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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.
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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
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Capurro B, Reina F, Carrera A, Monllau JC, Marqués-López F, Marín-Peña O, Torres-Eguía R, Tey-Pons M. Hip Labral Reconstruction With a Polyurethane Scaffold: Restoration of Femoroacetabular Contact Biomechanics. Orthop J Sports Med 2022; 10:23259671221118831. [PMID: 36119123 PMCID: PMC9478710 DOI: 10.1177/23259671221118831] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Many advances have been made in hip labral repair and reconstruction and in
the restoration of the suction seal. Purpose/Hypothesis: The purpose of this study was to evaluate the biomechanical effects of
segmental labral reconstruction with a synthetic polyurethane scaffold (PS)
in comparison with segmental labrectomy. Our hypothesis was that
reconstruction with a icroporous polyurethane implant would normalize joint
kinetics of the hip and restore the suction seal. Study Design: Controlled laboratory study. Methods: We used 10 hips from 5 fresh-frozen pelvises with an intact acetabular labrum
without osteoarthritis. Using an intra-articular pressure measurement
system, the contact area, contact pressure, and peak force were assessed for
the following conditions: intact labrum, partial anterosuperior labrectomy,
and PS reconstruction. For each condition, all specimens were analyzed in 4
positions (90° of flexion, 90° of flexion and internal rotation, 90° of
flexion and external rotation, and 20° of extension) and underwent a labral
seal test. The relative change from the intact condition was determined for
all conditions and positions. Results: Compared with the intact labrum, labrectomy resulted in a significant
decrease in the contact area (P < .001) and a
significant increase in the peak force (P < .001) and
contact pressure (P < .001) across all positions.
Compared with labrectomy, PS reconstruction resulted in a significant
increase in the contact area (P < .001) and a
significant decrease in the contact pressure (P ≤ .02) and
peak force (P < .001) across all positions. Compared
with the intact labrum, PS reconstruction restored the contact area and peak
force to normal values in all positions (P > .05),
whereas the contact pressure was significantly decreased compared with
labrectomy (P < .05) but did not return to normal
values. The labral seal was lost in all specimens after labrectomy but was
restored in 80% of the specimens after PS reconstruction. Conclusion: Femoroacetabular contact biomechanics significantly worsened after partial
labrectomy; reconstruction using a PS restored the contact area and peak
force to the intact state and improved the contact pressure increases seen
after partial labrectomy. The contact area and peak force were normalized,
and the labral seal was re-established in most cases. Clinical Relevance: This study provides biomechanical evidence for the use of a scaffold for
labral reconstruction.
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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.,NEOMA Research Group, Department of Medical Sciences, Universitat de Girona, Girona, Spain.,GIPCA - Grupo Ibérico de cirugía Preservación de Cadera, Spain - Portugal
| | - Francisco Reina
- NEOMA Research Group, Department of Medical Sciences, Universitat de Girona, Girona, Spain
| | - Anna Carrera
- NEOMA Research Group, Department of Medical Sciences, Universitat de Girona, Girona, Spain
| | - Joan Carles Monllau
- Department of Orthopaedic Surgery and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fernando Marqués-López
- Department of Orthopaedic Surgery and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oliver Marín-Peña
- GIPCA - Grupo Ibérico de cirugía Preservación de Cadera, Spain - Portugal.,Department of Orthopaedic Surgery and Traumatology, Hospital Infanta Leonor, Universidad Complutense de Madrid, Madrid, Spain
| | - Raúl Torres-Eguía
- GIPCA - Grupo Ibérico de cirugía Preservación de Cadera, Spain - Portugal.,Department of Orthopaedic Surgery and Traumatology, Clínica CEMTRO, Madrid, Spain
| | - Marc Tey-Pons
- Department of Orthopaedic Surgery and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.,GIPCA - Grupo Ibérico de cirugía Preservación de Cadera, Spain - Portugal
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Wirries N, Dienst M. [Labral lesions in femoroacetabular impingement syndrome: evidence-based treatment]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:450-457. [PMID: 35507061 DOI: 10.1007/s00132-022-04253-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The acetabular labrum and the adjacent rim cartilage are the primary targets of primary or secondary degeneration processes in the hip joint. Currently, femoroacetabular impingement syndrome (FAIS) is considered the main mechanical pathology leading to chondrolabral damage. The treatment options for labrum tears range from a debridement/resection, repair to augmentation or transplantation. AIM Description of surgical treatment options for pathologic changes of the acetabulare labrum and their results with a focus on FAIS. MATERIALS AND METHODS A literature search was performed on https://pubmed.ncbi.nlm.nih.gov using the following key words: hip, labrum, therapy, resection, repair, augmentation, reconstruction. RESULTS The different surgical procedures as labrum therapy reduce pain and increase the joint function. Labral repair, augmentation, and reconstruction tend to have better results compared to resection but are associated with a higher rate of postoperative intraarticular adhesions. DISCUSSION In addition to reducing pain and improving function, the goal of surgical treatment of labrum lesions should be to maintain the functions of the labrum. The labrum should be preserved, in cases of adequate tissue quality and width. In the setting of resective procedures, the resection should be limited to the unstable parts of the labrum. The results of labral augmentation and reconstruction are promising, allowing these procedures to be considered for patients with ongoing symptoms in the revision situation with labral defects or an insufficient residual labrum.
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Affiliation(s)
- Nils Wirries
- Orthopädische Klinik, Medizinische Hochschule Hannover, DIAKOVERE Annastift, Anna-von Borries Str. 1-7, 30625, Hannover, Deutschland.
| | - Michael Dienst
- Orthopädische Chirurgie München (OCM), München, Deutschland
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Randelli F, Bonin N, Papavasiliou A. Editorial (ESSKA-SHPS supplement). J Hip Preserv Surg 2021; 8:i2-i3. [PMID: 34178364 PMCID: PMC8221377 DOI: 10.1093/jhps/hnab047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Filippo Randelli
- Hip Department (CAD) Gaetano Pini-CTO Orthopedic Institute, Università degli Studi di Milano, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
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