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Acetabular labral reconstruction with medial meniscal allograft: preliminary results of a new surgical technique

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Reconstruction of the acetabular labrum during femoroacetabular impingement (FAI) surgery is accepted when the labrum is deficient and irreparable. Here we describe a novel technique using fresh-frozen medial meniscal allograft for labral reconstruction during surgical hip dislocation for correction of pincer FAI due to acetabular overcoverage.

Methods

The results from seven hips (six patients) that underwent this procedure with 1 year minimum follow-up, and radiographs are presented.

Results

Six of the seven hips had improvements in pain, hip flexion, hip abduction, and Merle d'Aubigné-Postel scores. Only one patient with pre-existing osteoarthritis underwent reoperation with conversion to total hip arthroplasty. All digastric trochanteric osteotomies healed, and there were no cases of femoral head osteonecrosis or progression of Tönnis grades.

Conclusions

The medial meniscus is a morphologically and clinically suitable option for labral reconstruction and effectively restores the hip fluid seal.

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References

  1. Ito K, Leunig M, Ganz R (2004) Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res 429:262–71

    Article  Google Scholar 

  2. Wingstrand H, Wingstrand A, Krantz P (1990) Intracapsular and atmospheric pressure in the dynamics and stability of the hip a biomechanical study. Acta Orthop Scand 61:231–235

    Article  CAS  PubMed  Google Scholar 

  3. Ferguson SJ, Bryant JT, Ganz R, Ito K (2000) The acetabular labrum seal: a poroelastic finite element model. Clin Biomech 15:463–468

    Article  CAS  Google Scholar 

  4. Crawford MJ, Dy CJ, Alexander JW, Thompson M, Schroder SJ, Vega CE et al (2007) The 2007 Frank stinchfield award the biomechanics of the hip labrum and the stability of the hip. Clin Orthop Relat Res 465:16–22

    Article  PubMed  Google Scholar 

  5. Philippon MJ, Nepple JJ, Campbell KJ, Dornan GJ, Jansson KS, LaPrade RF et al (2014) 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 22:722–729

    Article  PubMed  Google Scholar 

  6. Nepple JJ, Philippon MJ, Campbell KJ, Dornan GJ, Jansson KS, LaPrade RF et al (2014) 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 22:730–736

    Article  PubMed  Google Scholar 

  7. Geyer MR, Philippon MJ, Fagrelius TS, Briggs KK (2013) Acetabular labral reconstruction with an iliotibial band autograft: outcome and survivorship analysis at minimum 3-year follow-up. Am J Sports Med 41:1750–1756

    Article  PubMed  Google Scholar 

  8. Boykin RE, Patterson D, Briggs KK, Dee A, Philippon MJ (2013) Results of arthroscopic labral reconstruction of the hip in elite athletes. Am J Sports Med 41:2296–2301

    Article  PubMed  Google Scholar 

  9. Walker JA, Pagnotto M, Trousdale RT, Sierra RJ (2012) Preliminary pain and function after labral reconstruction during femoroacetabular impingement surgery. Clin Orthop Relat Res 470:3414–3420

    Article  PubMed  PubMed Central  Google Scholar 

  10. Philippon MJ, Arner JW, Crawford MD, Bolia IK, Briggs KK (2020) Acetabular Labral reconstruction with iliotibial band autograft: outcome and survivorship at a minimum 10-year follow-up. J Bone Jt Surg Am 102(18):1581–1587

    Article  Google Scholar 

  11. Sierra RJ, Trousdale RT (2009) Labral reconstruction using the ligamentum teres capitis: report of a new technique. Clin Orthop Relat Res 467:753–759

    Article  PubMed  Google Scholar 

  12. Weidner J, Wyatt M, Beck M (2018) Labral augmentation with ligamentum capitis femoris: presentation of a new technique and preliminary results. J Hip Preserv Surg 5:47–53

    Article  PubMed  PubMed Central  Google Scholar 

  13. Philippon MJ, Briggs KK, Hay CJ, Kuppersmith DA, Dewing CB, Huang MJ (2010) Arthroscopic labral reconstruction in the hip using iliotibial band autograft: technique and early outcomes. Arthroscopy 26:750–756

    Article  PubMed  Google Scholar 

  14. Matsuda DK, Burchette RJ (2013) Arthroscopic hip labral reconstruction with a gracilis autograft versus labral refixation: 2-year minimum outcomes. Am J Sports Med 41:980–987

    Article  PubMed  Google Scholar 

  15. Park SE, Ko Y (2013) Use of the quadriceps tendon in arthroscopic acetabular labral reconstruction: potential and benefits as an autograft option. Arthrosc Tech 2:e217–e219

    Article  PubMed  PubMed Central  Google Scholar 

  16. Domb BG, Gupta A, Stake CE, Hammarstedt JE, Redmond JM (2014) Arthroscopic labral reconstruction of the hip using local capsular autograft. Arthrosc Tech 3:e355–e359

    Article  PubMed  PubMed Central  Google Scholar 

  17. Redmond JM, Cregar WM, Martin TJ, Vemula SP, Gupta A, Domb BG (2015) Arthroscopic labral reconstruction of the hip using semitendinosus allograft. Arthrosc Tech 4:e323–e329

    Article  PubMed  PubMed Central  Google Scholar 

  18. Moya E, Natera LG, Cardenas C, Astarita E, Bellotti V, Ribas M (2016) Reconstruction of massive posterior nonrepairable acetabular labral tears with peroneus brevis tendon allograft: arthroscopy-assisted mini-open approach. Arthrosc Tech 5:e1015–e1022

    Article  PubMed  PubMed Central  Google Scholar 

  19. Sharfman ZT, Amar E, Sampson T, Rath E (2016) Arthroscopic labrum reconstruction in the hip using the indirect head of rectus femoris as a local graft: surgical technique. Arthrosc Tech 5:e361–e364

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wiberg G (1939) Studies on dysplastic acetabula and congenital subluxation of the hip joint: with special referance to the complication of osteoarthritis. Acta Chir Scand Suppl 83:28–38

    Google Scholar 

  21. Tönnis D, Heinecke A (1999) Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Jt Surg Am 81:1747–1770

    Article  Google Scholar 

  22. Ficat P, Arlet J (1980) Necrosis of the femoral head. Ischemia and necrosis of bone: Williams & Wilkins, pp 53–74

    Google Scholar 

  23. Brooker AF, Bowerman JW, Robinson RA, Riley LH (1973) Ectopic ossification following total hip replacement incidence and a method of classification. J Bone Jt Surg Am 55:1629–32

    Article  CAS  Google Scholar 

  24. D’Aubigne RM, Postel M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Jt Surg Am 36(3):451–75

    Article  Google Scholar 

  25. Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U (2001) Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Jt Surg Br 83:1119–1124

    Article  CAS  Google Scholar 

  26. Moed BR (2010) The modified gibson posterior surgical approach to the acetabulum. J Orthop Trauma 24:315–322

    Article  PubMed  Google Scholar 

  27. Steppacher SD, Huemmer C, Schwab JM, Tannast M, Siebenrock KA (2014) Surgical hip dislocation for treatment of femoroacetabular impingement: factors predicting 5-year survivorship. Clin Orthop Relat Res 472:337–348

    Article  PubMed  Google Scholar 

  28. Zurmühle CA, Anwander H, Albers CE, Hanke MS, Steppacher SD, Siebenrock KA et al (2017) Periacetabular osteotomy provides higher survivorship than rim trimming for acetabular retroversion. Clin Orthop Relat Res 475:1138–1150

    Article  PubMed  Google Scholar 

  29. Haemer JM, Carter DR, Giori NJ (2012) The low permeability of healthy meniscus and labrum limit articular cartilage consolidation and maintain fluid load support in the knee and hip. J Biomech 45:1450–1456

    Article  PubMed  Google Scholar 

  30. Dhollander AA, Lambrecht S, Verdonk PC, Audenaert EA, Almqvist KF, Pattyn C et al (2012) First insights into human acetabular labrum cell metabolism. Osteoarthr Cartil 20:670–677

    Article  CAS  Google Scholar 

  31. Nogami R, Kaku N, Shimada T, Tabata T, Tagomori H, Tsumura H (2020) Three-dimensional architecture of the acetabular labrum in the human hip joint. Med Mol Morphol 53:21–27

    Article  PubMed  Google Scholar 

  32. Ferguson SJ, Bryant JT, Ito K (2001) The material properties of the bovine acetabular labrum. J Orthop Res 19:887–896

    Article  CAS  PubMed  Google Scholar 

  33. Barbour SA, King W (2003) The safe and effective use of allograft tissue: an update. Am J Sports Med 31:791–797

    Article  PubMed  Google Scholar 

  34. Arnoczky SP, DiCarlo EF, O’Brien SJ, Warren RF (1992) Cellular repopulation of deep-frozen meniscal autografts: an experimental study in the dog. Arthrosc J Arthrosc Relat Surg 8:428–436

    Article  CAS  Google Scholar 

  35. Rodeo SA, Seneviratne A, Suzuki K, Felker K, Wickiewicz TL, Warren RF (2000) Histological analysis of human meniscal allografts a preliminary report. J Bone Jt Surg Am 82:1071–82

    Article  CAS  Google Scholar 

  36. Sekiya JK, Ellingson CI (2006) Meniscal allograft transplantation. J Am Acad Orthop Surg 14:164–174

    Article  PubMed  Google Scholar 

  37. Yahia L, Zukor D (1994) Irradiated meniscal allotransplants of rabbits: study of the mechanical properties at 6 months postoperation. Acta Orthop Belg 60:210–215

    CAS  PubMed  Google Scholar 

  38. Getgood A, LaPrade RF, Verdonk P, Gersoff W, Cole B, Spalding T et al (2017) International meniscus reconstruction experts forum (imref) 2015 consensus statement on the practice of meniscal allograft transplantation. Am J Sports Med 45:1195–1205

    Article  PubMed  Google Scholar 

  39. Xue C, Zhang L, Shuang F, Zhang Y, Luo D, Kang X et al (2013) Robust revascularization, despite impaired VEGF production, after meniscus allograft transplantation in rabbits. Am J Sports Med 41:2668–2675

    Article  PubMed  Google Scholar 

  40. Wada Y, Amiel M, Harwood F, Moriya H, Amiel D (1998) Architectural remodeling in deep frozen meniscal allografts after total meniscectomy. Arthroscopy 14:250–257

    Article  CAS  PubMed  Google Scholar 

  41. Gómez EM, Cardenas C, Astarita E, Bellotti V, Tresserra F, Natera LG et al (2017) Labral reconstruction with tendon allograft: histological findings show revascularization at 8 weeks from implantation. J Hip Preserv Surg 4:74–79

    Article  PubMed  PubMed Central  Google Scholar 

  42. Hanke MS, Steppacher SD, Zurmühle CA, Siebenrock KA, Tannast M (2016) Hips with protrusio acetabuli are at increased risk for failure after femoroacetabular impingement surgery: a 10-year followup. Clin Orthop Relat Res 474:2168–2180

    Article  PubMed  PubMed Central  Google Scholar 

  43. Pun SY, Hingsammer A, Millis MB, Kim YJ (2017) Is increased acetabular cartilage or fossa size associated with pincer femoroacetabular impingement? Clin Orthop Relat Res 475:1013–1023

    Article  PubMed  Google Scholar 

  44. Liechti EF, Ferguson SJ, Tannast M (2015) Protrusio acetabuli: joint loading with severe pincer impingement and its theoretical implications for surgical therapy. J Orthop Res 33:106–113

    Article  PubMed  Google Scholar 

  45. Atzmon R, Radparvar JR, Sharfman ZT, Dallich AA, Amar E, Rath E (2018) Graft choices for acetabular labral reconstruction. J Hip Preserv Surg 5:329–338

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

No funding was provided for this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Stanford Child and Adult Hip Preservation Center, Stanford University School of Medicine, 450 Broadway Street, Pavilion C, 4th Floor, Stanford, Redwood City, CA, USA

    Michael J. Chen, Ian Hollyer, Stephanie Y. Pun & Michael J. Bellino

Authors
  1. Michael J. Chen
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  2. Ian Hollyer
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  3. Stephanie Y. Pun
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  4. Michael J. Bellino
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Correspondence to Michael J. Chen.

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Chen, M.J., Hollyer, I., Pun, S.Y. et al. Acetabular labral reconstruction with medial meniscal allograft: preliminary results of a new surgical technique. Eur J Orthop Surg Traumatol 32, 515–521 (2022). https://doi.org/10.1007/s00590-021-02986-2

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  • DOI: https://doi.org/10.1007/s00590-021-02986-2

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