AANA Lab Course 907-Arthroscopic/Open Strategies - Hip Preservation-Graft Choices and Preparation for Labrum Reconstruction-John J. Christoforetti, MD

Graft Choices and Preparation for Labrum Reconstruction-John J. Christoforetti, MD

Pdf Summary

Labrum reconstruction involves replacing damaged acetabular labrum tissue with substitutes using allografts, autografts, or local tissues. Various graft options include local tissues (hip capsule, ligamentum teres), autografts (iliotibial band, gracilis/semitendinosus tendons), and allografts (iliotibial band, tibialis anterior, hamstrings). Synthetic grafts have also been explored but remain less common.<br /><br />Fixation typically uses spot-weld techniques with suture anchors (all-suture, knotless, or standard anchors). Techniques to secure grafts include base refixation, simple sutures, overlays, or spanning anchors. Reconstruction methods vary from segmental (replacing only damaged parts) to total labrum reconstruction (replacing the entire labrum), with augmentation approaches using autograft segments adjacent to native tissue.<br /><br />Total labrum reconstruction is often more straightforward for severely damaged labra but requires precise understanding of safe anchor drilling angles. It is considered an "all-in" procedure, necessitating complete replacement once the native labrum is removed, though some expert debate exists regarding its broad applicability.<br /><br />Graft preparation and insertion demand meticulous technique, ensuring proper graft size (typically 5-6 mm) and tension to achieve a functional suction seal for hip stability. Avoiding weak junctions and inaccurate measurements is critical since too short or too long grafts compromise outcomes. Techniques like the knotless pull-through method help achieve proper tension and fixation.<br /><br />Common challenges include the proximity of the sciatic nerve during graft pull-through, difficulty trimming the graft in place, and risks like graft ossification. Despite multiple graft options and techniques, clear absolute indications for labrum reconstruction and evidence favoring specific graft types remain lacking.<br /><br />In summary, labrum reconstruction offers several technical options and graft choices, yet requires expert skill and judgment to optimize hip joint function and avoid complications.

Keywords

labrum reconstruction

acetabular labrum

allografts

autografts

synthetic grafts

suture anchors

total labrum reconstruction

graft preparation

hip stability

sciatic nerve