Advertisement

Labral Management: An Overview

Chapter

Abstract

The labrum has a dense pattern of nociceptive innervation, and thus, lesions of this structure tend to be quite painful. Labral lesions are by far the most common pathology encountered in the hip and the problem most easily discerned by imaging technology such as MRI or MRA. However, isolated labral tears are uncommon, and the etiology is multifactorial. This chapter details the assessment and management of the damaged labrum and also how this interfaces with the treatment of accompanying pathology. The various etiologies are described with emphasis given to the techniques necessary to correct the causation and how this impacts results and future outcomes. These range from trauma to intrinsic labral disease, synovial-based disorders, and morphologic abnormalities on a spectrum from FAI to dysplasia. There is a spectrum of management available for the damaged labrum ranging from simple debridement, primary repair, refixation in conjunction with bony correction, and labral reconstruction. All aspects are outlined providing a comprehensive strategy for this complex topic.

Keywords

Articular Surface Labral Tear Labral Lesion Labral Repair Anterolateral Portal 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Byrd JWT. Hip arthroscopy utilizing the supine position. Arthroscopy. 1994;10(3):275–80.PubMedCrossRefGoogle Scholar
  2. 2.
    Byrd JWT. Hip arthroscopy: surgical indications. Arthroscopy. 2006;22(12):1260–2.PubMedCrossRefGoogle Scholar
  3. 3.
    Byrd JWT. Labral lesions, an elusive source of hip pain: case reports and review of the literature. Arthroscopy. 1996;12(5):603–12.PubMedCrossRefGoogle Scholar
  4. 4.
    Ganz R, Parvizi J, Beck M, et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–20.PubMedGoogle Scholar
  5. 5.
    Wenger DE, Kendell KR, Miner MR, et al. Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop Relat Res. 2004;426:145–50.PubMedCrossRefGoogle Scholar
  6. 6.
    Byrd JWT, Jones KS. Prospective analysis of hip arthroscopy with two year follow up. Arthroscopy. 2000;16(6):578–87.PubMedCrossRefGoogle Scholar
  7. 7.
    Byrd JWT, Jones KS. Diagnostic accuracy of clinical assessment. MRI, gadolinium MRI, and intraarticular injection in hip arthroscopy patients. Am J Sports Med. 2004;32(7):1668–74.PubMedCrossRefGoogle Scholar
  8. 8.
    Sampson TG. Complications of hip arthroscopy. Clin Sports Med. 2001;20(4):831–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Kelly BT, Shapiro GS, Digiovanni CW, et al. Vascularity of the hip labrum, a cadaveric investigation. Arthroscopy. 2005;21(1):3–11.PubMedCrossRefGoogle Scholar
  10. 10.
    Seldes RM, Tan V, Hunt J, et al. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res. 2001;382:232–40.PubMedCrossRefGoogle Scholar
  11. 11.
    Kim YT, Azuma H. The nerve endings of the acetabular labrum. Clin Orthop Relat Res. 1995;320:175–81.Google Scholar
  12. 12.
    Konrath GA, Hamel AJ, Olson SA, et al. The role of the acetabular labrum and the transverse acetabular ligament in load transmission in the hip. J Bone Joint Surg Am. 1998;80(12):1781–8.PubMedGoogle Scholar
  13. 13.
    Ferguson SJ, Bryant JT, Ganz R, et al. The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech. 2000;33(8):953–60.PubMedCrossRefGoogle Scholar
  14. 14.
    Ferguson SJ, Bryant JT, Ganz R, et al. The acetabular labrum seal: a poroelastic finite element model. Clin Biomech. 2000;15(6):463–8.CrossRefGoogle Scholar
  15. 15.
    Ferguson SJ, Bryant JT, Ganz R, et al. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;36(2):171–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Ferguson SJ. Biomechanics of the acetabular labrum, Ph.D. Thesis. Queen’s University, Kingston; 2000: ISBN 3–905363–00–3.Google Scholar
  17. 17.
    Takechi H, Nagashima H, Ito S. Intra-articular pressure of the hip joint outside and inside the limbus. J Jpn Orthop Assoc. 1982;56(6):529–36.Google Scholar
  18. 18.
    Lippitt S, Matsen F. Mechanisms of glenohumeral joint stability. Clin Orthop Relat Res. 1993;291:20–8.PubMedGoogle Scholar
  19. 19.
    Cole BJ, Millett PJ, Romeo AA, et al. Arthroscopic treatment of anterior glenohumeral instability: indications and techniques. Instr Course Lect. 2004;53:545–58.PubMedGoogle Scholar
  20. 20.
    Espinosa N, Rothenfluh DA, Beck M, et al. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am. 2006;88(5):925–35.PubMedCrossRefGoogle Scholar
  21. 21.
    Byrd JWT, Jones KS. Hip arthroscopy for labral pathology: prospective analysis with 10-year follow-up. Arthroscopy. 2009;25(4):365–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Edwards III RB, Yu L, Markel M. The basic science of thermally assisted chondroplasty. Clin Sports Med. 2002;21(4):619–47, viii.PubMedCrossRefGoogle Scholar
  23. 23.
    Murphy KP, Ross AE, Javernick MA, et al. Repair of the adult acetabular labrum. Arthroscopy. 2006;22(5):567.el–3.Google Scholar
  24. 24.
    Kelly BT, Weiland DE, Schenker ML, et al. Arthroscopic labral repair in the hip: surgical technique and review of the literature. Arthroscopy. 2005;21(12):1496–504.PubMedCrossRefGoogle Scholar
  25. 25.
    Philippon MJ, Arnoczky SP, Torrie A. Arthroscopic repair of the acetabular labrum: a histologic assessment of healing in an ovine model. Arthroscopy. 2007;23(4):376–80.PubMedCrossRefGoogle Scholar
  26. 26.
    Byrd JWT. Routine arthroscopy and access: central and peripheral compartments/iliopsoas bursa/peritrochanteric space. In: Byrd JWT, editor. Operative hip arthroscopy. 3rd ed. New York: Springer; 2012.Google Scholar
  27. 27.
    Byrd JWT. Utility of the modified anterior portal. AAOS Multimedia Education Center, 2012 Annual Meeting. San Francisco; 2012.Google Scholar
  28. 28.
    Philippon MJ, Briggs KK, Hay CJ, et al. Arthroscopic labral reconstruction in the hip using iliotibial band autograft: technique and early outcomes. Arthroscopy. 2010;26(6):750–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Sierra RJ, Trousdale RT. Labral reconstruction using the ligamentum teres capitis: report of a new technique. Clin Orthop Relat Res. 2009;467(3):753–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York  2013

Authors and Affiliations

  1. 1.Nashville Sports Medicine FoundationNashvilleUSA

Personalised recommendations