Scope Essentials 2024-Labral Management – Debride, Repair, Reconstruct, Augment

Video Transcription

Video Summary

Dr. Robert Parisian, an orthopedic sports medicine surgeon specializing in hip preservation, discusses acetabular labrum management. The acetabular labrum, which wraps about 270 degrees around the acetabulum, plays a critical role in hip stability by deepening the socket, increasing surface area, distributing forces, and maintaining a fluid suction seal essential for joint stability. Labral pathology arises primarily from femoroacetabular impingement (FAI), involving CAM and pincer lesions causing outside-in chondrolabral damage, or from dysplasia, causing inside-out lesions with labral hypertrophy or normal morphology.<br /><br />Labral tears are primarily managed with repair, emphasizing rim preparation, anchor placement, and knotless suture techniques to restore the chondrolabral junction and suction seal. Intraoperative videos demonstrate meticulous anchor placement and suture management ensuring effective repair. Outcomes indicate high rates of return to sport, with success affected by age, cartilage quality, and labral size. Hypotrophic labra and borderline dysplasia require further study.<br /><br />Variants like everted labrum need inversion and repair to restore function. When labral tissue is irreparable, reconstruction using allografts can restore biomechanical properties better than excision alone, though repair remains biomechanically superior when possible. Labral augmentation preserves healthy native tissue combined with graft and shows promising outcomes. Overall, repair is first-line treatment, with debridement, augmentation, and reconstruction as appropriate in complex cases.

Asset Caption

Robert Parisien, M.D.

Keywords

acetabular labrum

hip preservation

labral tear repair

femoroacetabular impingement

labral reconstruction

allograft augmentation

knotless suture technique

hip stability