Sometimes hip labral tears cannot be fixed with traditional debridement and repair surgery. In these cases, doctors may recommend a relatively new procedure called hip labral reconstruction. Hip labral reconstruction uses a graft to reconstruct the torn or damaged portion.

See Surgery for Repairing a Torn Hip Labrum

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When Is Hip Labral Reconstruction Recommended?

The major difference between a repairable hip labrum—where the torn section of the labrum is reattached to the hip’s socket— and one that requires reconstruction is the amount of remaining, undamaged tissue.

  • Too little labral tissue means the labrum cannot make an adequate seal between the hip’s ball and socket.1 There is not enough healthy tissue to make surgical repairs.
  • Too much labral tissue can get in the way, preventing the compression necessary provide a tight seal between the ball and socket. In these cases, the labrum may not be able to heal properly unless replaced.

The size threshold for “too much” or “too little” labral tissue has not been formally determined by the medical literature and is therefore determined on a case-by-case basis.1

Not all doctors will recommend hip labral reconstruction or be experienced with performing it. Labral reconstruction is a relatively new procedure and currently not considered a standard surgical treatment. Research regarding this surgery’s safety and efficacy are ongoing, though early studies have generally shown positive early outcomes.2

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Hip Labral Graft Tissue

The graft is a piece of soft tissue that can come from a patient or donor:

  • Allograft. An allograft is soft tissue—generally from the iliotibial band—from another person. Typically, the donor is a healthy, relatively young person who passed away suddenly.
  • Autograft. An autograft is tissue from another part of the patient’s body. A hip labral tear autograft is often taken from the iliotibial band or from a hamstring tendon at the knee. The iliotibial band is a wide strip of fibrous tissue that extends down the outside of the upper leg.3

Graft options are typically selected after a careful review of a person’s medical history and hip anatomy.

Partial vs. Full Hip Labrum Reconstruction

Most damaged hip labrums still have some healthy tissue. The surgeon will decide whether to reconstruct the whole labrum or just the damaged portion.

  • Some surgeons believe that it is better to preserve as much native tissue as possible. These surgeons will replace just the damaged segment of a hip labrum, creating two junction points between the graft and the native labrum.
  • Other surgeons believe that the junction points between the native and graft material will negatively affect the suction seal with the hip's femoral head. This suction seal is essential to the health and stability of the hip joint. These surgeons prefer to reconstruct the entire hip labrum in hopes of ensuring a tighter seal.

Experts agree more research is needed in this area.

References:

  1. White BJ, Herzog MM. Labral Reconstruction: When to Perform and How. Frontiers in Surgery. 2015;2:27. doi:10.3389/fsurg.2015.00027.
  2. Scanaliato JP. Christensen DL. Salfiti CS. Herzog M. Wolff AB. Primary Circumferential Acetabular Labral Reconstruction: Achieving Outcomes Similar to Primary Labral Repair Despite More Challenging Patient Characteristics. American Journal of Sports Medicine. In press
  3. Iliotibial Band Syndrome. Sports-Health Website. Updated June 6th, 2014. Accessed February 13, 2018.
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