Arthroscopic Labral Reconstruction With Gracilis Autograft

Abstract

Despite growing interest in hip arthroscopy and labral preservation, some patients have severely damaged, degenerative, or deficient labrums and may be candidates for arthroscopic labral reconstruction. The ligamentum teres has been used as a graft source for open hip labral grafting, and the iliotibial band has been used in the arthroscopic setting. We present an alternative method of hip labral reconstruction using the gracilis autograft, which does not require post-harvest manipulation. Arthroscopic techniques for graft tensioning and labrum-graft overlap are introduced that may facilitate restoration of labral function in patients with otherwise non-salvageable labrums.

Hip Arthroscopy for Challenging Deformities: Global Pincer Femoroacetabular Impingement

“…Otherwise, we will typically perform labral reconstruction with gracilis autograft harvested from the ipsilateral knee. 10,15,16 In our case example the adjacent capsule was adhered to the thin labrum. During an acetabuloplasty-first approach (Fig 5), which enables access to the CC, we preserve a cuff of capsulolabral tissue for later reconstruction.…”

“…This may be exacerbated in the setting of coexisting coxa vara or breva. Hence we will try 1 of several options (Table 1): Distal portalefirst approach: Initial CC access in made through a distal portal (we prefer the modified midanterior portal 15,16 [MMAP], which is 3 cm anterior and 4 to 5 cm distal to the anterolateral portal when the latter is made with the hip in internal rotation), enabling a more collinear path into the anterior CC. Capsulotomy-first approach: An initial anterolateral capsulotomy may enable improved hip distraction so that CC access may then be safely achieved.…”

The Modified Mid-Anterior Portal for Hip Arthroscopy

“…A variety of advanced arthroscopic hip (e.g., labral reconstruction, [16][17][18] global acetabuloplasty [Fig 4], posterior cam decompression [Fig 5], osteosynthesis of an anterior acetabular fracture [ Fig 6] and femoral head osteochondritis dissecans, 19 and inferior capsular plication 20 ) and peritrochanteric procedures have been performed using the ALP and MMAP. However, the addition of the AP has been helpful in the performance of arthroscopic osteosynthesis of acute and malunited femoral head fractures.…”

Arthroscopic Labralization of the Hip: An Alternative to Labral Reconstruction

“…[1][2][3][4][5][6][7] Patients with severe anatomic and/or functional labral insufficiency deemed borderline candidates for reconstruction may benefit from hip labralization as an attractive alternative to labrectomy or reconstruction. 7 It is a relatively simple and quick procedure without graft harvest morbidity or allograft costs that can be performed in patients undergoing rim reduction.…”