AANA Lab Course 907-Arthroscopic/Open Strategies - Hip Preservation-Labrum Repair_ Why I Use What Suture Pattern and Where-J.W. Thomas Byrd, MD

Labrum Repair_ Why I Use What Suture Pattern and Where-J.W. Thomas Byrd, MD

Pdf Summary

Dr. J. W. Thomas Byrd's presentation on labrum repair emphasizes the importance of restoring the labrum's anatomy to regain hip function, leveraging its excellent healing capacity. Most labra are repairable, but success depends on precise surgical technique, particularly portal and anchor placement during hip arthroscopy.<br /><br />Byrd advocates the three-portal arthroscopic method for optimal access to the intraarticular compartment, a technique unchanged since 1990 but enhanced by technological advances. Portal placement is critical as it dictates anchor placement; however, initial portal positioning should prioritize joint access rather than anchor placement, which is more precisely achieved percutaneously.<br /><br />The percutaneous portal is generally positioned distal and lateral or anterior to allow effective anchor insertion with adequate divergence, aiming to place anchors as close to the acetabular rim as possible without causing articular cartilage or medial pelvic perforation. Inadequate anchor placement—too far from the rim—fails to restore native anatomy and function.<br /><br />Labrum repairs typically begin anteriorly, progressing laterally, reflecting the typical tear progression seen in femoroacetabular impingement (FAI). The anterior portal is favored for suture management and medial anchor placement, as more lateral percutaneous portals risk pelvic cortex perforation and iliopsoas irritation.<br /><br />Regarding suture patterns, Byrd uses variable techniques such as simple loop and modified single limb mattress, selected based on labrum size, morphology, and pathology pattern.<br /><br />He notes that repair failures seldom necessitate revision surgery and suggests current rehabilitation protocols may be overly cautious. While some caution remains due to experience with shoulder repairs, more aggressive rehab strategies might be considered in hip labral repair.<br /><br />In sum, successful hip labral repair hinges on precise portal and anchor placement to restore anatomy, tailored suture techniques, and balanced post-operative rehabilitation to optimize healing and function.

Keywords

hip labrum repair

labrum anatomy restoration

hip arthroscopy

three-portal technique

portal placement

anchor placement

percutaneous portal

femoroacetabular impingement

suture patterns

post-operative rehabilitation