ICL 305-1 Arthroscopic Management of Hip Labral Pathology and Impingement: 2014-Philippon Handout

Philippon Handout

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This document is a comprehensive overview of hip labral reconstruction authored by Marc J. Philippon, MD, highlighting the pathology, surgical techniques, and outcomes associated with labral deficiency and reconstruction.<br /><br />Labral deficiency arises primarily due to previous debridement, complex tears, arthrofibrosis, or adhesions that impair the labrum’s function, which is crucial for maintaining hip joint stability and acetabular fluid seal. Loss of labral tissue increases cartilage stress and fluid efflux, predisposing patients to early degenerative changes and joint instability.<br /><br />The goal of labral reconstruction is to restore the acetabular seal to improve joint fluid mechanics and reduce shear forces on the cartilage. Indications for reconstruction include complex or radial tears, degenerative tissue, small or deficient labrum from prior surgery or adhesions, unstable labrum, and failure to create a seal with the femoral head. Addressing concomitant femoroacetabular impingement (FAI) and instability is vital for success.<br /><br />The surgical technique involves arthroscopic portals, diagnostic evaluation, acetabular rim trimming to address bony impingement, harvesting a rectangular iliotibial band autograft, tubularizing the graft, and securely suturing it to the native labral tissue with suture anchors to restore the labral seal and hip stability. Dynamic examination confirms the elimination of impingement and restoration of labral suction effect.<br /><br />Outcomes show promising results: early studies report 6% conversion to total hip arthroplasty (THA) and high patient satisfaction scores. Midterm results demonstrate excellent survivorship (over 90% at 3-4 years) particularly in patients with joint space greater than 2 mm, with 86% of elite athletes returning to professional sports following reconstruction.<br /><br />In conclusion, labral reconstruction using iliotibial band autograft offers an effective treatment for irreparable labrum in properly selected patients, yielding excellent short- and midterm functional outcomes and patient satisfaction. Maintaining at least 2 mm of joint space preoperatively is a key criterion for favorable prognosis.<br /><br />Extensive references provide foundational and recent research supporting the clinical and biomechanical rationale behind these surgical interventions.

Keywords

hip labral reconstruction

labral deficiency

acetabular seal

arthroscopic surgery

iliotibial band autograft

femoroacetabular impingement

joint stability

cartilage stress

total hip arthroplasty conversion

athlete return to sport