Evolution of Technology

Operative Table

Hip arthroscopy is widely regarded as the most difficult joint to perform arthroscopy on, and demands optimal patient positioning, surgical instrumentation and, most importantly, surgeon skill and experience. Traditionally, labral repair and/or reconstruction, when performed arthroscopically, were done on a traction table. Through the use of traction and a perineal post, surgeons were able to distract the hip joint enough to enter it with their arthroscopic instruments.

This distraction however, came at a cost. Postoperative pudendal neuralgia, sexual dysfunction, genital numbness and genitourinary symptoms were extremely common postoperatively, with up to 50% of patients experiencing one of the above symptoms. While these adverse effects often subsided within a few months, 20% of patients still have symptoms up to one year postoperatively.

Evolution of Procedure

Labral Repair or Reconstruction

The current treatment of acetabular labral tears is based around labral repair and/or reconstruction. Traditionally, frayed and/or degenerative labra were debrided. Studies demonstrated inferior outcomes with debridement versus repair or reconstruction. With repair and reconstruction, surgeons are able to recreate the labral suction-seal, which restores normal fluid dynamics and hip biomechanics.

Recently, surgeons have begun augmenting their labral repairs with grafts, in order to better restore natural anatomy. Short and mid-term outcomes of repair and reconstruction have been promising, with multiple studies demonstrating predictable pain relief, improvement in hip-related quality of life and, for athletes, high return to play rates.

Repair and reconstruction are performed arthroscopically, and utilize a variety of anchors and graft materials. These surgeries are typically performed on an outpatient basis, and demand a prolonged course of post-operative rehabilitation and therapy in order to maximize outcomes.