Labral cuff refixation in the hip: rationale and operative technique for preserving the chondrolabral interface for labral repair: a case series

Abstract

Arthroscopic labral 'takedown' and refixation is utilized to permit adequate visualization and resection of the acetabular rim deformity, in patients with pincer or mixed femoroacetabular impingement. Deficiencies exist in present techniques, which include disruption of vital anatomical support and vascular structures to the labrum and chondrolabral junction, drill or anchor articular penetration risk, bunching, elevation and instability of the labrum. A new operative technique is described which preserves the important chondrolabral interface, accurately restoring the 'flap seal' of the acetabular labrum while minimizing vascular disruption and reducing the risk of drill and anchor penetration. A prospective series of 123 consecutive cases of pincer or mixed femoroacetabular impingement, treated with arthroscopic labral cuff refixation and preservation of the chondrolabral interface, is reported; operative technique and 2-year outcomes are presented.

Fig. 1.

‘Anterior Profile View’ of the labrum (as seen from the anterolateral portal) in a distracted right hip joint.

Fig. 2.

(a) Labral reflection using a hooked radiofrequency probe. (b) Labral Cuff preserved for ‘suspension’ refixation.

Fig. 3.

(a) Fully exposed acetabular rim and pincer deformity following chondrolabral reflection. (b) Completed acetabular recession with removal of pincer deformity. Note the preservation of the important intact chondrolabral junction. The ‘cuff’ is clearly identified in preparation for refixation of labrum.

Fig. 4.

Looped PDS suture (Ethicon, Somerville, NJ) is used to pull the distal limb of fixation suture through the ‘cuff’ of the labrum during labral refixation to acetabular bony rim (as seen from the anterolateral portal).

Fig. 5.

Labral cuff refixation with traction on (a) and traction off (b). The labrum has been repaired back to the recessed acetabular rim; the body of the labrum remains completely free from suture fixation and mobile to optimize function as a ‘flap-seal’.

Fig. 6.

Simple loop stitch repair: low screw insertion close to articular edge. Bunching and elevation, with instability and separation of chondrolabral junction, may result in increased contact stress on chondral verge.

Fig. 7.

Labral base fixation: low screw insertion is required to prevent elevation of labrum and poor sealing. Chondrolabral instability and separation may be increased with weight-bearing and extension moment.

Fig. 8.

Labral cuff repair: high screw insertion in safe zone away from articular edge; intact chondrolabral junction and tensioned cuff fixation provides stability with weight bearing and during motion.

Fig. 9.

(a) Repeat hip arthroscopy at 1 year following a simple looped labral repair demonstrates poor chondrolabral healing with separation, exposed sub-chondral bone and elevation of a bunched labrum restricting function as a mobile seal. (b) Repeat hip arthroscopy at 1 year following a labral cuff repair demonstrates a preserved and anatomical chondrolabral junction with the body of the labrum free from suture, permitting optimal function as a ‘flap seal’.