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Current Reviews in Musculoskeletal Medicine

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01-02-2021 | Hip Arthroscopy | Outcomes Research in Orthopedics (O Ayeni, Section Editor)

Graft Options in Hip Labral Reconstruction

Authors: Parth Lodhia, Mark O. McConkey, Jordan M. Leith, David R. Maldonado, Matthew J. Brick, Benjamin G. Domb

Published in: Current Reviews in Musculoskeletal Medicine | Issue 1/2021

Abstract

Purpose of Review

The last decade has seen a boom in hip arthroscopy with refined indications. Improved understanding of pathoanatomy and disease progression has allowed for the development of advanced techniques. Labral reconstruction has been developed to substitute a non-functional or absent labrum. It has become an important technique in the armamentarium of high-volume arthroscopic hip surgeons.

Recent Findings

Basic science studies have improved understanding of hip biomechanics in the presence and absence of a labrum with a labral reconstruction allowing for reconstitution of normalcy. Current techniques have shown success with autograft and allograft tissue options. While autograft tissue allows for easy access intra-operatively and maintains patient biology, donor site morbidity is possible. Allografts negate donor site morbidity and allow for an abundance of tissue but can be resource-intensive and face availability concerns. Recent studies support outcomes of labral reconstructions using both autograft and allograft. Promising results have also allowed for performing labral reconstruction in a primary setting.

Summary

Labral reconstruction can be successfully performed using both autograft and allograft. Patient biology should be respected, and native hip biomechanics restored. The literature is plentiful for appropriate surgical decision-making allowing the surgeon with multiple graft choices depending on training, experience, and resources.

Burman MS. Arthroscopy or the direct visualization of joints: an experimental cadaver study. Clin Orthop Relat Res. 1931;2001(390):5–9. https://doi.org/10.1097/00003086-200109000-00003.CrossRef

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

Palmer AJ, Malak TT, Broomfield J, Holton J, Majkowski L, Thomas GE, et al. Past and projected temporal trends in arthroscopic hip surgery in England between 2002 and 2013. BMJ Open Sport Exerc Med. 2016;2(1):e000082. https://doi.org/10.1136/bmjsem-2015-000082.CrossRefPubMedPubMedCentral

Lee AJ, Armour P, Thind D, Coates MH, Kang AC. The prevalence of acetabular labral tears and associated pathology in a young asymptomatic population. Bone Joint J. 2015;97-B(5):623–7. https://doi.org/10.1302/0301-620X.97B5.35166.CrossRefPubMed

Bsat S, Frei H, Beaule PE. The acetabular labrum: a review of its function. Bone Joint J. 2016;98-B(6):730–5. https://doi.org/10.1302/0301-620X.98B6.37099.CrossRefPubMed

Heerey JJ, Kemp JL, Mosler AB, Jones DM, Pizzari T, Souza RB, et al. What is the prevalence of imaging-defined intra-articular hip pathologies in people with and without pain? A systematic review and meta-analysis. Br J Sports Med. 2018;52(9):581–93. https://doi.org/10.1136/bjsports-2017-098264.

Alzaharani A, Bali K, Gudena R, Railton P, Ponjevic D, Matyas JR, et al. The innervation of the human acetabular labrum and hip joint: an anatomic study. BMC Musculoskelet Disord. 2014;15:41. https://doi.org/10.1186/1471-2474-15-41.

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. https://doi.org/10.1007/s00167-014-2874-z.CrossRefPubMed

Nepple JJ, Philippon MJ, Campbell KJ, Dornan GJ, Jansson KS, LaPrade RF, 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.CrossRefPubMed

10.

Hawellek T, Hubert J, Hischke S, Krause M, Bertrand J, Schmidt BC, et al. Calcification of the acetabular labrum of the hip: prevalence in the general population and relation to hip articular cartilage and fibrocartilage degeneration. Arthritis Res Ther. 2018;20(1):104. https://doi.org/10.1186/s13075-018-1595-y.

11.

McCarthy JC, Noble PC, Schuck MR, Wright J, Lee J. The Otto E. Aufranc Award: The role of labral lesions to development of early degenerative hip disease. Clin Orthop Relat Res 2001(393):25–37. https://doi.org/10.1097/00003086-200112000-00004.

12.

O’Connor M, Steinl GK, Padaki AS, Duchman KR, Westermann RW, Lynch TS. Outcomes of revision hip arthroscopic surgery: a systematic review and meta-analysis. Am J Sports Med. 2020;48(5):1254–62. https://doi.org/10.1177/0363546519869671.CrossRefPubMed

13.

White BJ, Herzog MM. Labral reconstruction: when to perform and how. Front Surg. 2015;2:27. https://doi.org/10.3389/fsurg.2015.00027.CrossRefPubMedPubMedCentral

14.

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

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. Arthroscopy. 2013;29(1):46–53. https://doi.org/10.1016/j.arthro.2012.07.011.CrossRefPubMed

16.

Haddad B, Konan S, Haddad FS. Debridement versus re-attachment of acetabular labral tears: a review of the literature and quantitative analysis. Bone Joint J. 2014;96-B(1):24–30. https://doi.org/10.1302/0301-620X.96B1.32425.CrossRefPubMed

17.

Wu ZX, Ren WX, Ren YM, Tian MQ. Arthroscopic labral debridement versus labral repair for patients with femoroacetabular impingement: a meta-analysis. Medicine (Baltimore). 2020;99(19):e20141. https://doi.org/10.1097/MD.0000000000020141.CrossRef

18.

Philippon MJ, Bolia IK, Locks R, Briggs KK. Labral preservation: outcomes following labrum augmentation versus labrum reconstruction. Arthroscopy. 2018;34(9):2604–11. https://doi.org/10.1016/j.arthro.2018.04.021.CrossRefPubMed

19.

Chandrasekaran S, Darwish N, Close MR, Lodhia P, Suarez-Ahedo C, Domb BG. Arthroscopic reconstruction of segmental defects of the hip labrum: results in 22 patients with mean 2-year follow-up. Arthroscopy. 2017;33(9):1685–93. https://doi.org/10.1016/j.arthro.2017.03.015.CrossRefPubMed

20.

Domb BG, Battaglia MR, Perets I, Lall AC, Chen AW, Ortiz-Declet V, et al. Minimum 5-year outcomes of arthroscopic hip labral reconstruction with nested matched-pair benchmarking against a labral repair control group. Am J Sports Med. 2019;47(9):2045–55. https://doi.org/10.1177/0363546518825259.

21.

White BJ, Patterson J, Herzog MM. Revision arthroscopic acetabular labral treatment: repair or reconstruct? Arthroscopy. 2016;32(12):2513–20. https://doi.org/10.1016/j.arthro.2016.07.024.CrossRefPubMed

22.

White BJ, Patterson J, Herzog MM. Bilateral hip arthroscopy: direct comparison of primary acetabular labral repair and primary acetabular labral reconstruction. Arthroscopy. 2018;34(2):433–40. https://doi.org/10.1016/j.arthro.2017.08.240.CrossRefPubMed

23.

White BJ, Patterson J, Scoles AM, Lilo AT, Herzog MM. Hip arthroscopy in patients over 40: greater success with labral reconstruction compared to labral repair. Arthroscopy. 2020;36:2137–44. https://doi.org/10.1016/j.arthro.2020.04.031.CrossRefPubMed

24.

Sierra RJ, Trousdale RT. Labral reconstruction using the ligamentum teres capitis: report of a new technique. Clin Orthop Relat Res. 2009;467(3):753–9. https://doi.org/10.1007/s11999-008-0633-5.CrossRefPubMed

25.

Philippon MJ, Briggs KK, Hay CJ, Kuppersmith DA, Dewing CB, Huang MJ. Arthroscopic labral reconstruction in the hip using iliotibial band autograft: technique and early outcomes. Arthroscopy. 2010;26(6):750–6. https://doi.org/10.1016/j.arthro.2009.10.016.CrossRefPubMed

26.

Walker JA, Pagnotto M, Trousdale RT, Sierra RJ. Preliminary pain and function after labral reconstruction during femoroacetabular impingement surgery. Clin Orthop Relat Res. 2012;470(12):3414–20. https://doi.org/10.1007/s11999-012-2506-1.CrossRefPubMedPubMedCentral

27.

White BJ, Stapleford AB, Hawkes TK, Finger MJ, Herzog MM. Allograft use in arthroscopic labral reconstruction of the hip with front-to-back fixation technique: minimum 2-year follow-up. Arthroscopy. 2016;32(1):26–32. https://doi.org/10.1016/j.arthro.2015.07.016.CrossRefPubMed

28.

Matsuda DK, Burchette RJ. Arthroscopic hip labral reconstruction with a gracilis autograft versus labral refixation: 2-year minimum outcomes. Am J Sports Med. 2013;41(5):980–7. https://doi.org/10.1177/0363546513482884.CrossRefPubMed

29.

Park SE, Ko Y. Use of the quadriceps tendon in arthroscopic acetabular labral reconstruction: potential and benefits as an autograft option. Arthrosc Tech. 2013;2(3):e217–9. https://doi.org/10.1016/j.eats.2013.02.003.CrossRefPubMedPubMedCentral

30.

Amar E, Sampson TG, Sharfman ZT, Caplan A, Rippel N, Atzmon R, et al. Acetabular labral reconstruction using the indirect head of the rectus femoris tendon significantly improves patient reported outcomes. Knee Surg Sports Traumatol Arthrosc. 2018;26(8):2512–8. https://doi.org/10.1007/s00167-017-4641-4.

31.••

Domb BG, Kyin C, Rosinsky PJ, Shapira J, Yelton MJ, Meghpara MB, et al. Circumferential labral reconstruction for irreparable labral tears in the primary setting: minimum 2-year outcomes with a nested matched-pair labral repair control group. Arthroscopy. 2020. https://doi.org/10.1016/j.arthro.2020.02.014Two-year results of this novel technique of total labral reconstruction showcased in this review show promising results in patients with femoroacetabular impingement along with irreparable labral tears with high patient-reported outcome scores, satisfaction, and comparable functional outcomes.

32.

Trivedi NN, Sivasundaram L, Su CA, Knapik D, Nho SJ, Mather RC 3rd, et al. Indications and outcomes of arthroscopic labral reconstruction of the hip: a systematic review. Arthroscopy. 2019;35(7):2175–86. https://doi.org/10.1016/j.arthro.2019.02.031.CrossRefPubMed

33.••

Rahl MD, LaPorte C, Steinl GK, O’Connor M, Lynch TS, Menge TJ. Outcomes after arthroscopic hip labral reconstruction: a systematic review and meta-analysis. Am J Sports Med. 2019;363546519878147:1748–55. https://doi.org/10.1177/0363546519878147. This review looks at the literature with an eye to compare results between autograft and allograft labral reconstructions in the hip.

34.••

Al Mana L, Coughlin RP, Desai V, Simunovic N, Duong A, Ayeni OR. The hip labrum reconstruction: indications and outcomes-an updated systematic review. Curr Rev Musculoskelet Med. 2019;12(2):156–65. https://doi.org/10.1007/s12178-019-09546-6. Builds on a similar study performed in 2014 showcasing recent findings in labral reconstruction of the hip. It alludes to the fast pace of research in this field and the rising popularity of this procedure. Short and mid term follow up results are presented.

35.

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(4):737–43. https://doi.org/10.1007/s00167-013-2804-5.CrossRefPubMed

36.

Safran MR. The acetabular labrum: anatomic and functional characteristics and rationale for surgical intervention. J Am Acad Orthop Surg. 2010;18(6):338–45. https://doi.org/10.5435/00124635-201006000-00006.CrossRefPubMed

37.

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

38.

Domb BG, Hartigan DE, Perets I. Decision making for labral treatment in the hip: repair versus debridement versus reconstruction. J Am Acad Orthop Surg. 2017;25(3):e53–62. https://doi.org/10.5435/JAAOS-D-16-00144.CrossRefPubMed

39.

Maldonado DR, Lall AC, Walker-Santiago R, Rosinsky P, Shapira J, Chen JW, et al. Hip labral reconstruction: consensus study on indications, graft type and technique among high-volume surgeons. J Hip Preserv Surg. 2019;6(1):41–9. https://doi.org/10.1093/jhps/hnz008.

40.

Woyski D, Mather RC 3rd. 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.CrossRefPubMedPubMedCentral

41.

Maldonado DR, Lall AC, Laseter JR, Kyin C, Chen JW, Go CC, et al. Primary hip arthroscopic surgery with labral reconstruction: is there a difference between an autograft and allograft? Orthop J Sports Med. 2019;7(3):2325967119833715. https://doi.org/10.1177/2325967119833715.

42.

Ferro FP, Philippon MJ, Rasmussen MT, Smith SD, LaPrade RF, Wijdicks CA. Tensile properties of the human acetabular labrum and hip labral reconstruction grafts. Am J Sports Med. 2015;43(5):1222–7. https://doi.org/10.1177/0363546514568086.CrossRefPubMed

43.

Shi YY, Chen LX, Xu Y, Hu XQ, Ao YF, Wang JQ. Acetabular labral reconstruction with autologous tendon tissue in a porcine model: in vivo histological assessment and gene expression analysis of the healing tissue. Am J Sports Med. 2016;44(4):1031–9. https://doi.org/10.1177/0363546515623784.CrossRefPubMed

44.

Domb BG, Gupta A, Stake CE, Hammarstedt JE, Redmond JM. Arthroscopic labral reconstruction of the hip using local capsular autograft. Arthrosc Tech. 2014;3(3):e355–9. https://doi.org/10.1016/j.eats.2014.02.004.CrossRefPubMedPubMedCentral

45.

Sampson TG. Surgical technique: arthroscopic rectus autograft. In: Nho S. LM, Larson C., Bedi A., Kelly B., editor. Hip arthroscopy and hip joint preservation surgery. New York: Springer; 2015. p. 6.

46.

Sharfman ZT, Amar E, Sampson T, Rath E. Arthroscopic labrum reconstruction in the hip using the indirect head of rectus femoris as a local graft: surgical technique. Arthrosc Tech. 2016;5(2):e361–4. https://doi.org/10.1016/j.eats.2016.01.008.CrossRefPubMedPubMedCentral

47.

Rathi R, Mazek J. Arthroscopic acetabular labral reconstruction with rectus femoris tendon autograft: our experiences and early results. J Orthop. 2018;15(3):783–6. https://doi.org/10.1016/j.jor.2018.05.048.CrossRefPubMedPubMedCentral

48.

Locks R, Chahla J, Bolia IK, Briggs KK, Philippon MJ. Outcomes following arthroscopic hip segmental labral reconstruction using autologous capsule tissue or indirect head of the rectus tendon. J Hip Preserv Surg. 2018;5(1):73–7. https://doi.org/10.1093/jhps/hnx033.CrossRefPubMed

49.

Deshmane PP, Kahlenberg CA, Patel RM, Han B, Terry MA. All-arthroscopic iliotibial band autograft harvesting and labral reconstruction technique. Arthrosc Tech. 2013;2(1):e15–9. https://doi.org/10.1016/j.eats.2012.10.001.CrossRefPubMed

50.

Geyer MR, Philippon MJ, Fagrelius TS, Briggs KK. Acetabular labral reconstruction with an iliotibial band autograft: outcome and survivorship analysis at minimum 3-year follow-up. Am J Sports Med. 2013;41(8):1750–6. https://doi.org/10.1177/0363546513487311.CrossRefPubMed

51.

Lebus GF, Briggs KK, Dornan GJ, McNamara S, Philippon MJ. Acetabular labral reconstruction: development of a tool to predict outcomes. Am J Sports Med. 2018;46(13):3119–26. https://doi.org/10.1177/0363546518796838.CrossRefPubMed

52.

Chahla J, Soares E, Bhatia S, Mitchell JJ, Philippon MJ. Arthroscopic technique for acetabular labral reconstruction using Iliotibial band autograft. Arthrosc Tech. 2016;5(3):e671–7. https://doi.org/10.1016/j.eats.2016.02.025.CrossRefPubMedPubMedCentral

53.

Matsuda DK. Arthroscopic labral reconstruction with gracilis autograft. Arthrosc Tech. 2012;1(1):e15–21. https://doi.org/10.1016/j.eats.2011.12.001.CrossRefPubMedPubMedCentral

54.

Rosinsky PJ, Shapira J, Lall AC, Domb BG. All about the ligamentum teres: from biomechanical role to surgical reconstruction. J Am Acad Orthop Surg. 2020;28(8):e328–e39. https://doi.org/10.5435/JAAOS-D-19-00352.CrossRefPubMed

55.

Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. 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 Joint Surg Br. 2001;83(8):1119–24. https://doi.org/10.1302/0301-620x.83b8.11964.CrossRefPubMed

56.

Domb BG, Gui C, Lodhia P. How much arthritis is too much for hip arthroscopy: a systematic review. Arthroscopy. 2015;31(3):520–9. https://doi.org/10.1016/j.arthro.2014.11.008.CrossRefPubMed

57.

Skendzel JG, Philippon MJ, Briggs KK, Goljan P. The effect of joint space on midterm outcomes after arthroscopic hip surgery for femoroacetabular impingement. Am J Sports Med. 2014;42(5):1127–33. https://doi.org/10.1177/0363546514526357.CrossRefPubMed

58.

Sheean AJ, Musahl V, Slone HS, Xerogeanes JW, Milinkovic D, Fink C, et al. Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often. Br J Sports Med. 2018;52(11):698–701. https://doi.org/10.1136/bjsports-2017-098769.

59.

Karns MR, Patel SH, Kolaczko J, Liu RW, Mather RCR, White BJ, et al. Acetabular rim length: an anatomical study to determine reasonable graft sizes for labral reconstruction. J Hip Preserv Surg. 2017;4(1):106–12. https://doi.org/10.1093/jhps/hnw038.CrossRefPubMed

60.

Lippe J, Armstrong A, Fulkerson JP. Anatomic guidelines for harvesting a quadriceps free tendon autograft for anterior cruciate ligament reconstruction. Arthroscopy. 2012;28(7):980–4. https://doi.org/10.1016/j.arthro.2012.01.002.CrossRefPubMed

61.

Redmond JM, Cregar WM, Martin TJ, Vemula SP, Gupta A, Domb BG. Arthroscopic labral reconstruction of the hip using semitendinosus allograft. Arthrosc Tech. 2015;4(4):e323–9. https://doi.org/10.1016/j.eats.2015.03.002.CrossRefPubMedPubMedCentral

62.••

Perets I, Hartigan DE, Chaharbakhshi EO, Walsh JP, Close MR, Domb BG. Circumferential labral reconstruction using the knotless pull-through technique-surgical technique. Arthrosc Tech. 2017;6(3):e695–e8. https://doi.org/10.1016/j.eats.2017.01.014This technique article elaborates further on the allograft reconstruction technique of choice of the authors of this review. The initial graft choice was a semitendinosus allograft; the authors have now moved onto tibialis anterior or posterior allografts for their shape and size which is more conducive to a labral reconstruction.CrossRefPubMedPubMedCentral

63.

Rathi R, Mazek J. Arthroscopic acetabular labral reconstruction with fascia lata allograft: clinical outcomes at minimum one-year follow-up. Open Orthop J. 2017;11:554–61. https://doi.org/10.2174/1874325001611010554.CrossRefPubMedPubMedCentral

64.

Carreira DS, Kruchten MC, Emmons BR, Martin RL. Arthroscopic labral reconstruction using fascia lata allograft: shuttle technique and minimum two-year results. J Hip Preserv Surg. 2018;5(3):247–58. https://doi.org/10.1093/jhps/hny028.CrossRefPubMedPubMedCentral

65.

Moya E, Natera LG, Cardenas C, Astarita E, Bellotti V, Ribas M. Reconstruction of massive posterior nonrepairable acetabular labral tears with peroneus brevis tendon allograft: arthroscopy-assisted mini-open approach. Arthrosc Tech. 2016;5(5):e1015–e22. https://doi.org/10.1016/j.eats.2016.05.003.CrossRefPubMedPubMedCentral

66.

Costa Rocha P, Klingenstein G, Ganz R, Kelly BT, Leunig M. Circumferential reconstruction of severe acetabular labral damage using hamstring allograft: surgical technique and case series. Hip Int. 2013;23(Suppl 9):S42–53. https://doi.org/10.5301/HIP.2013.11662.CrossRefPubMed

67.

Bhatia S, Ellman MB, Nho S, Mather RC 3rd, Bedi A, Aoki SK, et al. Bilateral hip arthroscopy: direct comparison of primary acetabular labral repair and primary acetabular labral reconstruction. Arthroscopy. 2018;34(6):1748–51. https://doi.org/10.1016/j.arthro.2018.03.027.CrossRefPubMed

Title: Graft Options in Hip Labral Reconstruction
Authors: Parth Lodhia
Mark O. McConkey
Jordan M. Leith
David R. Maldonado
Matthew J. Brick
Benjamin G. Domb
Publication date: 01-02-2021
Publisher: Springer US
Keyword: Hip Arthroscopy
Published in: Current Reviews in Musculoskeletal Medicine / Issue 1/2021
Electronic ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-020-09690-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Graft Options in Hip Labral Reconstruction

Abstract

Purpose of Review

Recent Findings

Summary

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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