Results: The present study showed the incidence of completely ossified transverse acetabular ligament in four hip bones, that is, 3.12% with completely ossified fibrous capsule of hip joint on the left side. The incidence of bony spurs along the margin of Obturator Foramen in four left hip bones is 6.25% along with the ossification of the gluteus maximus muscle on dorsal aspect of ilium. Out of six pelves, one pelvis presented complete ossification of erector spinae aponeurosis bilaterally on the dorsal surface of the sacrum along with complete ossification of sacrotuberous ligament of the right side and sacrospinous ligament of the left side along with bilateral ankylosed sacroiliac joint of pelvis. Conclusions: The knowledge of these abnormal ossifications of hip bones and pelvis may be of immense help to orthopedicians, surgeons, neurosurgeons, and radiologists to come to differential diagnosis and plan treatment accordingly.

Evaluation of Transverse Acetabular Ligament Assessment due to Acetabular Labral Tear in Patients Undergoing Magnetic Resonance Arthrography

Evaluation of Transverse Acetabular Ligament Assessment due to Acetabular Labral Tear in Patients Undergoing Magnetic Resonance Arthrography

1244 The TAL Suction Retractor: A Simple Technique for Visualising the Transverse Acetabular Ligament (TAL) During Total Hip Replacement (THR) Surgery

Abstract Introduction The transverse acetabular ligament (TAL) is an anatomical landmark that is of particular use during primary total hip replacements (THR). Visualisation is important to aid the orientation of the acetabular cup and it is a structure that can be identified in virtually every primary hip replacement surgery. We introduce a simple technique to facilitate this. Method A thoracic suction catheter is taped to the distal end of a blunt Hohmann’s retractor with two steristrips wrapping around the catheter and retractor leaving approximately 1-1.5cm of retractor exposed. Our preference is for a thoracic suction catheter with side holes and a proximal end which allows direct connection with the tip of the Yankauer suction. The blunt Hohmann’s retractor is used as the inferior acetabular retractor in the usual way, placed inferior to the transverse acetabular ligament, resting on the posterior ischial surface. The catheter suction tip should lie just under the TAL, in the most dependant point of the wound. Results The TAL suction catheter can be used continuously or intermittently to facilitate visualisation of the TAL during reaming, trialling, and acetabular cup placement. The TAL suction retractor provides suction in the most dependant point of the surgical wound, preventing unnecessary movement and facilitates a clutter-free surgical field leading to more streamlined and efficient surgery with potential reduced operative times. Conclusions The transverse acetabular ligament (TAL) suction retractor is a simple improvised surgical tool that makes it easier to visualise the TAL during acetabular preparation in total hip replacements.

Mechanical and Anatomical Alignment Guide Techniques Are Superior to Freehand in Achieving Target Orientation of an Acetabular Component.

BackgroundAchieving accurate and consistent acetabular component orientation remains a major challenge in total hip arthroplasty.MethodsWe used a pelvic model to compare freehand techniques vs mechanical and anatomical alignment guides in achieving a target operative inclination (OI) and operative anteversion (OA). Thirty subjects comprising consultant orthopedic surgeons, orthopedic trainees, and nonsurgical staff positioned an acetabular component in a pelvic model using 3 different methods for guiding inclination and another 3 for guiding version.ResultsUsing either a standard mechanical alignment guide (MAG) or a spirit level MAG technique eliminated outliers from target OI, while the freehand method resulted in 46.7% of measurements outside the OI target range. The spirit level MAG technique significantly outperformed the standard MAG technique in median unsigned deviation from target OI (0.8° vs 2.1°, P < .001). Either method of referencing the transverse acetabular ligament for version yielded lower deviations from target OA than the freehand method and fewer outliers from the ±5° target range. Surgical experience was not a significant factor for accurately achieving target OI and OA.ConclusionsEven in an idealized in vitro model, a wide range of OI and OA is seen with the freehand technique of cup placement by subjects of all levels of surgical experience. Using either a standard MAG or a spirit level MAG reduces deviations in target OI, with the spirit level MAG method yielding the best accuracy. Using the transverse acetabular ligament to guide cup anteversion yields more accurate OA.

Restoration of Labral Function in Primary Hip Arthroscopy From Labral Repair to Labral Reconstruction

AbstractThe function and importance of the labrum in hip biomechanics has been established. A labral tear is the most common pathology in patients undergoing hip arthroscopy, and adequate management is critical for favorable outcomes. Although labral debridement was initially performed for arthroscopic labral tear management, there has been a shift toward labral restoration techniques. Currently, restoration with labral repair remains the gold standard for labral tear treatment, particularly in the primary setting. When compared to labral debridement, the literature has shown that labral repair has more favorable outcomes.Irreparable labral tears, although unusual in the primary setting, present a challenge. Labral reconstruction and augmentation are recent advancements in this scenario of hip arthroscopy that can help restore labral function.Two alternatives of labral reconstruction have been described: segmental and circumferential. Clinical data for segmental labral reconstruction has reported good outcomes at short-, mid-, and long-term follow-up. Similarly, arthroscopic circumferential reconstruction has shown good to excellent results at short-term follow-up. As the name suggests, only a segment of the labrum is reconstructed during segmental reconstruction. In a circumferential reconstruction, the entire labrum is taken down from the most anterior to the most posterior aspect of the transverse acetabular ligament and is reconstructed using an auto or allograft. A benefit of circumferential labral reconstruction is the removal of the entire damaged labral tissue, a potential source of pain. However, there is no clear evidence that demonstrates the superiority of one method over the other.Labral graft reinforcement via tissue augmentation or labral augmentation is an interesting option because it preserves the native chondrolabral junction. Labral augmentation can also be used for hypoplastic labrum that intraoperatively demonstrates a deficient suction-seal.

The transverse acetabular ligament (TAL) suction retractor: a simple technique for viewing the TAL during total hip replacement (THR) surgery

Murphy, Ben MB BCh BAO, MCh, MRCSI; Pollock, Roisin MB BCh BAO; Ramchurn, Sumant MD; Hurson, Conor MB BCh BAO, AFRCSI, MCh, FRCSIAuthor Information