Orthopedics & Orthopedic Surgery
Area of Focus: Arthroscopy and Sports Medicine
Recent evidence suggests that the labrum is vital to hip function and preservation. However, sometimes the hip labrum is so damaged, degenerated, or deficient that anatomical and functional restoration by conventional repair or re-fixation is severely compromised. This video shows an innovative arthroscopic reconstruction of the hip labrum using the gracilis tendon harvested via a small knee incision.
The video begins with an introduction to and rationale for the procedure. Cameras capture the patient setup, diagnostics, debridement and rim trimming/ preparation segments, external views of the gracilis autograft harvest and preparation, graft insertion, and arthroscopic fixation. The procedure is performed via two arthroscopic hip portals without any inter-portal exchange, thus permitting economy of motion. Arthroscopic orientation and important anatomic structures that should be avoided are highlighted throughout the video. Technical pearls and pitfalls are detailed, and the rationale, key surgical points, and rehabilitation protocols are included.
The athletic patient shown in the video has a severely damaged and ossified labrum as well as coxa profunda or global femoroacetabular impingement. With the aid of a fluoroscopic templating technique, his rim is arthroscopically trimmed, even into the less common posterior region. The resultant labral reconstruction successfully spans a large labral defect and restores an anatomic fluid seal to a well-preserved femoral head. The video then shows portions of the arthroscopic femoral head-neck resection osteoplasty, ending with a dynamic arthroscopic confirmation that the on-going impingement has been eliminated, which we consider important to the protection of the new labral construct.