Graft choices for acetabular labral reconstruction

Abstract

The acetabular labrum plays a key role in maintaining hip function and minimizing hip degeneration. Once thought to be a rare pathology, advances in imaging have led to an increase in the number of diagnosed labral tears. While still a relatively new field, labral reconstruction surgery is an option for tears that are irreparable or require revision after primary repair. Various autograft and allograft options exist when considering labral reconstruction. The first labral reconstruction surgery was described using the ligamentum teres capitis, and has since evolved, incorporating more graft sources and reconstructive techniques. The purpose of this review is to assess and describe the different graft sources and technique currently implemented by hip surgeons. Moreover, this review attempts to determine whether a single labral reconstructive graft type is superior to the others. Techniques using the Ligamentum teres capitis autograft, ITB autograft, gracilis autograft, quadriceps tendon autograft, capsular autograft, semitendinosus allograft, indirect head of the rectus femoris autograft, peroneus brevis tendon allograft and Tensor fascia lata allograft were found. Scoring was available on 5 out of the 9 graft types. The advantages and disadvantages of each graft source is described as a comparative tool. No single graft type has shown increased benefit in acetabular labral reconstruction. The lack of uniform outcome measurements hinders comparison of reported outcomes. Surgeons should make an informed decision based on their experience as well as the patient’s history and needs when choosing which graft type would be best suited for their patients.

Surgical management of a lateral luxation of the tendon of the superficial digital flexor muscle using an autologous fascia lata graft

“…The FL graft has been used extensively in human surgery, including tendon repair,15–17 and has been used as augmentation for successful common calcaneal tendon repair in two dogs 18 19. Autologous grafts have numerous advantages over allogenic grafts, including low infection rate, no disease transmission, biocompatibility and lower cost 16. The FL graft specifically is relatively simple to harvest, is readily available with minimal donor site morbidity and is reported to have superior biomechanical properties in comparison with other free fascial grafts 11 20.…”

Impacto femoroacetabular e lesão do lábio acetabular – Parte 3: Tratamento cirúrgico

“…In complex lesions of the acetabular lip, in which the labial tissue is not healthy for repair, it is recommended reconstruction of the acetabular lip, which can be performed with autologous graft of the iliotibial band, femoral head ligament or allografts. 22,23 The orthopedist should be familiar with arthroscopic anatomy, as there may be difficulty in guiding the location and regarding the required amount of bone resection. Insufficient bone resection results in residual impact and is an important reason for reoperations.…”

“…Em lesões complexas do lábio acetabular, nas quais o tecido labial não é saudável para o reparo, recomenda-se a reconstrução do lábio acetabular, que pode ser realizada com enxerto autólogo da banda iliotibial, ligamento da cabeça femoral ou aloenxertos. 22 23 …”

“…In complex lesions of the acetabular lip, in which the labial tissue is not healthy for repair, it is recommended reconstruction of the acetabular lip, which can be performed with autologous graft of the iliotibial band, femoral head ligament or allografts. 22 23 …”

Does peer review have a future?

“…Yet how about the excellent piece by Atzmon et al . [7] on the graft choices for acetabular reconstruction? Utterly brilliant, and immensely helpful, in my view.…”