AANA Lab Course 905 - 2nd Annual Fellows Course-Labral Refixation – Tips and Tricks; Labral Reconstruction, Sanjeev Bhatia, M.D

Labral Refixation – Tips and Tricks; Labral Reconstruction, Sanjeev Bhatia, M.D

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This document by Dr. Sanjeev Bhatia focuses on labral reconstruction techniques during hip arthroscopy, particularly its indications, methods, and technical pearls. The labrum plays a critical role in hip joint stability and the suction seal, primarily affected by femoroacetabular impingement (FAI), which causes 96% of labral tears.<br /><br />Key points include:<br /><br />1. Labral Treatment Algorithm:  <br />   - Essential to address FAI concomitantly with labral issues.  <br />   - Labral repair is standard in most cases, preserving the native labrum with typically 3-4 suture anchors.  <br />   - Labral reconstruction is rarely needed and mainly reserved for revision surgeries where the labrum is irreparable.<br /><br />2. Labral Reconstruction Considerations:  <br />   - Reconstruction is used when the native labrum is too damaged, calcified, or failed previous repairs.  <br />   - Graft options include iliotibial (IT) band autograft/allograft, semitendinosus allograft, tibialis anterior allograft, and gracilis autograft.  <br />   - The quality of reconstruction depends heavily on graft quality and precise graft length matching the defect.<br /><br />3. Technical Approach - The “Kite Technique”:  <br />   - Involves placing anchors close to the articular margin for optimal suction seal.  <br />   - Measurement of the labral defect is done via suture strands ("stripe counting") between anchors to accurately size graft length.  <br />   - The graft is shuttled intra-articularly using two suture strands from anterior and posterior anchors for control ("kite flying").  <br />   - Careful suture management is critical to avoid entanglement, with anchor sutures tied sequentially (posterior first) to secure graft placement.<br /><br />4. Advantages of the Kite Technique:  <br />   - Precise graft fit, control, and fixation at both ends, suitable for segmental or circumferential reconstructions.  <br />   - It’s efficient but requires exact measurements and careful suture handling.<br /><br />The prevailing consensus stresses preserving the native labrum whenever possible, as labral repair shows superior outcomes to reconstruction. Reconstruction is reserved mainly for revision cases or rare primary reconstructions for restoring joint seal. The described meticulous surgical technique aims to optimize outcomes when labral reconstruction is necessary.

Keywords

labral reconstruction

hip arthroscopy

femoroacetabular impingement

labral repair

suture anchors

kite technique

graft options

labral defect measurement

suction seal

revision surgery