2015- Domb et al. Arthroscopic Labral Reconstruction of the Hip Using Semitendinosus Allograft

John M. Redmond, M.D., William M. Cregar, B.S., Timothy J. Martin, M.A., S. Pavan Vemula, M.A., Asheesh Gupta, M.D., M.P.H., and Benjamin G. Domb, M.D.

Abstract: The labrum of the hip is recognized as being important to the stability of the hip and a major cause of hip pain. Damage to the labrum may result in increased joint stress and articular damage. Labral damage is often treated through various methods, among them simple stitch repair, base refixation, and debridement. Labral reconstruction becomes necessary when the labrum is too damaged to salvage, which renders labral repair improbable and labral debridement ineffective. In contrast to other methods that have been described for this treatment, our technique uses a semitendinosus allograft as a graft source, allowing for arthroscopic hip labral reconstruction. This technique has many advantages and is easily reproducible. It has shown promising results in patients with labral damage. The purpose of this article is to detail the step-by-step surgical technique of labral reconstruction using a semitendinosus allograft, in addition to the indications, pearls, and pitfalls of the technique.

The acetabular labrum appears to have an important role in maintaining normal physiology within the hip joint. The labrum provides stability by both creating a suction seal and deepening the acetabulum. By increasing the acetabular surface area and maintaining adequate fluid pressure, direct contact stress on the articular surface can be distributed and therefore decreased.

There are instances in which the labral seal can become disrupted (i.e., labral tear), resulting in abnormal physiology and possibly pain. Labral tears alter the normal physiological environment of the hip joint, leading to joint destabilization with increased joint stress and subsequent articular damage.

Contact stress between the acetabular and femoral cartilage increases by as much as 92% in the absence of a labrum. The treatment of these lesions in young patients is especially important because there is a strong association between labral tears and the premature onset of degenerative changes.