Advertisement

Update in Labral Treatment of the Hip (ICL 12)

  • Christoph LampertEmail author
  • Marc Tey
  • Hatem Galal Said
  • Bent Lund
  • Michael Dienst
  • Ernest Schidlers
Chapter

Abstract

Labral tears have been described as a cause of hip pain in young, active patients [1]. It has been shown that those lesions can initiate joint osteoarthritis [2]. Some authors suggest that labral tear is a highly prevalent lesion with up to 90 % of labral detachment in elderly people [3]. On the other side, studies like the one of Wenger et al. [4] conclude that is a rare lesion in the absence of any structural or mechanic evident cause. That means that labral tear treatment is a complex one, because even if we decide a labral debridement, repair, or substitution, biomechanics must be restored, and that means that bony structural abnormalities must be addressed. Acetabular labrum is a complex structure, with an inner part of circumferential fibrocartilage fibers, surrounded by dense connective tissue where we can find nerves and vascular vessels. The shape of that labrum can be different in the different acetabular areas, and some shapes can predispose to labral tears, while different attachment patterns may difficult tear recognition [5]. Thorough knowledge of labral vascularity is important to understand healing patterns of labral detachment and repair [6].

Keywords

Joint Space Width Labral Tear Attachment Pattern Dense Connective Tissue Labral Repair 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Bibliography

  1. 1.
    Ikeda T, Awaya G, Suzuki S, Okada Y, Tada H. Torn acetabular labrum in young patients. Arthroscopic diagnosis and management. J Bone Joint Surg Br. 1988;70(1):13–6.PubMedGoogle Scholar
  2. 2.
    Fitzgerald Jr RH. Acetabular labrum tears. Diagnosis and treatment. Clin Orthop Relat Res. 1995;311:60–8.PubMedGoogle Scholar
  3. 3.
    Byers PD, Contepomi CA, Farkas TA. A post mortem study of the hip joint. Including the prevalence of the features of the right side. Ann Rheum Dis. 1970;29(1):15–31.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Wenger DE, Kendell KR, Miner MR, Trousdale RT. Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop Relat Res. 2004;426:145–50.CrossRefPubMedGoogle Scholar
  5. 5.
    Ye-Yeon Won I-HC, Nam-Su Chung, Kyung-Hun Song. Morphological study of the Acetabular Labrum. Yonsei Med J. 2003;44(5):855–62Google Scholar
  6. 6.
    Kalhor M, Horowitz K, Beck M, Nazparvar B, Ganz R. Vascular supply to the acetabular labrum. J Bone Joint Surg Am. 2010;92(15):2570–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Farjo LA, Glick JM, Sampson TG. Hip arthroscopy for acetabular labral tears. Arthroscopy. 1999;15(2):132–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Tan V, Seldes RM, Katz MA, Freedhand AM, Klimkiewicz JJ, Fitzgerald Jr RH. Contribution of acetabular labrum to articulating surface area and femoral head coverage in adult hip joints: an anatomic study in cadavera. Am J Orthop (Belle Mead NJ). 2001;30(11):809–12.Google Scholar
  9. 9.
    Ferguson SJ. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003 Feb;36(2):171–8Google Scholar
  10. 10.
    Konrath GA, Hamel AJ, Olson SA, Bay B, Sharkey NA. The role of the acetabular labrum and the transverse acetabular ligament in load transmission in the hip. J Bone Joint Surg Am. 1998;80(12):1781–8.PubMedGoogle Scholar
  11. 11.
    Hadley NA, Brown TD, Weinstein SL. The effects of contact pressure elevations and aseptic necrosis on the long-term outcome of congenital hip dislocation. J Orthop Res. 1990;8(4):504–13.CrossRefPubMedGoogle Scholar
  12. 12.
    Tey M. Study of labral function at hip biomechanics [Doctoral dissertation]. Barcelona: Universitat Autònoma de Barcelona; 2015. http://hdl.handle.net/10803/290840.
  13. 13.
    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(2):171–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Philippon MJ, Nepple JJ, Campbell KJ, Dornan GJ, Jansson KS, Laprade RF, 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.CrossRefPubMedGoogle Scholar
  15. 15.
    Krych AJ, Thompson M, Knutson Z, Scoon J, Coleman SH. Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: a prospective randomized study. Arthrosc: J Arthrosc Relat Surg. 2013;29(1):46–53.CrossRefGoogle Scholar
  16. 16.
    Mella C, Villalon I, Paccot D, Nunez A, Ledezma C. Hip arthroscopy and osteoarthritis: Where are the limits and Indications. SICOT-J. 2015 (in press).Google Scholar
  17. 17.
    Nepple JJ, Philippon MJ, Campbell KJ, Dornan GJ, Jansson KS, LaPrade RF, Wijdicks CA. 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.CrossRefPubMedGoogle Scholar
  18. 18.
    Byrd JW, Jones S. Arthroscopic management of femoroacetabular impingement in athletes. Am J Sports Med. 2011;39(1 suppl):7S–13.CrossRefPubMedGoogle Scholar
  19. 19.
    Guanche CA, Sikka RS. Acetabular labral tears with underlying chondromalacia: a possible association with high-level running. Arthrosc: J Arthrosc Relat Surg. 2005;21(5):580–5.CrossRefGoogle Scholar
  20. 20.
    Krych AJ, Kuzma SA, Kovachevich R, Hudgens JL, Stuart MJ, Levy BA. Modest mid-term outcomes after isolated arthroscopic debridement of acetabular labral tears. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):763–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87(7):1012–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Philippon MJ, Schroder e Souza BG, Briggs KK. Labrum: resection, repair and reconstruction sports medicine and arthroscopy review. Sports Med Arthrosc. 2010;18(2):76–82.CrossRefPubMedGoogle Scholar
  23. 23.
    Tey M, Erquicia J, Pelfort X, Miquel J, Gelber PE, Ribas M. Allogenic labral transplantation in hip instability following arthroscopic labrectomy. Hip Int. 2011;21(2):260–2.CrossRefPubMedGoogle Scholar
  24. 24.
    Ayeni OR, Alradwan H, de Sa D, Philippon MJ. The hip labrum reconstruction: indications and outcomes – a systematic review. Knee Surg Sports Traumatol Arthrosc. 2014;22:737–43.CrossRefPubMedGoogle Scholar

Copyright information

© ESSKA 2016

Authors and Affiliations

  • Christoph Lampert
    • 1
    Email author
  • Marc Tey
    • 2
  • Hatem Galal Said
    • 3
  • Bent Lund
    • 4
  • Michael Dienst
    • 5
  • Ernest Schidlers
    • 6
  1. 1.Orthopedic RosenbergSt. GallenSwitzerland
  2. 2.Hip Unit, Orthopaedics DepartmentHospital del Mar i EsperançaBarcelonaSpain
  3. 3.AssiutEgypt
  4. 4.Hospitalsenheden HorsensHorsensDenmark
  5. 5.OCM MünchenMunichGermany
  6. 6.Professor of Orthopaedic Sports MedicineHip Arthroscopy/Groin Injuries in Sports, Fortius Clinic and Leeds Beckett UniversityLondonUK

Personalised recommendations