Arthroscopic Hip Labral Augmentation Technique With Iliotibial Band Graft

Abstract

The importance of the acetabular labrum has been well documented for the function and overall health of the hip joint. Several biomechanical studies have shown the sealing effect of the acetabular labrum. In the past decade, labral repair procedures have gained increased attention, with the literature suggesting that the outcomes after hip arthroscopy are directly related to labral preservation. However, a primary labral repair can be challenging in cases of hypoplastic, ossified, or complex and irreparable labral tears in which there is insufficient tissue to perform a primary repair. For these cases, labral reconstruction becomes a viable option with good outcomes at short-term and midterm follow-up. A subset of these patients may show viable remnants of the labral circumferential fibers but, because of the low tissue volume, these remnant fibers are unable to maintain the suction seal. In this situation, a labral augmentation may be a viable alternative to labral reconstruction while preserving as much native labral tissue as possible. The purpose of this Technical Note is to describe an arthroscopic hip labral augmentation technique using iliotibial band autograft or allograft.

Hip Labral Augmentation With Tibialis Anterior Tendon Allograft Using the Knotless Pull-Through Technique

“…Similar revision rates and conversion to total hip arthroplasty were seen in both groups. However, the augmentation technique used by Locks et al 9 is notably different from that presented here. In their article, (1) an autograft needs to be harvested, (2) knots need to be tied, and (3) the labral defect must be measured.…”

“…In their article, (1) an autograft needs to be harvested, (2) knots need to be tied, and (3) the labral defect must be measured. 9 Labral defect measurement has been suggested by others for labral augmentation techniques, 17 but we believe that forgoing this step relieves the risk of graft-defect mismatch and provides for a more expedited procedure ( Table 2). Pearls and pitfalls of this procedure are reported in (Table 3).…”

“…We present our arthroscopic labral augmentation technique with important variations from previous descriptions. 9 First, the use of an allograft tendon avoids the risk of donor side morbidity. Second, the pull-through technique previously described for labral reconstruction avoids the need to measure the labral defect and eliminates length mismatch.…”

Hip arthroscopy for femoroacetabular impingement

“… 44 When the tissue is beyond repair, labral debridement or reconstruction can be performed depending on the case. Labral reconstructions have been performed using multiple types of grafts, such as the gracilis tendon 45 or the iliotibial band, 46 or the indirect head of the rectus femoris as a local graft 47 ( Supplemental Video 2 ).…”

Labral debridement, repair and reconstruction: current concepts

“…This is a technique that incorporates allograft or autograft tissue into a labral repair in order to augment the repair with more collagen for a larger labrum 46. This procedure is deemed appropriate when there is still intact circumferential labral tissue, but the tissue volume is inadequate to recreate the labral seal.…”