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

Handout - Five Tips to Make Your Labral Repair Easier

Pdf Summary

This lecture by Dr. Marc R. Safran from Stanford University outlines key tips and considerations for hip labral repair, emphasizing techniques to make the procedure easier and safer. The acetabular labrum functions in joint sealing, lubrication, cartilage nutrition, stability, load sharing, and proprioception.<br /><br />Comparing labral debridement versus repair, studies show improved outcomes and higher patient satisfaction with repair. For example, Larson (2012) reported higher Harris Hip Scores (HHS) and satisfaction after repair versus debridement in pincer and combined hips. A randomized controlled trial by Krych (2013) demonstrated better hip outcome scores and patient satisfaction with labral refixation.<br /><br />Five surgical tips include: starting anchor placement distally on the acetabular rim, using curved guides to optimize insertion angles and distances from cartilage, being cautious in the anterior (3 o’clock) position due to thin bone and minimal margin for safe drilling, ensuring anchors are fully and securely deployed, and managing sutures by placing all anchors before tying and preventing suture capture.<br /><br />Differences from shoulder labral repair include greater acetabular curvature and denser bone, leading to risk of inadvertent joint or subchondral penetration if not careful. Safe anchor insertion angles range roughly 100-150 degrees, varying by acetabular location. Avoiding articular cartilage perforation is critical to prevent cartilage damage or anchor failure. Fluoroscopy and direct arthroscopic visualization help monitor drill trajectory.<br /><br />Anterior acetabulum is the thinnest area prone to cortical perforation, anchor pull-out, or irritation (e.g., iliopsoas), especially if the drill angle is too steep or shallow. Acetabular bone density poses challenges since many anchors are designed for glenoid, potentially causing poor anchor seating or breakage upon insertion. Hence, surgeons must pull sutures to verify deployment.<br /><br />In summary, hip labral repair is more technically demanding than shoulder repair, but careful attention to starting position, guide use, drilling technique, and suture management can minimize complications and improve outcomes.

Keywords

hip labral repair

acetabular labrum

labral debridement vs repair

surgical tips hip labrum

anchor placement acetabulum

curved guides insertion angles

anterior acetabulum risks

anchor deployment verification

hip vs shoulder labral repair

arthroscopic hip surgery