Labral grafting in Hip Arthroscopy

The labrum is the structure often injured in conditions that cause damage to the hip joint such as femoro-acetabular impingement (FAI) and hip dysplasia. In FAI surgery we aim to repair the damage to the joint in particular the articular cartilage where possible and to repair the labrum. Sometimes part of the impingement relates to the bony prominence of the hip socket (acetabulum) and this needs to be trimmed back. There has been a gradual accumulation of information in the literature indicating that repairing the labrum produces better outcomes than removing it. The importance of the labrum appears to be in relation to the suction seal effect on the femoral head and the circulation of the synovial fluid around the joint. Usually the labral tissue is perfectly adequate to repair. In fact, even if there is bone growing down onto the labrum producing a bony rim, this can often be removed and it is possible to re-create an effective labrum from the local tissue.

There are occasions where the labrum is very damaged, or when it has been previously excised. In these circumstances it may be necessary to fashion a new labrum. In order to do this another tissue has to be used and shaped into something that looks like a labrum. Most commonly we would use a fascial graft from the thigh. This can be sewn into a shape that acts like a labrum. This graft can be introduced into the hip joint arthroscopically and stitched back to the bone at the site of the previously damaged labrum.

Early results in the literature suggest that this technique can be helpful in improving the outcome of hips where the labrum is deficient. As always in surgery for hip impingement the focus is also on addressing the underlying impingement that was responsible for the injury to the hip in the first place. If this is not corrected then symptoms will tend to recur or not improve