labral reconstruction: newport beach, ca 2014
TRANSCRIPT
Labral Reconstruction
Arthrex Hip SymposiumNewport Beach, CA
April 25, 2014
Andrew B. Wolff, MDWashington Orthopaedics and Sports Medicine
Washington, DC
Indications
• Revision– Previous labral resection/ aggressive
debridement with persistent pain and no arthritis
• Primary– “Hip at risk” with irreparable labrum
Revision
Primary: “Hip at risk”
25 yo, 12 yrs s/p SCFE pinning in situ
Primary: “Hip at risk”
27 yo former NCAA basketball player 8 yrs of hip pain
Graft Options• Autograft
– Iliotibial band– Hamstrings
• Allograft– Iliotibial band– Tibialis anterior– Tibialis posterior– Semitendinosus– Peroneus longus– Achilles
Autograft: ITB
Philippon et al AJSM 2010
• Longitudinal section of IT Band harvested through 5-7 cm open incision
• Graft is tubularized with 0 vicryl on back table
Literature
Philippon et al AJSM 2010• 47 pts minimum 1 yr f/u• 49% previous hip surgery• Avg age 37• Mean MHHS improved from
62 to 85• 4 pts went on to THA
– 3 of them had < 2mm jt space pre-op
Sierra, Trousdale CORR 2009• Open dislocation• Ligamentum teres autograft• 5 patients• 1 went on to THA
Literature
Domb et al. AJSM 2013
•Compared segmental labral resection to reconstruction with gracilis autograft•Min 2 yr f/u•Statistically significant improvement in HOS-ADL and NAHS
Labral recon case
• 47 year old female
• Degenerative labral tear repaired on contralateral side, revised to reconstruction with good results
• Requested primary labral reconstruction
