1
|
Cook JL, Rucinski K, Wissman R, Crecelius C, DeFroda S, Crist BD. Outcomes following open acetabular labrum reconstruction: Comparing fresh-frozen tendon with fresh meniscus allograft transplantation. J Orthop 2024; 53:13-19. [PMID: 38450061 PMCID: PMC10912234 DOI: 10.1016/j.jor.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024] Open
Abstract
Background Symptomatic acetabular labral insufficiency in young, active patients is often treated with labral repair or reconstruction using fresh-frozen allografts. However, fresh-frozen tendon allografts do not have tissue or material properties that closely mimic acetabular labral fibrocartilage. Recent studies suggest meniscal allografts may be a better biomechanical, geometric, and material alternative for acetabular labrum reconstruction (ALR). Hypothesis Patients undergoing open ALR using fresh meniscus allograft transplants (MAT) will have better outcomes than those using fresh-frozen tendon allografts transplants (TAT) when comparing initial treatment success, diagnostic imaging assessments, and patient-reported pain and function scores. Study design Cohort Study. Methods With IRB approval, patients undergoing ALR with either TAT or MAT were included when initial (>1-year) outcomes data related to treatment success, pain, and function were available. In addition, a subcohort of patients underwent magnetic resonance imaging at least 6-months after surgery to evaluate allograft healing. Results Initial success rate, defined as no need for ALR revision or conversion to total hip arthroplasty (THA), was 88.9% for the entire group (n = 27, TAT = 5, MAT = 22) with 1 (20%) patient in the TAT cohort and 2 patients (9.9%) in the MAT cohort undergoing THA. In the MAT cohort, significant improvements were documented for physical function and pain scores at 1 year and final follow-up (FFU)(mean 26.8 months). Improvements in pain and function were noted at 1-year, but not at FFU (mean 59.6 months) in the TAT group. MRIs completed at least 6 months after labrum reconstruction showed improved allograft integrity and integration in the MAT cohort over the TAT cohort. Conclusion For acetabular labrum reconstructions, MAT was associated with a higher initial success rate, superior patient reported outcomes, and subjectively better MRI findings when compared to TAT.
Collapse
Affiliation(s)
- James L. Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Kylee Rucinski
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Robert Wissman
- Department of Radiology, University of Missouri, Columbia, MO, USA
| | - Cory Crecelius
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Steven DeFroda
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Brett D. Crist
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| |
Collapse
|
2
|
Lee MS, Fong S, Lee AY, Norman M, Mahatme RJ, Pettinelli N, Park N, Gagné J, Gillinov SM, Islam W, Jimenez AE. Patients Undergoing Revision Hip Arthroscopy With Labral Reconstruction or Augmentation Demonstrate Favorable Patient Reported Outcomes: A Systematic Review. Arthroscopy 2024; 40:1923-1937. [PMID: 38154532 DOI: 10.1016/j.arthro.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 11/02/2023] [Accepted: 11/19/2023] [Indexed: 12/30/2023]
Abstract
PURPOSE To review current literature evaluating patient-reported outcomes (PROs) and survivorship in patients undergoing revision hip arthroscopy with labral reconstruction or augmentation. METHODS A systematic review was performed with the following key words: (revision) AND (hip OR femoroacetabular impingement) AND (arthroscopy OR arthroscopic) AND (reconstruction OR augmentation OR irreparable). PubMed, Cochrane Trials, and Scopus were queried in October 2022 using the criteria established in the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Studies were included if they involved patients undergoing revision hip arthroscopy with labral reconstruction or augmentation and reported preoperative and postoperative PROs at minimum 2-year follow-up. Only original research articles were included. Survivorship was defined as a nonconversion to total hip arthroplasty. Outcomes present in 3 or more studies underwent further statistical analysis with forest plots. Heterogeneity of studies was evaluated using the I2 statistic. RESULTS Five studies were reviewed, including 359 revision hip arthroscopies (335 with complete follow-up) with a follow-up that ranged from 2.2 to 5.2 years. Four studies reported on outcomes after revision labral reconstruction and 1 study reported on labral augmentation. Two out of 5 included studies evaluated for statistical significance between preoperative and postoperative outcomes. Three out of 5 studies reported a rate of at least 70% for achieving minimal clinically important difference in at least 1 PRO. At minimum 2-year follow-up, survivorship ranged from 93.5% to 100%. CONCLUSIONS Patients that underwent revision hip arthroscopy with labral reconstruction or augmentation demonstrated improvement in PROs with mixed rates of achieving clinical benefit and rates of survivorship at minimum 2-year follow-up ranging from 93.5% to 100%. LEVEL OF EVIDENCE Level IV, systematic review of level III to IV studies.
Collapse
Affiliation(s)
- Michael S Lee
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Scott Fong
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Amy Y Lee
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Mackenzie Norman
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Ronak J Mahatme
- University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A
| | | | - Nancy Park
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jack Gagné
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Stephen M Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Wasif Islam
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Andrew E Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A..
| |
Collapse
|
3
|
Gursoy S, Bessa F, Dandu N, Khan ZA, Huddleston HP, Williams BT, Vadhera AS, Clapp IM, Malloy P, Shewman EF, Nho SJ, Chahla J. Indirect Head of the Rectus Femoris Tendon as a Graft for Segmental Hip Labral Reconstruction: An Anatomic, Radiographical, and Biomechanical Study in Comparison With Iliotibial Labral Reconstruction. Am J Sports Med 2024; 52:1753-1764. [PMID: 38761016 DOI: 10.1177/03635465241251824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
BACKGROUND The indirect head of the rectus femoris (IHRF) tendon has been used as an autograft for segmental labral reconstruction. However, the biomechanical properties and anatomic characteristics of the IHRF, as they relate to surgical applications, have yet to be investigated. PURPOSE To (1) quantitatively and qualitatively describe the anatomy of IHRF and its relationship with surrounding arthroscopically relevant landmarks; (2) detail radiographic findings pertinent to IHRF; (3) biomechanically assess segmental labral reconstruction with IHRF, including restoration of the suction seal and contact pressures in comparison with iliotibial band (ITB) reconstruction; and (4) assess potential donor-site morbidity caused by graft harvesting. STUDY DESIGN Descriptive laboratory study. METHODS A cadaveric study was performed using 8 fresh-frozen human cadaveric full pelvises and 7 hemipelvises. Three-dimensional anatomic measurements were collected using a 3-dimensional coordinate digitizer. Radiographic analysis was accomplished by securing radiopaque markers of different sizes to the evaluated anatomic structures of the assigned hip.Suction seal and contact pressure testing were performed over 3 trials on 6 pelvises under 4 different testing conditions for each specimen: intact, labral tear, segmental labral reconstruction with ITB, and segmental labral reconstruction with IHRF. After IHRF tendon harvest, each full pelvis had both the intact and contralateral hip tested under tension along its anatomic direction to assess potential site morbidity, such as tendon failure or bony avulsion. RESULTS The centroid and posterior apex of the indirect rectus femoris attachment are respectively located 10.3 ± 2.6 mm and 21.0 ± 6.5 mm posteriorly, 2.5 ± 7.8 mm and 0.7 ± 8.0 mm superiorly, and 5.0 ± 2.8 mm and 22.2 ± 4.4 mm laterally to the 12:30 labral position. Radiographically, the mean distance of the IHRF to the following landmarks was determined as follows: anterior inferior iliac spine (8.8 ± 2.5 mm), direct head of the rectus femoris (8.0 ± 3.9 mm), 12-o'clock labral position (14.1 ± 2.8 mm), and 3-o'clock labral position (36.5 ± 4.4 mm). During suction seal testing, both the ITB and the IHRF reconstruction groups had significantly lower peak loads and lower energy to peak loads compared with both intact and tear groups (P = .01 to .02 for all comparisons). There were no significant differences between the reconstruction groups for peak loads, energy, and displacement at peak load. In 60° of flexion, there were no differences in normalized contact pressure and contact area between ITB or IHRF reconstruction groups (P > .99). There were no significant differences between intact and harvested specimen groups in donor-site morbidity testing. CONCLUSION The IHRF tendon is within close anatomic proximity to arthroscopic acetabular landmarks. In the cadaveric model, harvesting of the IHRF tendon as an autograft does not lead to significant donor-site morbidity in the remaining tendon. Segmental labral reconstruction performed with the IHRF tendon exhibits similar biomechanical outcomes compared with that performed with ITB. CLINICAL RELEVANCE This study demonstrates the viability of segmental labral reconstruction with an IHRF tendon and provides a detailed anatomic description of the tendon in the context of an arthroscopic labral reconstruction. Clinicians can use this information during the selection of a graft and as a guide during an arthroscopic graft harvest.
Collapse
Affiliation(s)
- Safa Gursoy
- Department of Orthopaedic Surgery, Faculty of Medicine, Acibadem University, Istanbul, Turkey
| | - Felipe Bessa
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Navya Dandu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Hailey P Huddleston
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brady T Williams
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Amar S Vadhera
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ian M Clapp
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Philip Malloy
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Elizabeth F Shewman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
4
|
Della Rocca F, Rosolani M, D'Addona A, D'Ambrosi R. Similar Clinical Outcomes for Arthroscopic Labral Reconstruction in Irreparable Cases Using the Indirect Head of the Rectus Femoris Tendon With an All-Inside Technique for Small Defects and the Iliotibial Band for Large Defects. Arthroscopy 2024; 40:1502-1513. [PMID: 38007094 DOI: 10.1016/j.arthro.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/14/2023] [Accepted: 10/20/2023] [Indexed: 11/27/2023]
Abstract
PURPOSE To evaluate the clinical outcomes and satisfaction rate of patients who underwent arthroscopic labral reconstruction for an irreparable labral tear with a minimum follow-up period of 2 years. Additionally, this study aimed to compare 2 different reconstructive techniques for small and large labral defects: the indirect head of the rectus femoris tendon (IHRFT) autograft with an all-inside technique used to repair small defects (≤3 hours) and the iliotibial band (ITB) autograft for large defects (>3 hours). METHODS A total of 24 hips treated with the IHRFT were compared with 24 hips treated with the ITB. All patients underwent clinical evaluation before surgery and during the most recent follow-up (42 ± 18 months). The evaluation included patient satisfaction, the modified Harris Hip Score, the Non-Arthritic Hip Score, the Hip Outcome Score, the Hip Outcome Score-sport subscale, the 12-item International Hip Outcome Tool, and the visual analog scale pain score. RESULTS All clinical scores were significantly improved (P < .001) at the latest follow-up in both groups. The final satisfaction was 7.1 ± 2.8 and 8.8 ± 1.6 for the IHRFT and ITB groups, respectively (P = .006). There was a significant difference in age (41.2 ± 6.0 years for the IHRFT group and 33 ± 8.5 for the ITB group; P = .004) and in surgery time (147.3 ± 39.4 minutes for the ITB group and 105.3 ± 25.7 for the IHRFT group; P < .001). One patient (4.2%) in the IHRFT group underwent total hip arthroplasty after 21.3 months (P = .999). CONCLUSIONS At the 2-year follow-up, treating small defects using IHRFT and larger defects using ITB resulted in good patient-reported outcome measures with a low rate of complications and failures. The ITB group reported a higher level of satisfaction at the final follow-up. LEVEL OF EVIDENCE Level III, retrospective comparative therapeutic trial.
Collapse
Affiliation(s)
| | | | | | - Riccardo D'Ambrosi
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy; Università degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milan, Italy.
| |
Collapse
|
5
|
Akhtar M, Razick D, Baig O, Aamer S, Asad S, Bernal C, Dhaliwal A, Shelton T. No Difference in Most Reported Outcome Measures for Allograft Versus Autograft for Hip Labral Reconstruction: A Systematic Review of Comparative Studies. Arthroscopy 2024:S0749-8063(24)00097-5. [PMID: 38336107 DOI: 10.1016/j.arthro.2024.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To systematically review studies comparing outcomes of allograft versus autograft for hip labral reconstruction. METHODS A systematic review following guidelines established by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) was performed in 3 databases using the terms "labrum," "hip," "acetabulum," "reconstruction," "augmentation," "allograft," and "autograft." Data on study characteristics, patient demographic characteristics, follow-up time, patient-reported outcomes (PROs), rates of revision surgery, and rates of conversion to total hip arthroplasty (THA) were collected. RESULTS Three studies were included, with Methodological Index for Non-randomized Studies (MINORS) scores ranging from 17 to 23. Among 92 patients receiving allografts, the mean ages ranged from 30.6 to 34.8 years; mean follow-up times, from 34.6 to 66.1 months; revision rates, from 0% to 23.6%; and conversion-to-THA rates, from 0% to 20%. Among 185 patients receiving autografts, the mean ages ranged from 34.6 to 35.9 years; mean follow-up times, from 32.7 to 80.8 months; revision rates, from 0% to 7.3%; and conversion-to-THA rates, from 0% to 6.7%. One study reported significantly higher revision rates in the allograft group. All studies reported no statistically significant differences in postoperative PROs, and all postoperative PROs significantly improved compared with preoperative PROs. Rates of achievement of the minimal clinically important difference and patient acceptable symptomatic state, reported by 1 study, were statistically similar between the 2 groups and ranged from 55.6% to 100% for the allograft group and from 53.8% to 84.6% for the autograft group. CONCLUSIONS There were no significant differences between allograft and autograft patients in terms of postoperative PROs; however, all PRO measures were slightly higher in allograft patients. Both revision and conversion-to-THA rates were higher in allograft patients in 2 studies, with the level of significance being reached in terms of revision in 1 study. The third study reported zero revisions and conversions to THA in allograft and autograft patients. LEVEL OF EVIDENCE Level III, systematic review of Level II and III studies.
Collapse
Affiliation(s)
- Muzammil Akhtar
- California Northstate University College of Medicine, Elk Grove, California, U.S.A..
| | - Daniel Razick
- California Northstate University College of Medicine, Elk Grove, California, U.S.A
| | - Osamah Baig
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, U.S.A
| | - Sonia Aamer
- California Northstate University College of Medicine, Elk Grove, California, U.S.A
| | - Shaheryar Asad
- California Northstate University College of Medicine, Elk Grove, California, U.S.A
| | - Carter Bernal
- California Northstate University College of Medicine, Elk Grove, California, U.S.A
| | - Anand Dhaliwal
- California Northstate University College of Medicine, Elk Grove, California, U.S.A
| | - Trevor Shelton
- Utah Valley Orthopedics and Sports Medicine, Intermountain Health, Provo, Utah, U.S.A
| |
Collapse
|
6
|
Maimaitimin M, Yang F, Huang H, Ao Y, Wang J. Can the Acetabular Labrum Be Reconstructed With a Meniscal Allograft? An In Vivo Pig Model. Clin Orthop Relat Res 2024; 482:386-398. [PMID: 37732715 PMCID: PMC10776144 DOI: 10.1097/corr.0000000000002860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/17/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND No single graft type has been shown to have a benefit in acetabular labral reconstruction. The native labrum and lateral meniscus share many similarities, suggesting that the meniscus may be a promising source of graft material in labral reconstruction. QUESTIONS/PURPOSES Using a pig model, we sought to evaluate the healing process of fresh-frozen meniscus allograft for acetabular reconstruction by assessing (1) MRI and macroscopic observations of the meniscus allograft; (2) histologic appearance and immunohistologic evaluation of the meniscus allograft, native meniscus, and labrum; (3) microscopic assessment of the native labrum and meniscus via scanning electron microscopy; and (4) biomechanical assessment of tensile properties. METHODS Twelve skeletally mature male miniature Bama pigs (24 hips) were randomly divided into two groups: labral defect group (control) and lateral meniscus allograft group. The selection of Bama pig specimens was based on the similarity of their acetabular labrum to that of the human acetabular labrum, characterized by the presence of fibrocartilage-like tissue lacking blood vessels. The pigs underwent bilateral hip surgery. Briefly, a 1.5-cm-long section was resected in the anterior dorsal labrum, which was left untreated or reconstructed using an allogeneic lateral meniscus. The pigs were euthanized at 12 and 24 weeks postoperatively, and then evaluated by macroscopic observations and MRI measurement to assess the extent of coverage of the labral defect. We also performed a histologic analysis and immunohistologic evaluation to assess the composition and structure of meniscus allograft, native labrum, and meniscus, as well as scanning electron microscopy assessment of the microstructure of the native labrum and meniscus and biomechanical assessment of tensile properties. RESULTS Imaging measurement and macroscopic observations revealed that the resected area of the labrum was fully filled in the lateral meniscus allograft group, whereas in the control group, the labral defect remained at 24 weeks. The macroscopic scores of the meniscus allograft group (8.2 ± 0.8) were higher than those of the control groups (4.8 ± 1.0) (mean difference 3.3 [95% CI 1.6 to 5.0]; p < 0.001). Moreover, in the meniscus allograft group, histologic assessment identified fibrocartilage-like cell cluster formation at the interface between the graft and acetabulum; cells and fibers arranged perpendicularly to the acetabulum and tideline structure that were similar to those of native labrum could be observed at 24 weeks. Immunohistochemical results showed that the average optical density value of Type II collagen at the graft-acetabulum interface was increased in the meniscus allograft group at 24 weeks compared with at 12 weeks (0.259 ± 0.031 versus 0.228 ± 0.023, mean difference 0.032 [95% CI 0.003 to 0.061]; p = 0.013). Furthermore, the tensile modulus of the lateral meniscus allograft was near that of the native labrum at 24 weeks (54.7 ± 9.9 MPa versus 63.2 ± 11.3 MPa, mean difference -8.4 MPa [95% CI -38.3 to 21.4]; p = 0.212). CONCLUSION In a pig model, lateral meniscus allografts fully filled labral defects in labral reconstruction. Regeneration of a fibrocartilage transition zone at the graft-acetabulum interface was observed at 24 weeks. CLINICAL RELEVANCE The use of an autograft meniscus for labral reconstruction may be a viable option when labral tears are deemed irreparable. Before its clinical implementation, it is imperative to conduct a comparative study involving tendon grafts, which are extensively used in current clinical practice.
Collapse
Affiliation(s)
- Maihemuti Maimaitimin
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, PR China
- Beijing Key Laboratory of Sports Injuries, Beijing, PR China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, PR China
| | - Fan Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, PR China
- Beijing Key Laboratory of Sports Injuries, Beijing, PR China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, PR China
| | - Hongjie Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, PR China
- Beijing Key Laboratory of Sports Injuries, Beijing, PR China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, PR China
| | - Yingfang Ao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, PR China
- Beijing Key Laboratory of Sports Injuries, Beijing, PR China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, PR China
| | - Jianquan Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, PR China
- Beijing Key Laboratory of Sports Injuries, Beijing, PR China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, PR China
| |
Collapse
|
7
|
Tian K, Gao G, He TC, Dong H, Zhang S, Zhang W, Wang J, Xu Y. Modified Technique for Labral Reconstruction of Hip Joint Using Autologous Iliotibial Band (ITB)-Make Labral Reconstruction Stress-Free. Arthrosc Tech 2023; 12:e1615-e1622. [PMID: 37780653 PMCID: PMC10533942 DOI: 10.1016/j.eats.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/11/2023] [Indexed: 10/03/2023] Open
Abstract
Current treatments for labral tear include surgical debridement, arthroscopic repair, and labral reconstruction. Although labral debridement and labral suture repair are suitable for most patients, labral reconstruction is the first treatment option when there is extensive labral degeneration or defect. Often, however, the labral degeneration or defect is only detected intraoperatively; therefore, the surgeon should always have a backup plan. The current labral reconstruction technique has shortcomings such as long operation time, difficult autograft harvesting, cumbersome graft preparation, and the need for a large surgical incision and re-sterilization and draping. To address these problems, we developed a modified technique for draping and surgery. This technique ensures preparedness for labral reconstruction during each hip arthroscopic surgery. The method also simplifies the steps for autologous iliotibial band graft harvesting and shortens operative time. We have achieved satisfactory clinical results with use of this technique over the past 2 years. In this Technical Note, we describe our technique. This modified labral reconstruction technique greatly improves surgical efficiency and could be a promising surgical technique for hip labral reconstruction.
Collapse
Affiliation(s)
- Kang Tian
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Department of Sports Medicine, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Guanying Gao
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Tong-Chuan He
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Orthopaedic Surgery and Rehabilitation Medicine, Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois, U.S.A
| | - Hanmei Dong
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Siqi Zhang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Weiguo Zhang
- Department of Sports Medicine, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Jianquan Wang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Yan Xu
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| |
Collapse
|
8
|
DeFroda SF, Crist B, Cook JL. Arthroscopic Hip Labral Reconstruction With Fresh Meniscal Allograft. Arthrosc Tech 2023; 12:e813-e821. [PMID: 37424660 PMCID: PMC10323673 DOI: 10.1016/j.eats.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/11/2023] [Indexed: 07/11/2023] Open
Abstract
The acetabular labrum is essential to maintaining the functional health of the hip joint through contributions to joint congruity, stability, and the negative pressure suction seal. Injury, overuse, long-standing developmental disorders, or failed primary labral repair can eventually lead to functional labral insufficiency requiring management via labral reconstruction. While numerous graft options exist for hip labral reconstruction, there is no current gold standard. The optimal graft should best mimic the native labrum with regard to geometry, structure, mechanical properties, and durability. This has led to the development of an arthroscopic technique for labral reconstruction with fresh meniscal allograft tissue.
Collapse
Affiliation(s)
- Steven F. DeFroda
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, U.S.A
| | - Brett Crist
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, U.S.A
| | - James L. Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, U.S.A
| |
Collapse
|
9
|
Capurro B, Tey-Pons M, Carrera A, Marqués-López F, Marín-Peña O, Torres-Eguía R, Monllau JC, Reina F. Polyurethane Scaffold vs Fascia Lata Autograft for Hip Labral Reconstruction: Comparison of Femoroacetabular Biomechanics. Orthop J Sports Med 2023; 11:23259671221150632. [PMID: 36846818 PMCID: PMC9944198 DOI: 10.1177/23259671221150632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Background The integrity of the acetabular labrum is critical in providing normal function and minimizing hip degeneration and is considered key for success in today's hip preservation algorithm. Many advances have been made in labral repair and reconstruction to restore the suction seal. Purpose/Hypothesis To compare the biomechanical effects of segmental labral reconstruction between the synthetic polyurethane scaffold (PS) and fascia lata autograft (FLA). Our hypothesis was that reconstruction with a macroporous polyurethane implant and autograft reconstruction of fascia lata would normalize hip joint kinetics and restore the suction seal. Study Design Controlled laboratory study. Methods Ten cadaveric hips from 5 fresh-frozen pelvises underwent biomechanical testing with a dynamic intra-articular pressure measurement system under 3 conditions: (1) intact labrum, (2) reconstruction with PS after a 3-cm segmental labrectomy, then (3) reconstruction with FLA. Contact area, contact pressure, and peak force were evaluated in 4 positions: 90º of flexion in neutral, 90º of flexion plus internal rotation, 90º of flexion plus external rotation, and 20º of extension. A labral seal test was performed for both reconstruction techniques. The relative change from the intact condition (value = 1) was determined for all conditions and positions. Results PS restored contact area to at least 96% of intact (≥0.96; range, 0.96-0.98) in all 4 positions, and FLA restored contact area to at least 97% (≥0.97; range, 0.97-1.19). Contact pressure was restored to ≥1.08 (range, 1.08-1.11) with the PS and ≥1.08 (range, 1.08-1.10) with the FLA technique. Peak force returned to ≥1.02 (range, 1.02-1.05) with PS and ≥1.02 (range, 1.02-1.07) with FLA. No significant differences were found between the reconstruction techniques in contact area in any position (P > .06), with the exception that FLA presented greater contact area in flexion plus internal rotation as compared with PS (P = .003). Suction seal was confirmed in 80% of PSs and 70% of FLAs (P = .62). Conclusion Segmental hip labral reconstruction using PS and FLA reapproximated femoroacetabular contact biomechanics close to the intact state. Clinical Relevance These findings provide preclinical evidence supporting the use of a synthetic scaffold as an alternative to FLA and therefore avoiding donor site morbidity.
Collapse
Affiliation(s)
- Bruno Capurro
- Department of Orthopaedic Surgery and Traumatology, Hospital del
Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Orthopaedic Surgery and Sport Traumatology, ReSport
Clinic, Barcelona, Spain.,Clinical Anatomy, Embryology and Neuroscience Research Group,
Medical Sciences Department, Faculty of Medicine, University of Girona, Girona,
Spain.,Grupo Ibérico de Cirugía de Preservación de Cadera, Portugal and
Spain.,Bruno Capurro Soler, PhD, Department of Orthopaedic Surgery and
Traumatology, Hospital del Mar, Passeig Marítim de la Barceloneta, 25, 08003,
Barcelona, Spain () (Twitter:
@DrBrunoCapurro)
| | - Marc Tey-Pons
- Department of Orthopaedic Surgery and Traumatology, Hospital del
Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.,Grupo Ibérico de Cirugía de Preservación de Cadera, Portugal and
Spain
| | - Anna Carrera
- Clinical Anatomy, Embryology and Neuroscience Research Group,
Medical Sciences Department, Faculty of Medicine, University of Girona, Girona,
Spain
| | - Fernando Marqués-López
- Department of Orthopaedic Surgery and Traumatology, Hospital del
Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oliver Marín-Peña
- Grupo Ibérico de Cirugía de Preservación de Cadera, Portugal and
Spain.,Department of Orthopaedic Surgery and Traumatology, Hospital Infanta
Leonor, Madrid, Spain
| | - Raúl Torres-Eguía
- Grupo Ibérico de Cirugía de Preservación de Cadera, Portugal and
Spain.,Department of Orthopaedic Surgery and Traumatology, Clínica Cemtro,
Madrid, Spain
| | - Joan Carles Monllau
- Department of Orthopaedic Surgery and Traumatology, Hospital del
Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francisco Reina
- Clinical Anatomy, Embryology and Neuroscience Research Group,
Medical Sciences Department, Faculty of Medicine, University of Girona, Girona,
Spain
| |
Collapse
|
10
|
DeFroda SF, Hanish S, Muhammad M, Cook JL, Crist B. Graft Options for Hip Labral Reconstruction. JBJS Rev 2022; 10:01874474-202212000-00001. [PMID: 36480655 DOI: 10.2106/jbjs.rvw.22.00124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
➢ Arthroscopic hip labral reconstruction is a complex procedure which is growing in use as indications, techniques, and surgical expertise advance. ➢ Graft selection is an important component of labral reconstruction based on relative advantages and disadvantages of available types of autografts and allografts. ➢ The ideal graft should mimic the native acetabular labrum form and function while also being affordable, readily available, and associated with low morbidity. ➢ High rates of patient satisfaction and positive patient-reported outcomes have been reported after labral reconstruction using several graft types.
Collapse
Affiliation(s)
- Steven F DeFroda
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Stefan Hanish
- School of Medicine, University of Missouri, Columbia, Missouri
| | - Maaz Muhammad
- School of Medicine, University of Missouri, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - Brett Crist
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| |
Collapse
|
11
|
Scanaliato JP, Green CK, Salfiti CE, Patrick CM, Wolff AB. Primary Arthroscopic Labral Management: Labral Repair and Complete Labral Reconstruction Both Offer Durable, Promising Results at Minimum 5-Year Follow-up. Am J Sports Med 2022; 50:2622-2628. [PMID: 35850143 DOI: 10.1177/03635465221109237] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Increased understanding of the acetabular labrum's role in hip joint biomechanics has led to a greater focus on the conservation and restoration of normal labral anatomic characteristics; however, labral repair is often not possible in the setting of severe intrasubstance damage or deficiency. PURPOSE To compare 5-year postoperative patient-reported outcomes between hips treated with primary complete arthroscopic labral reconstruction and those treated with primary labral repair. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All hips that underwent primary labral repair or reconstruction by the senior surgeon between January 2015 and December 2015 were included. Hips that had undergone a previous intra-articular procedure were excluded. Visual analog scales and patient-reported outcome (PRO) instruments were completed by patients within 1 week before surgery as a baseline measurement, between 22 and 26 months postoperatively for 2-year outcomes, and between 58 and 62 months for 5-year outcomes. PRO scores collected included the modified Harris Hip Score (mHHS), the 12-Item International Hip Outcome Tool, and the visual analog scale for pain and satisfaction. Pain and satisfaction were assessed using visual analog scales. RESULTS A total of 68 primary labral repairs and 62 primary complete labral reconstructions were included in the final analysis. Patients in the reconstruction cohort were older (38.3 vs 29.9 years; P < .001), had a higher incidence of severe labral tearing (62.90% vs 5.88%; P < .001), required a greater number of concomitant procedures (P < .001), and were more likely to have Beck grade III or IV chondral damage (12.94% vs 1.47%; P < .001). Both groups demonstrated statistically significant increases in outcome scores at minimum 5-year follow-up. Patients who underwent labral reconstruction had a significantly greater increase in mHHS from the preoperative assessment to latest follow-up compared with patients undergoing labral repair (27.43 vs 17.13; P = .04). No statistically significant differences between the 2 cohorts were found in achievement of minimal clinically important difference, Patient Acceptable Symptom State, maximum outcome improvement, and substantial clinical benefit at latest follow-up (P > .05). In total, 2 patients in the repair cohort and 3 patients in the reconstruction cohort required revision arthroscopy (P = .574). Further, 1 patient from each group converted to arthroplasty (P = .947). CONCLUSION The results of this study suggest that primary complete labral reconstruction is a viable surgical option for hips with moderate to severe labral pathology. At minimum 5-year follow-up, labral reconstruction produced similar outcomes to labral repair despite less favorable preoperative patient characteristics in the reconstruction cohort.
Collapse
Affiliation(s)
| | - Clare K Green
- Washington Orthopaedics and Sports Medicine, Washington, DC, USA
| | | | - Cole M Patrick
- Texas Tech University Health Sciences Center, El Paso, Texas USA
| | - Andrew B Wolff
- Washington Orthopaedics and Sports Medicine, Washington, DC, USA
| |
Collapse
|
12
|
Klosterman EL, Zacharias AJ, Dooley MS, Wilson NM, Turner EH, Goodspeed DC, Spiker AM. Treatment of Coxa Profunda With Open Surgical Hip Dislocation, Rim Resection, Cam Resection, and Labral Reconstruction. Arthrosc Tech 2022; 11:e1499-e1508. [PMID: 36061463 PMCID: PMC9437615 DOI: 10.1016/j.eats.2022.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/31/2022] [Indexed: 02/03/2023] Open
Abstract
Coxa profunda presents a unique challenge in surgical treatment approach given global acetabular overcoverage. Arthroscopic treatment can be fraught with difficulty obtaining hip distraction for safe arthroscopic instrumentation, and limited arthroscopic access may prevent sufficient osseous resection of the excess acetabular rim. Although hip arthroscopy use has increased markedly over the past decades for all types of hip pathology, coxa profunda may represent one unique indication for surgical hip dislocation. This technique describes open surgical hip dislocation, rim resection, femoral osteoplasty, and labral reconstruction using anterior tibialis allograft for coxa profunda with combined-type femoroacetabular impingement syndrome and labral ossification.
Collapse
Affiliation(s)
- Emma L. Klosterman
- Address correspondence to Emma L. Klosterman, M.D., Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, 6th Floor, Madison, WI 53705.
| | | | | | | | | | | | | |
Collapse
|
13
|
Maldonado DR, Kyin C, Simpson JR, Annin S, Jimenez AE, Saks BR, Lall AC, Domb BG. Minimum 5-Year Outcomes After Primary Segmental Labral Reconstruction for Irreparable Labral Tears in the Hip With Hamstring Grafts: With a Subanalysis Comparing Autograft Versus Allograft. Am J Sports Med 2022; 50:1876-1887. [PMID: 35486521 DOI: 10.1177/03635465221091192] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Comparable short-term outcomes have been obtained using hamstring allografts versus autografts after primary segmental labral reconstruction (SLR). Midterm results have not yet been determined. PURPOSE (1) To evaluate minimum 5-year patient-reported outcome (PRO) scores in patients who underwent primary SLR with hamstring grafts in the setting of femoroacetabular impingement syndrome (FAIS) and irreparable labral tears and (2) to compare the outcomes of hamstring autografts versus allografts in a subanalysis using propensity-matched groups. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Prospectively collected data were retrospectively reviewed for patients who underwent primary hip arthroscopy between September 2010 and November 2015. Patients were included if they underwent SLR using hamstring autografts or allografts and had preoperative and minimum 5-year PROs. The exclusion criteria were previous ipsilateral hip surgery or conditions, dysplasia, or Tönnis grade >1. Patients with autograft SLR were propensity matched 1 to 1 based on age, sex, and body mass index (BMI) to patients who underwent SLR using hamstring allografts. The minimal clinically important difference (MCID) and the Patient Acceptable Symptom State (PASS) were calculated. RESULTS Overall, 48 patients (N = hips 48) were eligible to be included in this study, and 41 patients (n = 41 hips [85.4%]) had a minimum 5-year follow-up reporting significant improvements in all PROs. Within the entire cohort, 9.8% required a secondary arthroscopy, with a mean time of 19 ± 1.8 months, and survivorship was 82.9%. Of the 41 included patients, 15 underwent an SLR with a hamstring autograft and were matched to 15 patients with labral reconstruction using a hamstring allograft. Groups were similar for sex (P > .999), age (P = .775), and BMI (P = .486). The mean follow-up times were 80.8 ± 25.5 and 66.1 ± 8.3 months (P = .223) for the autograft and allograft groups, respectively. Baseline PROs, preoperative radiographic measurements, surgical findings, and intraoperative procedures were similar. The groups achieved significant and comparable improvements for all PROs (P < .0001), satisfaction (P = .187), and the rate of achieving the MCID and the PASS. However, a tendency for higher postoperative PROs favoring allograft reconstruction was found. CONCLUSION At a minimum 5-year follow-up, patients who underwent primary arthroscopic SLR in the context of FAIS and irreparable labra, with either autograft or allograft hamstring tendons, reported significant improvements and comparable postoperative scores for all PROs, patient satisfaction, MCID, and PASS.
Collapse
Affiliation(s)
| | - Cynthia Kyin
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Jeffrey R Simpson
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Shawn Annin
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| |
Collapse
|
14
|
Laboudie P, Gauthier P, Kreviazuk C, Beaulé PE. Does labral treatment technique influence the outcome of FAI surgery? A matched-pair study of labral reconstruction versus repair and debridement with a follow-up of 10 years. J Hip Preserv Surg 2022; 9:95-101. [PMID: 35854806 PMCID: PMC9291390 DOI: 10.1093/jhps/hnac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/11/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to analyze the long-term clinical outcomes of labral reconstruction in patients undergoing femoro-acetabular impingement (FAI) surgery and compare them with labral repair and debridement. This is a single-center, single-surgeon, retrospective match-paired study from a prospectively collected hip preservation database. All patients underwent a hip surgical dislocation for FAI surgery. Eight patients underwent labral reconstruction with the ligamentum teres and were matched on sex, age and body mass index with 24 labral repair and 24 labral debridement (1:3). Failure was defined as conversion to total hip replacement (THR) and patient-reported outcome measures (PROMs) were collected. Mean follow-up was 9.8 years ±2.6 (5.2–13.9). There was a significant improvement in postoperative PROMs in the three groups regarding the WOMAC total, WOMAC function, HOOS-QoL, HOOS-ADL and HOOS-SRA (P < 0.05). There was no statistical difference between the three groups regarding postoperative PROMs and change in PROMs (P > 0.05). A total of 10 hips underwent joint replacement surgery at a mean time of 7.9 ± 3.5 years (2.4–12). There was no statistically significant difference between the three groups regarding the conversion rate to THR (P = 0.64) or time between surgery and conversion to THR (P = 0.15). Compared to a match-pair group of labral repair and debridement, labral reconstruction with ligamentum teres provides similar survival with conversion to a THR as an endpoint, as well as similar improvement in PROMs. Labral treatment can be safely adapted at the nature of the labral lesion with a treatment ‘à la carte’.
Collapse
Affiliation(s)
- Pierre Laboudie
- Division of Orthopedic Surgery, The Ottawa Hospital (TOH), 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
- Faculty of Medicine, The University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada
| | - Paul Gauthier
- Division of Orthopedic Surgery, The Ottawa Hospital (TOH), 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
- Faculty of Medicine, The University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada
| | - Cheryl Kreviazuk
- Division of Orthopedic Surgery, The Ottawa Hospital (TOH), 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Paul E Beaulé
- Division of Orthopedic Surgery, The Ottawa Hospital (TOH), 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
- Faculty of Medicine, The University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| |
Collapse
|
15
|
Allograft Labral Reconstruction of the Hip: Expanding Evidence Supporting Greater Utilization in Hip Arthroscopy. Curr Rev Musculoskelet Med 2022; 15:27-37. [PMID: 35141846 PMCID: PMC9076780 DOI: 10.1007/s12178-022-09741-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/04/2022]
Abstract
Purpose of Review The current review investigates outcomes and failure rates associated with arthroscopic circumferential allograft labral reconstruction of the hip, both as a revision and primary procedure in treating femoroacetabular hip impingement and labral-related pathology. Recent Findings Numerous studies within the last decade have demonstrated excellent patient-reported outcomes, high rates of return-to-play in athletes, and low failure rates in patients having undergone arthroscopic circumferential allograft labral reconstruction of the hip. Removal of chronically diseased and injured labral tissue can eliminate a significant pain-generator from the hip joint. Additionally, circumferential reconstruction of the labrum restores the hoop fiber strength and fluid seal akin to what would be seen with native, healthy labral tissue. Recent research has shown that arthroscopic circumferential allograft labral reconstruction may be used not only in the revision setting, but as a primary procedure. Circumferential labral reconstruction should be considered when a surgeon feels that the labrum is irreparable or has failed previous repair. Summary Arthroscopic circumferential allograft labral reconstruction of the hip can be utilized as treatment option not only in revision settings, but also in primary treatment for femoroacetabular impingement and labral pathology
Collapse
|
16
|
Editorial Commentary: Segmental Hip Labral Reconstruction May Be Superior to Circumferential Reconstruction: Bigger Isn't Better. Arthroscopy 2022; 38:349-351. [PMID: 35123714 DOI: 10.1016/j.arthro.2021.05.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 02/02/2023]
Abstract
Hip arthroscopic segmental and circumferential labral reconstruction show similar outcomes in short-term follow-up. Will bigger (circumferential reconstruction) eventually be largely a historical method? Bigger does not appear to be better, although some argue that segmental techniques inadequately restore the labrum's function, incompletely treat the defect, and result in mismatch at the labral-graft junction, which is also a "weak spot" for future tears. Yet, others show that circumferential reconstruction is without clear benefit and adds additional anchors, complexity and operating room time and costs. The next phase of research on hip labral reconstruction requires evaluation of the numerous variables within the category of "reconstruction." Today, a great number of different reconstruction techniques exist. Measuring a segmental defect can be challenging but is facilitated with methods such as the kite technique, use of a shoulder superior capsular reconstruction guide, or a pull-through method to simply avoid measuring. Graft options include ligamentum teres and iliotibial band, anterior and posterior tibialis, hamstring, fascia lata, autograft and allograft. Graft preparation, passage, and fixation techniques also vary widely. Finally, determining how much overlap with native labrum, ideal graft tension, or integrating the transverse acetabular ligament is more art than science. It's time we begin to critically evaluate the differences in reconstructive techniques.
Collapse
|
17
|
Gollwitzer H, Möckel G, Sobau C. Auswahl des Operationsverfahrens beim Femoroazetabulären Impingement-Syndrom. DER ORTHOPADE 2022; 51:219-229. [DOI: 10.1007/s00132-022-04213-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 01/11/2023]
|
18
|
Tey-Pons M, Capurro B, Torres-Eguia R, Marqués-López F, Leon-García A, Marín-Peña O. Labral reconstruction with polyurethane implant. J Hip Preserv Surg 2021; 8:i34-i40. [PMID: 34178369 PMCID: PMC8221378 DOI: 10.1093/jhps/hnab030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 12/15/2022] Open
Abstract
Surgical treatment of labral injuries has shifted from debridement to preservation over the past decades. Primary repair and secondary augmentation or reconstruction techniques are aimed at restoring the labral seal and preserving or improving contact mechanics. Currently, the standard of care for non-repairable tears favours the use of auto- or allografts. As an alternative, we present our initial experience using a synthetic, off-the-shelf polyurethane scaffold for augmentation and reconstruction of segmental labral tissue loss or irreparable labral damage. Three patients aged 37–44 (two male, one female) with femoroacetabular impingement without associated dysplasia (Wiberg > 25°) or osteoarthritis (Tönnis <2) were included in this series. Labral reconstruction (one case) and augmentation (two cases) were performed using a synthetic polyurethane scaffold developed for meniscal substitution (Actifit®, Orteq Ltd, London, UK) and adapted to the hip. Clinical results were analysed with patient-reported outcomes (PROMs) using non-arthritic hip score (NAHS) and daily live activities hip outcome score (DLA HOS) and magnetic resonance images (MRI) at 2- and 4-year follow-up. Clinically improvement was seen in all PROMs at 4 years. The NAHS scores improved from 57.7 to 82.3 (50.9% improvement) and HOS from 59 to 79.3 (35.3% improvement). Last follow-up MRIs confirmed the presence of the scaffold; however, the scaffold signal was still hyperintense compared to native labrum. There was no shrinkage in any scaffold and no progression to hip osteoarthritis seen. Reconstruction or augmentation of segmental labral defects with a polyurethane scaffold may be an effective procedure. At 4 years after implantation, our small cases series resulted in improved hip joint function, reduced pain and scaffold preservation on follow-up imaging.
Collapse
Affiliation(s)
- Marc Tey-Pons
- Department of Orthopaedic Surgery and Traumatology, Hospital del Mar, Barcelona 08003, Spain.,iMove Traumatología, Clínica Mi Tres Torres, Barcelona 08017, Spain.,Grupo Ibérico de Cirugía de Preservación de Cadera, GIPCA, Spain
| | - Bruno Capurro
- Department of Orthopaedic Surgery and Traumatology, Hospital del Mar, Barcelona 08003, Spain.,Grupo Ibérico de Cirugía de Preservación de Cadera, GIPCA, Spain.,Sport Orthopaedic Department, ReSport Clinic, Barcelona 08030, Spain
| | - Raúl Torres-Eguia
- Grupo Ibérico de Cirugía de Preservación de Cadera, GIPCA, Spain.,Hip Unit, Clínica Cemtro, Madrid 28035, Spain
| | - Fernando Marqués-López
- Department of Orthopaedic Surgery and Traumatology, Hospital del Mar, Barcelona 08003, Spain
| | - Alfonso Leon-García
- Department of Orthopaedic Surgery and Traumatology, Hospital del Mar, Barcelona 08003, Spain
| | - Oliver Marín-Peña
- Grupo Ibérico de Cirugía de Preservación de Cadera, GIPCA, Spain.,Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Infanta Leonor, Madrid 28031, Spain
| |
Collapse
|