AANA Lab Course 914 - Advanced Hip Arthroscopy-Circumferential Labral Reconstruction, Benjamin Domb, MD

Circumferential Labral Reconstruction, Benjamin Domb, MD

Pdf Summary

This presentation by Dr. Benjamin G. Domb, Chair of the American Hip Institute Research Foundation, focuses on hip labral anatomy, repair, and reconstruction techniques, emphasizing the importance of restoring the labrum’s critical biomechanical functions.<br /><br />The acetabular labrum plays a vital role in chondroprotection, joint stability, load bearing, maintaining a fluid film, and creating a suction seal with the femoral head, essential for hip joint health. Labral damage impairs these functions, necessitating precise surgical repair or reconstruction.<br /><br />Two primary anatomic labral repair methods are discussed: <br />1. Labral Base Refixation (LBR) technique, which preserves the triangular labral shape and transitional zone to restore the suction seal and labral-femoral head fit critical for joint stability.<br />2. Controlled Tension Anatomic (CTA) repair, designed for labra that cannot support LBR, uses selective tensioning to ensure consistent labral contact and seal against the femoral head. Despite being technically demanding, these techniques aim to integrate the labrum anatomically without detachment.<br /><br />For cases with segmental labral loss, calcification, failed repairs, or failed debridement, Dr. Domb introduces the Knotless Pull-Through Labral Reconstruction. This technique involves rim preparation, placing knotless anchors, and graft insertion with a straightforward pull-through method that negates the need for graft measurement, facilitating reproducible restoration of labral function. Clinical and biomechanical evidence supports that restoring the labrum yields better outcomes than debridement alone.<br /><br />The presentation underscores that labral preservation or reconstruction is essential to maintain the labrum’s biomechanical seal and role, which aligns with common sense and clinical experience. A flowchart guides surgical decision-making based on labral viability and stability.<br /><br />In summary, Dr. Domb advocates for anatomic labral repair or reconstruction to preserve the labrum's function and improve patient outcomes in hip arthroscopy.

Keywords

hip labral anatomy

labral repair techniques

labral reconstruction

acetabular labrum

biomechanical functions

Labral Base Refixation (LBR)

Controlled Tension Anatomic (CTA) repair

Knotless Pull-Through Labral Reconstruction

hip joint stability

hip arthroscopy outcomes