AOSSM/AANA Specialty Day 2020-Five Tips to Make Your Labral Repair Easier

Five Tips to Make Your Labral Repair Easier

Pdf Summary

This presentation by Dr. Marc R. Safran discusses key tips and considerations for performing hip labral repair, emphasizing its complexity compared to shoulder labral surgery. The hip labrum serves vital roles including joint sealing, lubrication, cartilage nutrition, stability, load sharing, and proprioception. Literature comparing labral resection (debridement) versus repair indicates better clinical outcomes and patient satisfaction with repair techniques.<br /><br />Key findings from studies show labral repair provides higher Harris Hip Scores (HHS), better Hip Outcome Scores (HOS), lower pain scores, and greater rates of normal or near-normal function versus debridement. A randomized controlled trial confirmed these benefits, especially in female patients with pincer and combined deformities.<br /><br />Five practical tips for making labral repair easier and safer are provided:<br /><br />1. Start anchor placement distally to avoid joint penetration.<br />2. Use curved suture anchor guides to improve anchor angle and distance from cartilage surface.<br />3. Exercise caution around the 3 o’clock anterior acetabulum position, which is thinnest and poses higher risk for joint or cortical penetration and complications such as iliopsoas irritation.<br />4. Ensure anchors are well deployed by testing pullout strength; anchor pullout is the most common failure.<br />5. Pass all sutures through anchors before tying, managing suture limbs carefully to avoid entanglement or capture.<br /><br />Differences from shoulder surgery include a greater radius of curvature of the acetabulum, denser bone making anchor deployment more challenging, and a limited safe margin especially anteriorly. Avoiding articular cartilage or subchondral penetration is critical, and fluoroscopy or arthroscopic visualization during drilling is recommended.<br /><br />Overall, with careful technique—starting anchor placement distally, using curved guides, vigilant drilling to avoid joint penetration, and managing sutures methodically—labral repair can be performed effectively despite its challenges. This improves joint function and patient satisfaction compared to labral debridement.

Keywords

hip labral repair

labral debridement

joint sealing

anchor placement

suture anchor guides

acetabulum anatomy

hip labrum function

clinical outcomes

arthroscopic surgery

Harris Hip Score