Arthroscopic Reconstruction of the Acetabular Labrum Using an Autograft Hip Capsule.

Background: Whereas uncomplicated labral tears with preserved fibers can be effectively treated with use of labral repair techniques, complex tears and hypoplastic labra require labral reconstruction Description: Following induction of anesthesia and appropriate patient positioning, puncture capsulotomy is performed to enter the hip joint Alternatives: Labral reconstruction options include autografts or allografts7. Potential allografts include the semitendinosus, tibialis anterior, iliotibial band, tensor fasciae latae, and peroneus brevis8-14. Remote autograft sites include the gracilis and quadriceps tendons16,17. These options are limited by increased donor site morbidity and operative time to obtain the grafts. Local autograft sites include the ligamentum teres, indirect head of the rectus femoris, iliotibial band, and hip capsule15,18-23,25. Rationale: Relative to autografts, the allografts most commonly utilized in labral reconstruction feature a heightened risk of disease transmission, increased cost, and a potentially lengthened time to graft incorporation Expected Outcomes: Labral reconstruction with capsular augmentation from the hip capsule showed significant improvement over baseline in functional outcomes at 3, 6, 12, and 24 months postoperatively in patients with complex labral tears that could not be treated with simple repair. Additionally, at 24 months postoperatively, 76.3%, 65.5%, and 60.8% of patient International Hip Outcome Tool-33 (iHOT-33) scores exceeded threshold values for the minimal clinically important difference, patient acceptable symptom state, and substantial clinical benefit, respectively Important Tips: For large cam lesions, 3D computed tomography is performed during preoperative planning.The anterolateral portal should be placed under fluoroscopic guidance with use of the intra-articular fluid-distention technique in order to minimize the risk of iatrogenic injury to the labrum and/or articular cartilage of the joint.The amount of capsular tissue to be elevated is determined by the extent of labral damage.When elevating the capsular tissue, meticulous care is required to preserve the blood supply to the capsule and labrum.Final suture tiedown is performed with no traction applied, which assures an in-round repair and restores the labral suction seal.Intermittent traction is utilized to minimize the risk of nerve palsies. No traction is applied for prepping and draping, bone marrow aspirate harvesting, suture tie-down, or femoral neck osteoplasty. Minimal traction is applied for capsular elevation, acetabuloplasty, anchor placement, and suture tensioning.Our approach utilizes the puncture capsulotomy technique, which was shown in a previous study of 163 patients to have zero risk of common arthroplasty complications, such as microinstability and revision for capsular plication Acronyms and Abbreviations: FAI = femoroacetabular impingementITB = iliotibial bandTFL = tensor fasciae lataeLT = ligamentum teresiHOT-33 = International Hip Outcome Tool-33MCID = minimal clinically important differencePASS = patient acceptable symptom stateSCB = substantial clinical benefitCT = computed tomographyAP = anteroposteriorMRI = magnetic resonance imagingASIS = anterior superior iliac spineBMAC = bone marrow aspirate concentrateDVT = deep vein thrombosis.