Circumferential reconstruction of severe acetabular labral damage using hamstring allograft: surgical technique and case series.

Abstract

With excessive acetabular coverage, such as coxa profunda or protrusio, contact between the femoral neck and acetabular rim cause direct damage to the labrochondral junction, and indirect edge loading from a levering effect which may result in hip arthrosis. Arthrosis may be delayed or avoided by addressing the overcoverage and restoring mechanical function of the labrum. We describe four cases of adjunctive complete acetabular labral replacement for circumferential, irreparable labral injury using fresh frozen semitendinous allografts through surgical hip dislocation. Over a two-year period four patients (age range: 20 to 47 years) underwent surgical hip dislocation to address femoroacetabular impingement with rim trimming, femoral osteochondroplasty, and labral reconstruction. Pre- and postoperative patient reported outcomes were assessed by Oxford Hip Score (OHS), Hip Outcome Score (HOS), and Global Treatment Outcome (GTO) score. Disease progression was graded using AP pelvic radiographs and arthroMR. The average LCE correction was 18º (range 7-25º), achieving an average LCE of 33º (range 32-35) postoperatively. Using protected weight bearing all trochanteric osteotomies healed within six weeks after surgery. OA did not progress in any hips. Mean OHS and HOS scores improved 6.3 and 19.8 at one-year follow up. All four patients reported good results according to the GTO. There were two adverse events that resolved and did not affect outcome. Despite complex deformities and preexisting cartilage and labrum wear in this young cohort, three of four patients reported significant functional improvement after treatment of this rare condition. Preliminary experience with circumferential labral reconstruction using hamstring allografts is promising, although long-term data needs to be established.