The Biomechanical Case for Labral Debridement
Department of Orthopaedic Surgery, William Beaumont Hospital, 3535 W Thirteen Mile Road, Suite 744, Royal Oak, MI, 48073, USA, . Clinical Orthopaedics and Related Research
(Impact Factor: 2.77).
06/2012; 470(12). DOI: 10.1007/s11999-012-2446-9
BACKGROUND: Labral repair is increasingly performed in conjunction with open and arthroscopic surgical procedures used to treat patients with mechanically related hip pain. The current rationale for labral repair is based on restoring the suction-seal function and clinical reports suggesting improved clinical outcome scores when acetabular rim trimming is accompanied by labral repair. However, it is unclear whether available scientific evidence supports routine labral repair. QUESTIONS/PURPOSES: The questions raised in this review were: (1) does labral repair restore normal histologic structure, tissue permeability, hip hydrodynamics, load transfer, and in vivo kinematics; and (2) does labral repair favorably alter the natural course of femoroacetabular impingement (FAI) treatment or age-related degeneration of the acetabular labrum? METHODS: An electronic literature search for the keywords acetabular labrum was performed. Three hundred fifty-five abstracts were reviewed and 52 selected for full-text review that described information concerning pertinent aspects of labral formation, development, degeneration, biomechanics, and clinical results of labral repair or resection. RESULTS: Several clinical studies support labral repair when performed in conjunction with acetabular rim trimming. Little data support or refute the use of routine labral repair for all patients with symptomatic labral damage associated with FAI. It is not known whether or how labral repair affects the natural course of FAI. CONCLUSIONS: Based on the current understanding of labral degenerative changes associated with mechanical hip abnormalities, the low biologic likelihood of restoring normal tissue characteristics, and mechanical data suggesting minimal consequence from small labral resections, routine labral repair over labral débridement is not supported.
Available from: Ravindra Gudena
- "Despite advancements in techniques of labrum repair, it is still unclear whether labral repair is a better long-term treatment than partial labrectomy for a labral tear
. For example, a recent review on the management of labral tears did not support routine labral repair over labral debridement
. There is a paucity of well-performed clinical studies, as well as few studies that clearly describe the neurohistology of the labrum. "
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ABSTRACT: The aim of the current study was to evaluate the innervation of the acetabular labrum in the various zones and to understand its potential role in nociception and proprioception in hips with labral pathology.
A total of twenty hip labrums were tagged and excised intraoperatively from patients undergoing a total hip replacement. After preparation, the specimens were cut to a thickness of 10 mum and divided into four quadrants (zones) using a clock face pattern. Neurosensory structure distribution was then evaluated using Hematoxylin and Eosin (H and E), and immunoreactivity to S-100.
All specimens had abundant free nerve endings (FNEs). These were seen predominantly superficially and on the chondral side of the labrum. In addition, predominantly three different types of nerve end organs (NEOs) were identified in all twenty specimens. FNEs and NEOs were more frequently seen in the antero-superior and postero-superior zones. Four specimens had abundant vascularity and disorganised architecture of FNEs in the deeper zones of the antero-superior quadrant suggestive of a healed tear. Myofibroblasts were present in abundance in all the labral specimens and were distributed uniformly throughout all labral zones and depth.
The current study shows that the human acetabular labrum has abundant FNEs and NEOs. These are more abundant in the antero-superior and postero-superior zones. The labrum, by virtue of its neural innervation, can potentially mediate pain as well as proprioception of the hip joint, and be involved in neurosecretion that can influence connective tissue repair.
BMC Musculoskeletal Disorders 02/2014; 15(1):41. DOI:10.1186/1471-2474-15-41 · 1.72 Impact Factor
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ABSTRACT: Hip arthroscopy is a rapidly progressing field that has advanced in function and survivorship over the past decade. As increasing literature is published on outcomes of hip arthroscopy, a retrospective review has allowed for the identification of factors that affect survivorship. Within this review, the authors present the factors identified to date that affect survivorship after hip arthroscopy while raising questions about the future direction of the field.
Orthopedic Clinics of North America 10/2013; 44(4):489-498. DOI:10.1016/j.ocl.2013.06.002 · 1.25 Impact Factor
Available from: Fred R T Nelson
The Journal of Bone and Joint Surgery 01/2014; 96(2):e16. DOI:10.2106/JBJS.M.01254 · 5.28 Impact Factor
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