Graft Options for Hip Labral Reconstruction

DeFroda, Steven F.; Hanish, Stefan; Muhammad, Maaz; Cook, James L.; Crist, Brett D.

doi:10.2106/jbjs.rvw.22.00124

Cited by 4 publications

(4 citation statements)

References 63 publications

(146 reference statements)

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“…Labral reconstruction emphasizes recapitulation of labrum structure and function in order to reestablish joint health. 5 …”

Section: Introductionmentioning

confidence: 99%

“… 10 , 16 , 17 , 18 , 19 , 20 , 21 Meniscus allografts have been recently implemented for open labral reconstruction based on their similarities in size, shape, and geometry; tissue composition and architecture; synthetic and metabolic profiles; and material properties when compared to acetabular labrum tissue. 5 , 22 , 23 , 24 , 25 , 26 , 27 In an effort to avoid the morbidity associated with open hip surgery and replicate the advantages noted for outpatient surgery with use of tendon allografts, we have developed an arthroscopic technique for hip labral reconstruction using fresh meniscal allograft.…”

Section: Introductionmentioning

confidence: 99%

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Arthroscopic Hip Labral Reconstruction With Fresh Meniscal Allograft

DeFroda

Crist

Cook

2023

Arthroscopy Techniques

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“…Labral reconstruction emphasizes recapitulation of labrum structure and function in order to reestablish joint health. 5 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Arthroscopic Hip Labral Reconstruction With Fresh Meniscal Allograft

DeFroda

Crist

Cook

2023

Arthroscopy Techniques

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“…Multiple labral reconstruction techniques have been described [5], with allograft being the preferred choice for reconstruction among high-volume surgeons [16]. However, although numerous techniques using a ligamentum teres autograft [30], iliotibial band autograft [22], gracilis autograft [17], quadriceps tendon autograft [20], capsular autograft [8], indirect head of the rectus femoris autograft [28], semitendinosus allograft [24], peroneus brevis tendon allograft [19], and meniscus allograft [7] have been reported, no single graft type has been demonstrated to be superior in acetabular labral reconstruction [1].…”

Section: Introductionmentioning

confidence: 99%

Can the Acetabular Labrum Be Reconstructed With a Meniscal Allograft? An In Vivo Pig Model

Maimaitimin,

Yang,

Huang

et al. 2023

Clin Orthop Relat Res

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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.

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“…One promising allograft source for labral reconstruction is the human meniscus because of its similarities to the labrum in size, shape, tissue architecture, and material properties relative to tendon tissue [3,6]. Proof-ofconcept small case series have shown that meniscal allografts can be used clinically for acetabular labral reconstruction in humans, with no adverse events in the short term [3,6]. Further studies examining the histologic and biomechanical benefits of this reconstruction technique are therefore warranted.…”

mentioning

confidence: 99%

CORR Insights®: Can the Acetabular Labrum Be Reconstructed With a Meniscal Allograft? An In Vivo Pig Model

Ricciardi

2023

Clin Orthop Relat Res

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Graft Options for Hip Labral Reconstruction

Cited by 4 publications

References 63 publications

Arthroscopic Hip Labral Reconstruction With Fresh Meniscal Allograft

Arthroscopic Hip Labral Reconstruction With Fresh Meniscal Allograft

Can the Acetabular Labrum Be Reconstructed With a Meniscal Allograft? An In Vivo Pig Model

CORR Insights®: Can the Acetabular Labrum Be Reconstructed With a Meniscal Allograft? An In Vivo Pig Model

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