Reconstruction of Massive Posterior Nonrepairable Acetabular Labral Tears With Peroneus Brevis Tendon Allograft: Arthroscopy-Assisted Mini-Open Approach

Abstract

Many of the described labral-reconstruction procedures are purely arthroscopic. This approach only allows segmentary reconstructions. For more extensive reconstructions, surgical dislocation of the hip still represents the more suitable approach. We present an arthroscopy-assisted procedure combined with an anterior mini-open approach, which could be considered for reconstruction of nonrepairable labral lesions located in the posterior aspect of the acetabulum and massive reconstructions in cases of global-pincer femoroacetabular impingement and protrusio acetabuli. Our technique saves the morbidity that might be related to the surgical dislocation of the hip and incorporates a peroneus brevis tendon allograft. This option may restore the anatomy and labral function without morbidity at the donor site, as well as remove graft length restrictions during massive reconstructions.

Reconstruction of Nonrepairable Acetabular Labral Tears with Allografts: Mid-Term Results

“…Described allografts used to labral reconstruction in the literature include; semitendinosus allograft, iliotibial band allograft, hamstring allograft and allogenic labral transplantation (13, 27-28-29-30-31).…”

The Anatomical Basis of the Vascularized Fibularis Brevis Grafts

“…Incorporation of the fibularis brevis tendon allograft to restore the anatomy of the labrum and also its function without morbidity at the donor site has been reported. The tendon has been used for reconstruction of non-repairable labrum lesions located in the posterior aspect of the acetabulum and massive reconstructions in cases of global-pincer femur-acetabulum impingement and protrusion-acetabuli (Moya et al, 2016).…”

Graft choices for acetabular labral reconstruction

“…tensor fascia lata, quadriceps and hamstrings). The purported advantages of autografts over allografts include a lower infection rate, no risk of disease transmission or immune reaction and lower cost [11, 17]. An additional benefit of autograft use is their ability to histologically convert to fibrocartilage tissue after integration with the local tissue [44].…”

“…Moya et al [11] first described labral reconstruction using the peroneus brevis tendon in 2016. The use of this allograft is associated with decreased operating time and predictable graft size and quality.…”