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Emerging concepts in arthroscopic hip preservation surgery: Labral reconstruction and capsular preservation
Published in K. Mohan Iyer, Hip Preservation Techniques, 2019
Victoria Das, Michael B. Ellman, Sanjeev Bhatia
Recent advancements in the hip preservation literature with regards to the anatomy and biomechanical function of two important hip structures, the labrum and fibrous hip capsule, have inspired novel interest in preserving or reconstructing these two structures when necessary. Labral reconstruction is a treatment option that uses a graft to reconstruct the native labrum. The technique and outcomes of labral reconstruction have been described relatively recently, and labral reconstruction is a cutting-edge procedure that has shown promising early outcomes in properly indicated patients.4,6,9,42,43,45 Equally important, the hip capsule acts as a fibrous mesh composed of multiple ligaments that support and stabilize the joint throughout motion. There are several studies demonstrating the importance of maintaining capsular integrity during hip arthroscopy,3,14,39 and various capsular preservation techniques have been developed to optimize clinical outcomes.
Femoroacetabular impingement: the past, current controversies and future perspectives
Published in The Physician and Sportsmedicine, 2018
Surgical treatment of FAI has been divided into open surgical dislocation, arthroscopy and arthroscopy-assisted surgery combined with mini-open techniques. Open approaches remain an effective tool for correction of intra- and extra-articular deformity. Almost the same functional outcome scores in patients undergoing open dislocation and those with arthroscopic treatment were reported; however, in health-related quality of life scores, the arthroscopy group tends to show greater improvements postoperatively [16]. It should also be kept in mind that the minimally invasive arthroscopic approach may not safely address conditions such as cam-type deformities with considerable posterolateral extension, deficient acetabular coverage, protrusio acetabuli, or coxa profunda [17]. The labrum plays an important role with regard to hip stability through the suction-seal effect, as well as protecting cartilage by distributing the mechanical load. Labrum repair was reported to be associated with significant improvement in the modified Harris Hip Score in comparison with labral debridement [18]. There have been several labral repair techniques described, but thus far no definitive evidence exists to support any particular method of repair, and no significant improvement in one technique over another has been reported using an objective outcome measure [19]. Labral reconstruction is also an option, especially in young patients whose labrum is deficient due to prior debridement or other reasons. However, there has been no strong comparative evidence except large case series and cohort studies addressing labral reconstruction thus far [20].
Femoroacetabular impingement: a common cause of hip pain
Published in The Physician and Sportsmedicine, 2018
Travis J Menge, Nathan W Truex
Labral repair is indicated when the labrum is torn at the chondrolabral junction, which compromises the suction-seal mechanism of the hip. These are usually found at the base of the labrum and have been associated with greater chondral damage adjacent to the tear. The repair is achieved with sutures anchored into the acetabular rim, with the number of sutures dependent on the size of the tear. Labral reconstruction is indicated when the labrum is severely damaged or deficient. In these cases, the labrum is unamenable to holding sutures for repair due to extensive damage, and must be reconstructed using auto- or allograft tissue.