Labral Refixation: Current Techniques and Indications
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Labral tears have been associated with femoroacetabular impingement, instability, sports-related activity or trauma, capsular laxity or hypermobility, dysplasia, and degeneration. Disruption of the labrum increases the rate of acetabular cartilage compression and the contact stress between the femoral and acetabular cartilage. If left untreated, these lesions will alter normal hip joint function and may eventually lead to osteoarthritis.
For the labrum with adequate tissue (>7 mm), the labrum is repaired if it is detached or torn. If the labrum is bruised, a rim reduction and repair is performed, especially in the presence of cartilage damage and the labral–chondral junction. Labri are debrided only if there is enough substance to maintain the function of the labrum. Care must be taken to fix the labrum so that it provides adequate seal with the femoral head.
Two-year outcome on 122 patients who underwent arthroscopic treatment for femoroacetabular impingement and chondrolabral dysfunction showed that, overall, most patients showed an improvement in symptoms and function and were satisfied with the results. Independent predictors of improved outcomes were joint space >2 mm and repair of labral pathology instead of debridement. Several other studies have shown excellent results following labral refixation and repair.
Labral tears have been associated with femoroacetabular impingement, instability, sports-related activity or trauma, capsular laxity or hypermobility, dysplasia, and degeneration. Untreated labral tears can result in premature osteoarthritis of the hip. Debridement only used to be the standard of care, but excellent results reveal arthroscopic labral repair and refixation are an option with good outcomes.
- Adeeb S, Ali A, Shrive N, Frank C, Smith D. Modelling the behaviour of ligaments: a technical note. Comput Methods Biomech Biomed Engin. 2004;7(1):33–42. CrossRef
- Apprich S, Mamisch TC, Welsch GH, Bonel H, Siebenrock KA, Kim YJ, Trattnig S, Dudda M. Evaluation of articular cartilage in patients with femoroacetabular impingement (FAI) using T2* mapping at different time points at 3.0 Tesla MRI: a feasibility study. Skeletal Radiol. 2012;41:987–95. CrossRef
- Burnett RS, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am. 2006;88(7):1448–1457. CrossRef
- Byrd JW, Jones KS. Hip arthroscopy in the presence of dysplasia. Arthroscopy. 2003;19:1055–1060. CrossRef
- Crawford MJ, Dy CJ, Alexander JW, Thompson M, Schroder SJ, Vega CE, Patel RV, Miller AR, McCarthy JC, Lowe WR, Noble PC. The 2007 Frank Stinchfield Award. The biomechanics of the hip labrum and the stability of the hip. Clin Orthop Relat Res. 2007;465:16–22.
- Dorell JH, Catterall A. The torn acetabular labrum. J Bone Joint Surg Br. 1986;68:400–403.
- Espinosa N, Rothenfluh DA, Beck M, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am. 2006;88(5):925–35. CrossRef
- Ferguson SJ, Bryant JT, Ganz R, Ito K. The acetabular labrum seal: A poroelastic finite element model. Clin Biomech. 2000; 15:463–468. CrossRef
- Ferguson SJ, Bryant JT, Ganz R, Ito K. The influence of the acetabular labrum on hip joint cartilage consolidation: A poroelastic finite element model. J Biomech. 2000;33:953–960. CrossRef
- Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech 2003;36:171–178. CrossRef
- Ferguson SJ, Bryant JT, Ito K. The material properties of the bovine acetabular labrum. J Orthop Res. 2001;19:887–96. CrossRef
- Ganz R, Parvizi J, Beck M, Leunig M, N otzli H, Siebenrock KA. Femoroacetabular impingement: A cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003:112–120.
- Ito K, Leunig M, Ganz R. Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res. 2004;429:262–71. CrossRef
- Kelly BT, Weiland DE, Schenker M, et al. Arthroscopic labral repair in the hip: surgical technique and review of the literature. Arthroscopy 2005;21(12):1496–504. CrossRef
- Larson CM, Giveans MR. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement. Arthroscopy. 2009;25(4):369–76. CrossRef
- Larson CM, Wulf CA. Intraoperative fluoroscopy for evaluation of bony resection during arthroscopic management of femoroacetabular impingement in the supine position. Arthroscopy. 2009;25(10):1183–92. CrossRef
- Lertwanich P, Ejnisman L, Torry MR, Giphart JE, Philippon MJ. Defining a safety margin for labral suture anchor insertion using the acetabular rim angle. Am J Sports Med. 2011;39 Suppl:111 S–6 S. CrossRef
- McCarthy JC, Noble PC, Schuck MR, Wright J, Lee J. The role of labral lesions to development of early degenerative hip disease. Clin Orthop Relat Res. 2001:25–37.
- McCarthy JC, Noble PC, Schuck MR, Wright J, Lee J. The watershed labral lesion: Its relationship to early arthritis of the hip. J Arthroplasty 2001;16:S81–S87. CrossRef
- Myers CA, Register BC, Lertwanich P, Ejnisman L, Pennington WW, Giphart JE, LaPrade RF, Philippon MJ. Role of the acetabular labrum and the iliofemoral ligament in hip stability: an in vitro biplane fluoroscopy study. Am J Sports Med. 2011;39 Suppl:85 S–91 S. CrossRef
- Philippon MJ. Arthroscopic capsulorrhaphy of the hip: A review of 12 cases. Arthroscopy 2000;16:416 (abstr).
- Philippon MJ. The role of arthroscopic thermal capsulorrhaphy in the hip. Clin Sports Med. 2001;20:817–829. CrossRef
- Philippon MJ. New frontiers in hip arthroscopy: the role of arthroscopic hip labral repair and capsulorrhaphy in the treatment of hip disorders. Instr Course Lect. 2006;55:309–16.
- Philippon MJ, Arnoczky SP, Torrie A. Arthroscopic repair of the acetabular labrum: a histologic assessment of healing in an ovine model. Arthroscopy. 2007;23(4):376–80 CrossRef
- Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br. 2009 Jan;91(1):16–23. CrossRef
- Philippon MJ, Schenker ML. A new method for acetabular rim trimming and labral repair. Clin Sports Med. 2006;25(2):293–7. CrossRef
- Philippon MJ, Stubbs AJ, Schenker ML, Maxwell RB, Ganz R, Leunig M. Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review. Am J Sports Med. 2007 Sep;35(9):1571–80. CrossRef
- Philippon MJ, Wolff AB, Briggs KK, Zehms CT, Kuppersmith DA. Acetabular rim reduction for the treatment of femoroacetabular impingement correlates with preoperative and postoperative center-edge angle. Arthroscopy. 2010;26(6):757–61. CrossRef
- Labral Refixation: Current Techniques and Indications
HSS Journal ®
Volume 8, Issue 3 , pp 240-244
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- labral tear
- labral refixation
- femoroacetabular impingement
- acetabular rim
- Author Affiliations
- 1. Steadman Philippon Research Institute, 181 W. Meadow Dr., Suite 1000, Vail, CO, 81657, USA
- 2. The Steadman Clinic, Vail, CO, USA
- 3. Department of Surgery, McMasters University, Hamilton, Ontario, Canada