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Surgical Technique: Arthroscopic Labral Management

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Hip Arthroscopy and Hip Joint Preservation Surgery

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Abstract

The acetabular labrum is an integral component of hip joint function and stability. It functions to maintain the suction seal, aid in load disbursement, and regulate synovial fluid dynamics (Philippon et al., Knee Surg Sports Traumatol Arthrosc 22(4):722–729, 2014; Nepple et al., Knee Surg Sports Traumatol Arthrosc 22(4):730–736, 2014; Cadet et al., Am J Sports Med. 40(10):2218–2223, 2012). Acetabular labral tears are the most common indication for hip arthroscopy and are highly associated with femoral acetabular impingement syndrome (FAIS). The intrinsic labral blood supply is poor, so spontaneous healing rates are low, and the natural history typically involves progressive severity of pathology (Kuhns et al., Front Surg 2:58, 2015). Surgical management of labral tears has shown significant improvement in clinical outcomes and hip function. Surgical options for labral treatment currently include debridement, repair, reconstruction, and augmentation. In this chapter, we will review labral anatomical considerations and focus on decision-making principles for labral debridement, repair, reconstruction, and augmentation. We additionally will discuss our preferred surgical technique for labral debridement and repair as techniques for labral reconstruction and augmentation will be discussed in subsequent chapters.

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References

  1. Safran MR. The acetabular labrum: anatomic and functional characteristics and rationale for surgical intervention. J Am Acad Orthop Surg. 2010;18:338–45.

    Article  Google Scholar 

  2. Wenger DE, Kendell KR, Miner MR, et al. Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop Relat Res. 2004;426:145–50.

    Article  Google Scholar 

  3. Burnett RS, Della Rocca GJ, Prather H, et al. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am. 2006;88:1448–57.

    Article  Google Scholar 

  4. Petersen W, Petersen F, Tillmann B. Structure and vascularization of the acetabular labrum with regard to the pathogenesis and healing of labral lesions. Arch Orthop Trauma Surg. 2003;123:283–8.

    Article  Google Scholar 

  5. Martin RL, Enseki KR, Draovitch P, et al. Acetabular labral tears of the hip: examination and diagnostic challenges. J Orthop Sports Phys Ther. 2006;36:503–15.

    Article  Google Scholar 

  6. Seldes RM, Tan V, Hunt J, et al. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res. 2001;382:232–40.

    Article  Google Scholar 

  7. McCarthy J, Noble P, Aluisio FV, et al. Anatomy, pathologic features, and treatment of acetabular labral tears. Clin Orthop Relat Res. 2003;406:38–47.

    Article  Google Scholar 

  8. Kelly BT, Shapiro GS, Digiovanni CW, et al. Vascularity of the hip labrum: a cadaveric investigation. Arthroscopy. 2005;21:3–11.

    Article  Google Scholar 

  9. Putz R, Schrank C. Anatomy of the labro-capsular complex. Orthopade. 1998;27:675–80.

    PubMed  Google Scholar 

  10. Czerny C, Hofmann S, Neuhold A, et al. Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging. Radiology. 1996;200(1):225–30. https://doi.org/10.1148/radiology.200.1.8657916.

    Article  CAS  PubMed  Google Scholar 

  11. Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med. 2009;2(2):105–17. https://doi.org/10.1007/s12178-009-9052-9.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lage LA, Patel JV, Villar RN. The acetabular labral tear: an arthroscopic classification. Arthroscopy. 1996;12:269–72.

    Article  CAS  Google Scholar 

  13. Philippon MJ, Nepple JJ, Campbell KJ, et al. The hip fluid seal—part I: the effect of an acetabular labral tear, repair, resection, and reconstruction on hip fluid pressurization. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):722–9. https://doi.org/10.1007/s00167-014-2874-z.

    Article  PubMed  Google Scholar 

  14. Nepple JJ, Philippon MJ, Campbell KJ, et al. The hip fluid seal—part II: the effect of an acetabular labral tear, repair, resection, and reconstruction on hip stability to distraction. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):730–6. https://doi.org/10.1007/s00167-014-2875-y.

    Article  PubMed  Google Scholar 

  15. Crawford MJ, Dy CJ, Alexander JW, et al. The 2007 Frank Stinchfield Awa\rd. The biomechanics of the hip labrum and the stability of the hip. Clin Orthop Relat Res. 2007;465:16–22.

    Article  Google Scholar 

  16. Johannsen AM, Ejnisman L, Behn AW, Shibata K, Thio T, Safran MR. Contributions of the capsule and labrum to hip mechanics in the context of hip microinstability. Orthop J Sports Med. 2019;7(12):232596711989084. https://doi.org/10.1177/2325967119890846.

    Article  Google Scholar 

  17. Ferguson SJ, Bryant JT, Ganz R, et al. The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech. 2000;33:953–60.

    Article  CAS  Google Scholar 

  18. Ferguson SJ, Bryant JT, Ganz R, et al. The acetabular labrum seal: a poroelastic finite element model. Clin Biomech (Bristol, Avon). 2000;15:463–8.

    Article  CAS  Google Scholar 

  19. Ferguson SJ, Bryant JT, Ganz R, et al. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;36:171–8.

    Article  CAS  Google Scholar 

  20. Cadet ER, Chan AK, Vorys GC, Gardner T, Yin B. Investigation of the preservation of the fluid seal effect in the repaired, partially resected, and reconstructed acetabular labrum in a cadaveric hip model. Am J Sports Med. 2012;40(10):2218–23. https://doi.org/10.1177/0363546512457645.

    Article  PubMed  Google Scholar 

  21. Song Y, Ito H, Kourtis L, et al. Articular cartilage friction increases in hip joints after the removal of acetabular labrum. J Biomech. 2012;45:524–30.

    Article  Google Scholar 

  22. Greaves LL, Gilbart MK, Yung AC, et al. Effect of acetabular labral tears, repair and resection on hip cartilage strain: a 7T MR study. J Biomech. 2010;43:858–63.

    Article  Google Scholar 

  23. Sawyer GA, Briggs KK, Dornan GJ, Ommen ND, Philippon MJ. Clinical outcomes after arthroscopic hip labral repair using looped versus pierced suture techniques. Am J Sports Med. 2015;43(7):1683–8. https://doi.org/10.1177/0363546515581469.

    Article  PubMed  Google Scholar 

  24. Bozic KJ, Chan V, Valone FH, Feeley BT, Vail TP. Trends in hip arthroscopy utilization in the United States. J Arthroplast. 2013;28(8):140–3. https://doi.org/10.1016/j.arth.2013.02.039.

    Article  Google Scholar 

  25. Colvin AC, Harrast J, Harner C. Trends in hip arthroscopy. J Bone Joint Surg Am Vol. 2012;94(4):e23-1-5. https://doi.org/10.2106/JBJS.J.01886.

    Article  Google Scholar 

  26. Farjo LA, Glick JM, Sampson TG. Hip arthroscopy for acetabular labral tears. Arthroscopy. 1999;15:132–7.

    Article  CAS  Google Scholar 

  27. Santori N, Villar RN. Acetabular labral tears: result of arthroscopic partial limbectomy. Arthroscopy. 2000;16:11–5.

    Article  CAS  Google Scholar 

  28. O’Leary JA, Berend K, Vail TP. The relationship between diagnosis and outcome in arthroscopy of the hip. Arthrosc J Arthrosc Relat Surg. 2001;17(2):181–8. https://doi.org/10.1053/jars.2001.21481.

    Article  Google Scholar 

  29. Potter BK, Freedman BA, Andersen RC, Bojescul JA, Kuklo TR, Murphy KP. Correlation of short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement. Am J Sports Med. 2005;33(6):864–70. https://doi.org/10.1177/0363546504270567.

    Article  PubMed  Google Scholar 

  30. Byrd JWT, Jones KS. Hip arthroscopy for labral pathology: prospective analysis with 10-year follow-up. Arthrosc J Arthrosc Relat Surg. 2009;25(4):365–8. https://doi.org/10.1016/j.arthro.2009.02.001.

    Article  Google Scholar 

  31. Kim KC, Hwang DS, Lee CH, et al. Influence of femoroacetabular impingement on results of hip arthroscopy in patients with early osteoarthritis. Clin Orthop Relat Res. 2007;456:128–32.

    Article  Google Scholar 

  32. Tanzer M, Noiseux N. Osseous abnormalities and early osteoarthritis: the role of hip impingement. Clin Orthop Relat Res. 2004;429:170–7.

    Article  Google Scholar 

  33. Riff AJ, Kunze KN, Movassaghi K, et al. Systematic review of hip arthroscopy for Femoroacetabular impingement: the importance of labral repair and capsular closure. Arthrosc J Arthrosc Relat Surg. 2019;35(2):646–656.e3. https://doi.org/10.1016/j.arthro.2018.09.005.

    Article  Google Scholar 

  34. Krych AJ, Thompson M, Knutson Z, et al. Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: a prospective randomized study. Arthroscopy. 2013;29:46–53.

    Article  Google Scholar 

  35. Larson CM, Giveans MR, Stone RM. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: mean 3.5-year follow-up. Am J Sports Med. 2012;40:1015–21.

    Article  Google Scholar 

  36. Menge TJ, Briggs KK, Dornan GJ, McNamara SC, Philippon MJ. Survivorship and outcomes 10 years following hip arthroscopy for Femoroacetabular impingement: labral debridement compared with labral repair. J Bone Joint Surg. 2017;99(12):997–1004. https://doi.org/10.2106/JBJS.16.01060.

    Article  PubMed  Google Scholar 

  37. Woyski D, Mather R. “Chad.” surgical treatment of labral tears: debridement, repair, reconstruction. Curr Rev Musculoskelet Med. 2019;12(3):291–9. https://doi.org/10.1007/s12178-019-09575-1.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Byrd JW, Jones KS. Arthroscopic management of femoroacetabular impingement: minimum 2-year follow-up. Arthroscopy. 2011;27:1379–88.

    Article  Google Scholar 

  39. McCormick F, Nwachukwu BU, Alpaugh K, et al. Predictors of hip arthroscopy outcomes for labral tears at minimum 2-year follow-up: the influence of age and arthritis. Arthroscopy. 2012;28:1359–64.

    Article  Google Scholar 

  40. Espinosa N, Rothenfluh DA, Beck M, et al. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am. 2006;88:925–35.

    PubMed  Google Scholar 

  41. Philippon MJ, Briggs KK, Yen YM, et al. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg (Br). 2009;91:16–23.

    Article  CAS  Google Scholar 

  42. Kim YT, Azuma H. The nerve endings of the acetabular labrum. Clin Orthop Relat Res. 1995;320:176–81.

    Google Scholar 

  43. Shindle MK, Voos JE, Nho SJ, et al. Arthroscopic management of labral tears in the hip. J Bone Joint Surg Am. 2008;90(Suppl 4):2–19.

    Article  Google Scholar 

  44. Philippon MJ, Peixoto LP, Goljan P. Acetabular labral tears: debridement, repair, reconstruction. Oper Tech Sports Med. 2012;20:281–6.

    Article  Google Scholar 

  45. Kuhns BD, Weber AE, Levy DM, Wuerz TH. The natural history of Femoroacetabular impingement. Front Surg. 2015;2:58. https://doi.org/10.3389/fsurg.2015.00058.

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Rush Medical College, Rush University, Chicago, IL, USA

    Kevin C. Parvaresh, Frank McCormick & Shane J. Nho

  2. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Kevin C. Parvaresh & Shane J. Nho

  3. Department of Orthopedics, University of Utah Health Care, Salt Lake City, UT, USA

    Andrew E. Federer

Authors
  1. Kevin C. Parvaresh
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  2. Frank McCormick
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  3. Andrew E. Federer
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  4. Shane J. Nho
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Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Shane J. Nho

  2. Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, USA

    Bedi Asheesh

  3. Department of Orthopedic Surgery, Case Western Reserve University, Cleveland, OH, USA

    Michael J. Salata

  4. Department of Orthopedic Surgery, Duke Medical Center, Durham, NC, USA

    Richard C. Mather III

  5. Department of Orthopedic Surgery, Weill Medical College of Cornell Univers, New York, NY, USA

    Bryan T. Kelly

Section Editor information

  1. Hospital for Special Surgery, New York, United States

    Benedict U. Nwachukwu

Electronic Supplementary Material(S)

  • Standard arthroscopic labral repair as described. (MP4 63042 kb)

  • Video demonstration of the suction seal. Substantial negative pressure is shown with axial traction with eventual suction release with significant force. (MP4 28524 kb)

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Parvaresh, K.C., McCormick, F., Federer, A.E., Nho, S.J. (2021). Surgical Technique: Arthroscopic Labral Management. In: Nho, S.J., Asheesh, B., Salata, M.J., Mather III, R.C., Kelly, B.T. (eds) Hip Arthroscopy and Hip Joint Preservation Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7321-3_57-2

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  • DOI: https://doi.org/10.1007/978-1-4614-7321-3_57-2

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  • Print ISBN: 978-1-4614-7321-3

  • Online ISBN: 978-1-4614-7321-3

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Chapter history

  1. Latest

    Surgical Technique: Arthroscopic Labral Management
    Published:
    30 July 2021

    DOI: https://doi.org/10.1007/978-1-4614-7321-3_57-2

  2. Original

    Surgical Technique: Arthroscopic Labral Management
    Published:
    07 June 2014

    DOI: https://doi.org/10.1007/978-1-4614-7321-3_57-1

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