2014- Domb et al. Arthroscopic Labral Reconstruction of the Hip Using Local Capsular Autograft. Arthroscopy Techniques.

Abstract: Labral reconstruction is becoming an important treatment modality for hips with nonsalvageable labra. Nonsalvageable labra can be present in cases of intrasubstance damage, revision surgery after debridement, labral calcification, and hypoplasia. Previous methods of reconstruction have been performed in an open manner and arthroscopically using ligamentum teres, iliotibial band, and gracilis autograft. We present an alternate method of arthroscopic labral reconstruction using capsular autograft. The technique uses readily available capsular tissue during arthroscopy with no donor-site morbidity. This technique may be valuable in appropriately selected patients with labral deficiency.

Biomechanical and clinical studies continue to document the importance of the hip labrum. Ferguson et al. 1,2 have shown the importance of the labrum in providing a fluid seal and assisting in contact force transmission. Clinically, the results of labral repair appear to be better than those of labral resection. 3,4 Ideally, when one is treating patients with labral tears, the labrum can be preserved because labral damage has been associated with degenerative changes in the hip joint. 5

At the time of surgery, many patients have labral tissue that cannot be salvaged. This may be because of significant tearing, degenerative tissue, or hypoplasia. Patients also present after labral debridement with persistent postoperative pain. Many of these patients have undergone significant labral resection. When the labrum is nonsalvageable or nonexistent, labral reconstruction is a viable treatment option. To our knowledge, three types of labral reconstruction have been described. Philippon et al. 6