AOSSM/AANA Specialty Day 2020-Indications for Labral Reconstructions_ What is the Evidence

Indications for Labral Reconstructions_ What is the Evidence_

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This presentation by Dr. Marc J. Philippon reviews the indications, techniques, and evidence supporting hip labral reconstruction (LR), particularly in athletes and patients with irreparable labral damage. Labral reconstruction has evolved from addressing small labral deficiencies with capsular grafts to managing complex irreparable tears, severe tissue degeneration, ossification, dysplasia, and revision cases with adhesions.<br /><br />Key goals of LR include re-creating the hip joint seal, essential for maintaining hydrostatic pressure that supports load distribution, joint stabilization, and cartilage nutrition. Preservation of any viable native labral tissue is emphasized, leading to the development of labral augmentation (LA) techniques, which increase labral volume while preserving vascularization and innervation.<br /><br />Biomechanical studies demonstrate LR significantly restores intra-articular fluid pressurization and hip stability close to intact states. Mid- to long-term outcome data show significant improvements in patient-reported scores (mHHS, HOS-ADL, HOS-Sport) and high patient satisfaction after LR and LA, with 86% of athletes returning to sport, 71% at the same level. Comparative studies suggest LA yields better functional outcomes than LR, supporting preservation of native tissue when possible.<br /><br />Histological analyses up to 7.5 years post-op reveal viable, fibrovascular connective tissue regeneration at the chondro-labral junction. Predictive tools using preoperative scores, joint space, and surgical history help identify patients likely to achieve good results, with greater joint space (>2mm) and younger age correlating with longer hip preservation and fewer conversions to total hip arthroplasty.<br /><br />Challenges of LR include its complexity, loss of graft innervation that may delay symptom recognition, and donor site morbidity if autografts are used. Despite this, LR remains the preferred treatment for irreparable labral tears, with emerging evidence supporting LA as a superior option when native tissue remains.<br /><br />In conclusion, current level 4 evidence and biomechanical data endorse LR with appropriate patient selection and favor labral preservation strategies to optimize outcomes. Longer-term survivorship studies and advanced predictive models may further refine patient care.

Keywords

hip labral reconstruction

labral augmentation

irreparable labral damage

hip joint seal

biomechanical studies

patient-reported outcomes

athlete return to sport

fibrovascular tissue regeneration

predictive tools

total hip arthroplasty conversion