Research progress in arthroscopic treatment of acetabular labrum injury_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 CAO Jiangang , CHEN Desheng

Department of Sports Injury and Arthroscopy, Tianjin Hospital, Tianjin, 300222, P.R.China;

Corresponding author：

CAO Jiangang, Email: realcjg@sina.com

Keywords：

Acetabular labrum injury; labral debridement; labral repair; labral reconstruction; labral augmentation

DOI：

10.7507/1002-1892.202002161

Video：

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Objective To review the surgical methods of arthroscopy in the treatment of acetabular labrum injury, and to provide reference for clinical treatment.Methods The literature about the surgical methods and clinical results of hip arthroscopy in the treatment of acetabular labrum injury was reviewed and analyzed.Results In the early stages of hip arthroscopy, the removal of the torn labrum is the primary treatment option. The current principles of treatment are based on the specific circumstances of a torn labrum, including acetabular labrum debridement, acetabular labrum repair, acetabular labrum reconstruction, and acetabular labrum augmentation.Conclusion Hip arthroscopy has become the preferred technique for the treatment of acetabular labrum injury. Labral repair is still the first choice, and labral reconstruction is used when acetabular labrum injury cannot be repaired.

Citation： CAO Jiangang, CHEN Desheng. Research progress in arthroscopic treatment of acetabular labrum injury. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(12): 1607-1611. doi: 10.7507/1002-1892.202002161 Copy

1.	Ross JR, Larson CM, Bedi A. Indications for hip arthroscopy. Sports Health, 2017, 9(5): 402-413.
2.	Frank JM, Harris JD, Erickson BJ, et al. Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: a systematic review. Arthroscopy, 2015, 31(6): 1199-1204.
3.	Philippon MJ, Briggs KK, Carlisle JC, et al. Joint space predicts tha after hip arthroscopy in patients 50 years and older. Clin Orthop Relat Res, 2013, 471(8): 2492-2496.
4.	Harris JD, Gerrie BJ, Varner KE, et al. Radiographic prevalence of dysplasia, cam, and pincer deformities in elite ballet. Am J Sports Med, 2016, 44(1): 20-27.
5.	Collins JA, Ward JP, Youm T. Is prophylactic surgery for femoroacetabular impingement indicated? A systematic review. Am J Sports Med, 2014, 42(12): 3009-3015.
6.	Seldes RM, Tan V, Hunt J, et al. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res, 2001, (382): 232-240.
7.	Smith MV, Panchal HB, Ruberte Thiele RA, et al. Effect of acetabular labrum tears on hip stability and labral strain in a joint compression model. Am J Sports Med, 2011, 39 Suppl: 103S-110S.
8.	Ferguson SJ, Bryant JT, Ganz R, et al. The acetabular labrum seal: a poroelastic finite element model. Clin Biomech (Bristol, Avon), 2000, 15(6): 463-468.
9.	Dwyer MK, Jones HL, Hogan MG, et al. The acetabular labrum regulates fluid circulation of the hip joint during functional activities. Am J Sports Med, 2014, 42(4): 812-819.
10.	Philippon MJ, Nepple JJ, Campbell KJ, 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): 722-729.
11.	Alzaharani A, Bali K, Gudena R, et al. The innervation of the human acetabular labrum and hip joint: an anatomic study. BMC Musculoskelet Disord, 2014, 15: 1-8.
12.	Safran MR. Microinstability of the hip-gaining acceptance. J Am Acad Orthop Surg, 2019, 27(1): 12-22.
13.	李旭, 张晋, 王雪松. 髋关节镜下骨赘切除联合盂唇修补治疗合并髋臼股骨撞击症的盂唇损伤的中长期随访结果. 中国运动医学杂志, 2018, 37(10): 817-820.
14.	Samim M, Youm T, Burke C, et al. Hip arthroscopy-MRI correlation and differences for hip anatomy and pathology: what radiologists need to know. Clin Imaging, 2018, 52: 315-327.
15.	Theige M, David S. Nonsurgical treatment of acetabular labral tears. J Sport Rehabil, 2018, 27(4): 380-384.
16.	Grant LF, Cooper DJ, Conroy JL. The HAPI ‘hip arthroscopy pre-habilitation intervention’ study: Does pre-habilitation affect outcomes in patients undergoing hip arthroscopy for femoro-acetabular impingement? J Hip Preserv Surg, 2017, 4(1): 85-92.
17.	Griffin DR, Dickenson EJ, Wall PDH, et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): A multicentre randomised controlled trial. Lancet, 2018, 391(10136): 2225-2235.
18.	Kunze KN, Beck EC, Nwachukwu BU, et al. Early hip arthroscopy for femoroacetabular impingement syndrome provides superior outcomes when compared with delaying surgical treatment beyond 6 months. Am J Sports Med, 2019, 47(9): 2038-2044.
19.	Vassalo CC, Barros AAG, Costa LP, et al. Clinical outcomes of arthroscopic repair of acetabular labral tears. BMJ Open Sport Exerc Med, 2018, 4(1): e000328.
20.	Woyski D, Mather RC. Surgical treatment of labral tears: Debridement, repair, reconstruction. Curr Rev Musculoskelet Med, 2019, 12(3): 291-299.
21.	Ha YC, Kim KC, Shin YE. Patient satisfaction after arthroscopic repair of acetabular labral tears. Clin Orthop Surg, 2014, 6(2): 159-164.
22.	Byrd JW, Jones KS. Hip arthroscopy for labral pathology: Prospective analysis with 10-year follow-up. Arthroscopy, 2009, 25(4): 365-368.
23.	Menge TJ, Briggs KK, Dornan GJ, et al. Survivorship and outcomes 10 years following hip arthroscopy for femoroacetabular impingement: labral debridement compared with labral repair. J Bone Joint Surg (Am), 2017, 99(12): 997-1004.
24.	Menge TJ, Bhatia S, McNamara SC, et al. Femoroacetabular impingement in professional football players: return to play and predictors of career length after hip arthroscopy. Am J Sports Med, 2017, 45(8): 1740-1744.
25.	Domb BG, Rybalko D, Mu B, et al. Acetabular microfracture in hip arthroscopy: clinical outcomes with minimum 5-year follow-up. Hip Int, 2018, 28(6): 649-656.
26.	Dwyer MK, Tumpowsky C, Boone A, et al. What is the association between articular cartilage damage and subsequent tha 20 years after hip arthroscopy for labral tears? Clin Orthop Relat Res, 2019, 477(5): 1211-1220.
27.	Chen AW, Yuen LC, Ortiz-Declet V, et al. Selective debridement with labral preservation using narrow indications in the hip: minimum 5-year outcomes with a matched-pair labral repair control group. Am J Sports Med, 2018, 46(2): 297-304.
28.	Miozzari HH, Celia M, Clark JM, et al. No regeneration of the human acetabular labrum after excision to bone. Clin Orthop Relat Res, 2015, 473(4): 1349-1357.
29.	Song Y, Ito H, Kourtis L, et al. Articular cartilage friction increases in hip joints after the removal of acetabular labrum. J Biomech, 2012, 45(3): 524-530.
30.	Philippon MJ, Arnoczky SP, Torrie A. Arthroscopic repair of the acetabular labrum: a histologic assessment of healing in an ovine model. Arthroscopy, 2007, 23(4): 376-380.
31.	Kalhor M, Horowitz K, Beck M, et al. Vascular supply to the acetabular labrum. J Bone Joint Surg (Am), 2010, 92(15): 2570-2575.
32.	Audenaert EA, Dhollander AA, Forsyth RG, et al. Histologic assessment of acetabular labrum healing. Arthroscopy, 2012, 28(12): 1784-1789.
33.	Nepple JJ, Philippon MJ, Campbell KJ, 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): 730-736.
34.	Bsat S, Frei H, Beaulé PE. The acetabular labrum: A review of its function. Bone Joint J, 2016, 98-B(6): 730-735.
35.	Larson CM, Giveans MR, Stone RM. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: Mean 3.5-year follow-up. Am J Sports Med, 2012, 40(5): 1015-1021.
36.	Hevesi M, Krych AJ, Johnson NR, et al. Multicenter analysis of midterm clinical outcomes of arthroscopic labral repair in the hip: Minimum 5-year follow-up. Am J Sports Med, 2018, 46(2): 280-287.
37.	Riff AJ, Kunze KN, Movassaghi K, et al. Systematic review of hip arthroscopy for femoroacetabular impingement: The importance of labral repair and capsular closure. Arthroscopy, 2019, 35(2): 646-656.
38.	Harris JD. Hip labral repair: options and outcomes. Curr Rev Musculoskelet Med, 2016, 9(4): 361-367.
39.	Locks R, Chahla J, Frank JM, et al. Arthroscopic hip labral augmentation technique with iliotibial band graft. Arthrosc Tech, 2017, 6(2): e351-e356.
40.	Lee S, Wuerz TH, Shewman E, et al. Labral reconstruction with iliotibial band autografts and semitendinosus allografts improves hip joint contact area and contact pressure: an in vitro analysis. Am J Sports Med, 2015, 43(1): 98-104.
41.	Philippon MJ, Briggs KK, Hay CJ, et al. Arthroscopic labral reconstruction in the hip using iliotibial band autograft: Technique and early outcomes. Arthroscopy, 2010, 26(6): 750-756.
42.	Maldonado DR, Lall AC, Walker-Santiago R, et al. Hip labral reconstruction: consensus study on indications, graft type and technique among high-volume surgeons. J Hip Preserv Surg, 2019, 6(1): 41-49.
43.	Ferro FP, Philippon MJ, Rasmussen MT, et al. Tensile properties of the human acetabular labrum and hip labral reconstruction grafts. Am J Sports Med, 2015, 43(5): 1222-1227.
44.	Rathi R, Mazek J. Arthroscopic acetabular labral reconstruction with rectus femoris tendon autograft: Our experiences and early results. J Orthop, 2018, 15(3): 783-786.
45.	Domb BG, El Bitar YF, Stake CE, et al. Arthroscopic labral reconstruction is superior to segmental resection for irreparable labral tears in the hip: A matched-pair controlled study with minimum 2-year follow-up. Am J Sports Med, 2014, 42(1): 122-130.
46.	Chandrasekaran S, Darwish N, Mu BH, et al. Arthroscopic reconstruction of the irreparable acetabular labrum: A match-controlled study. Arthroscopy, 2019, 35(2): 480-488.
47.	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): 433-440.
48.	Philippon MJ, Bolia IK, Locks R, et al. Labral preservation: Outcomes following labrum augmentation versus labrum reconstruction. Arthroscopy, 2018, 34(9): 2604-2611.

1. Ross JR, Larson CM, Bedi A. Indications for hip arthroscopy. Sports Health, 2017, 9(5): 402-413.
2. Frank JM, Harris JD, Erickson BJ, et al. Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: a systematic review. Arthroscopy, 2015, 31(6): 1199-1204.
3. Philippon MJ, Briggs KK, Carlisle JC, et al. Joint space predicts tha after hip arthroscopy in patients 50 years and older. Clin Orthop Relat Res, 2013, 471(8): 2492-2496.
4. Harris JD, Gerrie BJ, Varner KE, et al. Radiographic prevalence of dysplasia, cam, and pincer deformities in elite ballet. Am J Sports Med, 2016, 44(1): 20-27.
5. Collins JA, Ward JP, Youm T. Is prophylactic surgery for femoroacetabular impingement indicated? A systematic review. Am J Sports Med, 2014, 42(12): 3009-3015.
6. Seldes RM, Tan V, Hunt J, et al. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res, 2001, (382): 232-240.
7. Smith MV, Panchal HB, Ruberte Thiele RA, et al. Effect of acetabular labrum tears on hip stability and labral strain in a joint compression model. Am J Sports Med, 2011, 39 Suppl: 103S-110S.
8. Ferguson SJ, Bryant JT, Ganz R, et al. The acetabular labrum seal: a poroelastic finite element model. Clin Biomech (Bristol, Avon), 2000, 15(6): 463-468.
9. Dwyer MK, Jones HL, Hogan MG, et al. The acetabular labrum regulates fluid circulation of the hip joint during functional activities. Am J Sports Med, 2014, 42(4): 812-819.
10. Philippon MJ, Nepple JJ, Campbell KJ, 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): 722-729.
11. Alzaharani A, Bali K, Gudena R, et al. The innervation of the human acetabular labrum and hip joint: an anatomic study. BMC Musculoskelet Disord, 2014, 15: 1-8.
12. Safran MR. Microinstability of the hip-gaining acceptance. J Am Acad Orthop Surg, 2019, 27(1): 12-22.
13. 李旭, 张晋, 王雪松. 髋关节镜下骨赘切除联合盂唇修补治疗合并髋臼股骨撞击症的盂唇损伤的中长期随访结果. 中国运动医学杂志, 2018, 37(10): 817-820.
14. Samim M, Youm T, Burke C, et al. Hip arthroscopy-MRI correlation and differences for hip anatomy and pathology: what radiologists need to know. Clin Imaging, 2018, 52: 315-327.
15. Theige M, David S. Nonsurgical treatment of acetabular labral tears. J Sport Rehabil, 2018, 27(4): 380-384.
16. Grant LF, Cooper DJ, Conroy JL. The HAPI ‘hip arthroscopy pre-habilitation intervention’ study: Does pre-habilitation affect outcomes in patients undergoing hip arthroscopy for femoro-acetabular impingement? J Hip Preserv Surg, 2017, 4(1): 85-92.
17. Griffin DR, Dickenson EJ, Wall PDH, et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): A multicentre randomised controlled trial. Lancet, 2018, 391(10136): 2225-2235.
18. Kunze KN, Beck EC, Nwachukwu BU, et al. Early hip arthroscopy for femoroacetabular impingement syndrome provides superior outcomes when compared with delaying surgical treatment beyond 6 months. Am J Sports Med, 2019, 47(9): 2038-2044.
19. Vassalo CC, Barros AAG, Costa LP, et al. Clinical outcomes of arthroscopic repair of acetabular labral tears. BMJ Open Sport Exerc Med, 2018, 4(1): e000328.
20. Woyski D, Mather RC. Surgical treatment of labral tears: Debridement, repair, reconstruction. Curr Rev Musculoskelet Med, 2019, 12(3): 291-299.
21. Ha YC, Kim KC, Shin YE. Patient satisfaction after arthroscopic repair of acetabular labral tears. Clin Orthop Surg, 2014, 6(2): 159-164.
22. Byrd JW, Jones KS. Hip arthroscopy for labral pathology: Prospective analysis with 10-year follow-up. Arthroscopy, 2009, 25(4): 365-368.
23. Menge TJ, Briggs KK, Dornan GJ, et al. Survivorship and outcomes 10 years following hip arthroscopy for femoroacetabular impingement: labral debridement compared with labral repair. J Bone Joint Surg (Am), 2017, 99(12): 997-1004.
24. Menge TJ, Bhatia S, McNamara SC, et al. Femoroacetabular impingement in professional football players: return to play and predictors of career length after hip arthroscopy. Am J Sports Med, 2017, 45(8): 1740-1744.
25. Domb BG, Rybalko D, Mu B, et al. Acetabular microfracture in hip arthroscopy: clinical outcomes with minimum 5-year follow-up. Hip Int, 2018, 28(6): 649-656.
26. Dwyer MK, Tumpowsky C, Boone A, et al. What is the association between articular cartilage damage and subsequent tha 20 years after hip arthroscopy for labral tears? Clin Orthop Relat Res, 2019, 477(5): 1211-1220.
27. Chen AW, Yuen LC, Ortiz-Declet V, et al. Selective debridement with labral preservation using narrow indications in the hip: minimum 5-year outcomes with a matched-pair labral repair control group. Am J Sports Med, 2018, 46(2): 297-304.
28. Miozzari HH, Celia M, Clark JM, et al. No regeneration of the human acetabular labrum after excision to bone. Clin Orthop Relat Res, 2015, 473(4): 1349-1357.
29. Song Y, Ito H, Kourtis L, et al. Articular cartilage friction increases in hip joints after the removal of acetabular labrum. J Biomech, 2012, 45(3): 524-530.
30. Philippon MJ, Arnoczky SP, Torrie A. Arthroscopic repair of the acetabular labrum: a histologic assessment of healing in an ovine model. Arthroscopy, 2007, 23(4): 376-380.
31. Kalhor M, Horowitz K, Beck M, et al. Vascular supply to the acetabular labrum. J Bone Joint Surg (Am), 2010, 92(15): 2570-2575.
32. Audenaert EA, Dhollander AA, Forsyth RG, et al. Histologic assessment of acetabular labrum healing. Arthroscopy, 2012, 28(12): 1784-1789.
33. Nepple JJ, Philippon MJ, Campbell KJ, 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): 730-736.
34. Bsat S, Frei H, Beaulé PE. The acetabular labrum: A review of its function. Bone Joint J, 2016, 98-B(6): 730-735.
35. Larson CM, Giveans MR, Stone RM. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: Mean 3.5-year follow-up. Am J Sports Med, 2012, 40(5): 1015-1021.
36. Hevesi M, Krych AJ, Johnson NR, et al. Multicenter analysis of midterm clinical outcomes of arthroscopic labral repair in the hip: Minimum 5-year follow-up. Am J Sports Med, 2018, 46(2): 280-287.
37. Riff AJ, Kunze KN, Movassaghi K, et al. Systematic review of hip arthroscopy for femoroacetabular impingement: The importance of labral repair and capsular closure. Arthroscopy, 2019, 35(2): 646-656.
38. Harris JD. Hip labral repair: options and outcomes. Curr Rev Musculoskelet Med, 2016, 9(4): 361-367.
39. Locks R, Chahla J, Frank JM, et al. Arthroscopic hip labral augmentation technique with iliotibial band graft. Arthrosc Tech, 2017, 6(2): e351-e356.
40. Lee S, Wuerz TH, Shewman E, et al. Labral reconstruction with iliotibial band autografts and semitendinosus allografts improves hip joint contact area and contact pressure: an in vitro analysis. Am J Sports Med, 2015, 43(1): 98-104.
41. Philippon MJ, Briggs KK, Hay CJ, et al. Arthroscopic labral reconstruction in the hip using iliotibial band autograft: Technique and early outcomes. Arthroscopy, 2010, 26(6): 750-756.
42. Maldonado DR, Lall AC, Walker-Santiago R, et al. Hip labral reconstruction: consensus study on indications, graft type and technique among high-volume surgeons. J Hip Preserv Surg, 2019, 6(1): 41-49.
43. Ferro FP, Philippon MJ, Rasmussen MT, et al. Tensile properties of the human acetabular labrum and hip labral reconstruction grafts. Am J Sports Med, 2015, 43(5): 1222-1227.
44. Rathi R, Mazek J. Arthroscopic acetabular labral reconstruction with rectus femoris tendon autograft: Our experiences and early results. J Orthop, 2018, 15(3): 783-786.
45. Domb BG, El Bitar YF, Stake CE, et al. Arthroscopic labral reconstruction is superior to segmental resection for irreparable labral tears in the hip: A matched-pair controlled study with minimum 2-year follow-up. Am J Sports Med, 2014, 42(1): 122-130.
46. Chandrasekaran S, Darwish N, Mu BH, et al. Arthroscopic reconstruction of the irreparable acetabular labrum: A match-controlled study. Arthroscopy, 2019, 35(2): 480-488.
47. 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): 433-440.
48. Philippon MJ, Bolia IK, Locks R, et al. Labral preservation: Outcomes following labrum augmentation versus labrum reconstruction. Arthroscopy, 2018, 34(9): 2604-2611.

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