Arthroscopic Reconstruction of the Acetabular Labrum Using an Autograft Hip Capsule

Whereas uncomplicated labral tears with preserved fibers can be effectively treated with use of labral repair techniques, complex tears and hypoplastic labra require labral reconstruction . Standard reconstruction techniques feature grafted tissue that is added to existing, deficient tissue or that is utilized to replace a hypoplastic labrum entirely . However, such approaches utilizing allografts or remote autografts are limited because they often necessitate extensive debridement of the existing labrum to prepare a site for graft implantation, an approach that can damage and devascularize the chondrolabral junction . The presently described technique, arthroscopic capsular autograft labral reconstruction, is suitable for simple tears as well as hypoplastic, degenerative, and complex tears, and negates the challenges of utilizing allografts or remote autografts by supplementing the labrum. In addition, this technique avoids substantial resection, thus preserving the chondrolabral junction . Following induction of anesthesia and appropriate patient positioning, puncture capsulotomy is performed to enter the hip joint . In the presence of a sufficiently intact labrum, 3 to 5 mm of capsule is elevated to augment the labrum and preserve the blood supply. In the presence of a severely deficient or hypoplastic labrum, the capsule is elevated 5 to 10 mm to reconstruct the labrum. Following capsular augmentation and potential acetabuloplasty, 2.3-mm bioabsorbable composite anchors are utilized to secure the elevated capsular tissue and the remaining labral tissue to the acetabular rim. Loop suture or a vertical mattress suture technique is then utilized to complete the repair. A Weston knot and several half-hitches are placed while dynamically tensioning along the capsular aspect of the repair in order to secure the labral reconstruction to the acetabular rim with concurrent release of traction. Anchors are placed roughly 1 cm apart to prevent strangulation of the capsular vessels . Labral reconstruction options include autografts or allografts7. Potential allografts include the semitendinosus, tibialis anterior, iliotibial band, tensor fasciae latae, and peroneus brevis8-14. Remote autograft sites include the gracilis and quadriceps tendons16,17. These options are limited by increased donor site morbidity and operative time to obtain the grafts. Local autograft sites include the ligamentum teres, indirect head of the rectus femoris, iliotibial band, and hip caps