Labral Reconstruction
The labrum is a ring of strong fibrocartilaginous tissue which lines the perimeter of the hip joint socket (acetabulum). The labrum serves many functions. It acts as a shock absorber, lubricates the hip joint, and distributes the pressure equally throughout the cartilage. The labrum holds the head of the femur in place and prevents the lateral and vertical movement of the femoral head within the joint. It also deepens the acetabular cavity and offers stability against femoral head translation.
Labral tears may be caused by trauma, femoroacetabular impingement (FAI), hip hypermobility, dysplasia, and degeneration. It is a rare condition that can be seen in athletes playing sports such as ice hockey, soccer, golf and ballet. Structural abnormalities may also cause a hip labral tear.
Patients with a labral tear of the hip may experience hip pain, clicking or locking of the joint and restricted range of motion. Patients may also experience dull pain on movement of the hip joint that may not subside on rest.
Hip labral tears are often diagnosed based on symptoms, history, physical examination and radiological techniques. Magnetic resonance arthrography may be more appropriate for diagnosing hip labral tear.
Your doctor will recommend conservative treatment initially prescribing nonsteroidal anti-inflammatory drugs, steroid injections and referral to physical therapy. These methods may offer symptomatic relief in a few weeks to months. If conservative treatment does not improve the pain, then surgery is required to repair or reconstruct the torn labrum.
The goal of labrum reconstructive surgery is to restore the normal function of the labrum and prevent further damage to the cartilage.
Some of the surgical procedures include:
Arthroscopy:
Small incisions are made on the hip joint. An arthroscope is passed through one of the incisions. The arthroscope is an instrument that has tiny camera attached to the end. It enables the surgeon to view the area being operated on a bigger screen and also identifies the torn cartilage.
Depending on the severity of the tea, the torn section of labrum may be removed or the torn ends reattached and secured to the rim of the bone using small anchors.
Anchors are screw-like structures that have sutures attached. These anchors are placed on the torn labrum and the sutures are pulled tightly re-attaching the tissue to the bone. Later the incisions are closed using dissolvable sutures.
Open surgery:
Open surgery is performed in a similar way as arthroscopy but the torn labrum is treated by making a large incision over the hip area to access the joint.
Grafting:
Grafting is indicated in chronic cases where the labrum is so severely damaged that it is unable to be repaired. This is done using a graft taken from the patient (autograft) or from donor tissue (allograft). The grafts are stitched to the native labral margins.
Advantages of arthroscopy over open surgery:
- Smaller incisions
- Less bleeding
- Less pain
- Promotes faster healing
Post-operative care
The recovery following a hip labrum reconstruction will depend on the complexity of the surgery. Physical therapy is recommended as a part of a rehabilitation program which includes strengthening and stretching exercises to improve the function and movement of the joint.
Some of the possible complications associated with surgery include:
- Joint stiffness
- Recurrent pain
- Infection at operated site
- Bleeding
- Nerve damage
