Anatomic Acetabular Labral Repair

The important role of the acetabular labrum in maintaining stability and optimising fluid pressurisation of the hip joint is well recognised. Preservation and repair of the labrum is now considered an essential component of the arthroscopic management of labral tears and bony deformity correction in patients with symptomatic femoroacetabular impingement and hip dysplasia. Biomechanical studies have demonstrated improved stability and restoration of the sealing properties, vital for hydrostatic fluid pressurisation and reduction in cartilage contact forces, with labral repair. Clinical studies have shown labral repair, not only to have better results compared with debridement, but in conjunction with bony deformity correction, is durable, with successful medium to long-term outcome. Although a number of repair techniques have evolved to restore anatomy and function of the labrum, there are many deficiencies with traditional looped and pierced repair techniques including elevation and bunching, loss of fluid seal, rigidity of the labral body, low anchor positioning increasing risk of joint penetration, disruption of the important chondrolabral junction, and iatrogenic damage to labral tissue. Anatomic labral repair protects the intact chondrolabral junction and important fibrovascular attachments to the labrum; utilising a suspension repair technique the labral body is free from suture and iatrogenic injury, and remains stable but mobile to optimise the flap seal mechanism, vital for fluid pressurisation; the high anchor position reduces risk of joint penetration. Minimum 2-year clinical outcome demonstrates the excellent results from anatomic labral repair which protects and restores the anatomy, blood supply, and function of the labrum. This article describes the applied anatomy and the vital functions of the acetabular labrum, discusses the principles and controversies surrounding standard repair methods and details the operative technique, rationale and outcome for anatomic labral repair. (c) 2020 Elsevier Inc. All rights reserved.