ePoster #112 - ISHA Annual Scientific Meeting 2016

Arthroscopic Reconstruction Of The Acetabular Labrum Using Allograft Fascia Lata: Technique And Longterm Results

Dominic Carreira, MD, Fort Lauderdale, FL UNITED STATES
John Patrick Kozy, BS, Fort Lauderdale, FL UNITED STATES
M. Russell Giveans, PhD, Edina, MN UNITED STATES

Broward Health, Fort Lauderdale, FL, UNITED STATES

FDA Status Not Applicable

Summary: Arthroscopic Reconstruction of the Acetabular Labrum using Allograft Fascia Lata: Technique and 2 Year Follow-up

Abstract:
Introduction: Acetabular labral tears cannot always be repaired. Arthroscopic labral debridement alone has been associated with inferior outcomes compared to procedures which restore the labrum. The purpose of this study is to describe a technique for labrum reconstruction and to determine the efficacy and safety of an all-arthroscopic hip labrum reconstruction using allograft fascia lata. Methods: Patients were selected to undergo hip arthroscopy based on positive physical exam findings and imaging studies evaluating the status of the articular cartilage, confirming labrum tearing, and evaluating for the presence of femoroacetabular impingement. A standard hip arthroscopy was performed. Patients with irreparable tears at the time of arthroscopy were reconstructed using freeze-dried allograft fascia lata that was tubularized using 2-0 Vicryl suture. The shuttle technique consists of resecting the irreparable tissue, fixating the labral tissue outside of the joint to the suture of two anchors that are placed at the anteromedial and posterolateral ends of resected labrum, shuttling the tissue into the joint, and fixating the remaining labral tissue in standard arthroscopic anchors with additional anchors. No adjustments were made to the postoperative protocol for patients undergoing reconstruction. Results: 54 hips with a mean age of 44.8 years were treated with an all-arthroscopic allograft labrum reconstruction. Minimum follow-up was 22 months with a mean of 30 months. Pre-operative compared to latest post-operative mean scores demonstrated statistically significant improvements for Modified Harris Hip Score HHS, Hip Outcome Score, IHOT 12, SF-12 Mental, SF-12 Physical and Tegner Activity Scale. Based on mHHS scale, the overall failure rate was 7.7%. No correlation was noted with age or BMI (p>0.05). There was a high rate of chondroplasty (46%) and microfracture (30 %) in this patient population. Temporary neuropraxias were noted in 4% of patients. One patient had a superficial portal infection which resolved with oral antibiotics. Conclusion: Patients demonstrated significant improvement with allograft labrum reconstruction. The shuttle technique is safe and effective and avoids the need to fixate the free end of the graft from inside the joint. Compared to historical controls of hip arthroscopy, this patient population was older and included a high rate of chondroplasty or microfracture.