Concurrent Arthroscopic Revision of the Hip Labral and Anterior Capsular Reconstruction Utilizing Iliotibial Band Autograft

Abstract

The labrum and capsule are indispensable structures for stability and the prevention of arthritis in the hip. Subsequent revision has been performed on patients who went through the failure of previous hip arthroscopic surgery, which caused the defect of the labrum and capsule, leading to continued hip pain and dysfunction postoperatively. For a select few patients, the labrum's rerupture is beyond the scope of conventional suturing techniques, necessitating a reconstructive procedure to re-establish its integrity. Additionally, an attempt at secondary closure of the capsule can be challenging because of capsular limb adherence to the surrounding soft tissues. We describe a technique for simultaneous arthroscopic labral and anterior hip joint capsule reconstruction using an iliotibial band autograft. This procedure allows simultaneous reconstruction of the hip labrum and capsule stability with minimally invasive approaches to revise and re-establish the structural stability of the hip joint.

Fig 1

The patient underwent surgery on the left hip and was positioned in a supine manner. (A) shows the view observed under arthroscopy through the ALP. (B) presents what is seen through the MAP.

Fig 2

(A) The iliotibial band is harvested from the proximal thigh of the ipsilateral limb. The size we routinely use is 5 × 6 cm for the quadrilateral-shaped iliotibial band graft. The harvested graft then is divided into 2 distinct parts. (B) Part for capsular reconstruction: the primary graft is utilized for the reconstruction of the joint capsule, and it is shaped into a roughly quadrilateral sheet form. (C) Part for labral reconstruction: we allocate the thicker section for the labral graft to facilitate the adjustment of its diameter as needed.

Fig 3

(A) The graft for labral reconstruction. The graft is generally slightly longer than the length of the labral defect (with about 2-3 mm of surplus at both ends), and after the reconstruction is completed, the excess parts at both ends can be trimmed off. (B) The quasi-rectangular-shaped graft for capsular reconstruction.

Fig 4

(A) The anchors should be positioned approximately 2 to 3 mm from the acetabular rim, with a distance of 10 to 12 mm between each anchor. (B) One tail thread (white FiberWire [Arthrex], indicated by the blue arrow) of the most medial anchor is passed through medial end (displayed as a circular roll) of the graft used for the fixation of the medial graft end. The red arrow indicates the medial traction suture, while the black arrow points to the lateral end’s traction suture.

Fig 5

(A) The medial end of the graft is fixed in place at the anchor position of the 3-o’clock direction. (B, C) Once the medial end of the graft is firmly anchored in place, the lateral end traction suture, indicated by the red arrow, is pulled out through the anterolateral portal. This action straightens the graft, as indicated by the yellow arrow, within the joint, which is essential for the subsequent steps of suturing and fixing it securely with anchor screws.

Fig 6

(A) The black arrow points to the positions of the 4 anchors on the acetabular side (first at 3-o’clock, second at 2-o’clock, third at 1-o’clock, and fourth at 12-o’clock). We can see that the labral graft (yellow font) has been fixed in place. The white tail threads of all the anchors have been knotted and trimmed. We have left the blue tail threads of the first, third, and fourth screws for the corresponding graft suture replacement. (B) The red arrow indicates the 2 preplaced polydioxanone sutures within the residual joint capsule tissue. (C) The red-marked No. 2-0 absorbable sutures on the acetabular side of the graft will be used to replace the corresponding blue tail threads of the numbered anchors on the acetabulum. The 2 No. 2-0 FiberWire sutures (Arthrex) indicated by the red arrow correspond to the preplaced polydioxanone sutures, which are shown in A. (D) The graft is fed along the tail thread of the first anchor into the joint and then tied and fixed into place. (E) The completed fixation of the joint capsular graft.