Arthroscopic Hip Labral Repair

Marc J. Philippon

Ioanna K. Bolia

Karen K. Briggs

The greatly increased prevalence of hip injuries over the past 15 years is mainly due to the improved description and diagnosis of femoroacetabular impingement (FAI), which is the most common indication for hip arthroscopy today. The damage caused by FAI includes chondrolabral dysfunction, where impingement causes damage to the labrum and the adjacent cartilage (Fig. 31-1). Treatment of labral tears has evolved since early in the decade, and extensive research has been done on the advantages of labral repair over labral debridement.

Figure 31-1 | A labral tear involving the chondrolabral junction. The cartilage has separated from the labrum and the acetabulum (arrows). L, labrum; C, cartilage.

The acetabular labrum is a dense, fibrocartilage connective tissue ring attached to the bony rim of the acetabulum, which deepens the acetabulum and extends the coverage of the femoral head.¹ The labrum has been shown to enhance hip stability and also provides a fluid seal with the femoral neck.²,³ Anatomical, biomechanical, and outcomes studies have led to arthroscopic labral repair being the preferred treatment of labral tears in selected patients (Table 31-1).

Table 31-1 | Tips for patient selection for hip arthroscopy

Positive physical examination indicating hip pathology
Well-defined pathology on MRI and radiographs
Outcome score not too low
Patient willing to comply with rehabilitation
Good presurgical muscle strength
Condition (BMI)

Diagnosis and Preoperative Planning

• The patient should be evaluated to determine duration and type of symptoms, history of trauma, prior surgeries, level of physical activity, impact of the injury on the patient’s quality of life, patient’s knowledge of his or her condition, and the patient’s expectation of treatment.⁴

• Specific tests included in the clinical examination include the following:

• Anterior and posterior impingement test

• FABER (Flexion, ABduction, and External Rotation) distance test

• Dial test

• Trendelenburg test

• Dynamic motion evaluation to recreate symptoms

• The most common complaint of patients with labral pathology resulting in hip dysfunction is anterior groin pain exacerbated by hip flexion.

• Additional testing includes the following:

• Gait analysis

• Muscle strength testing

• Range-of-motion measurement

• Maneuvers to rule out distracting pathology such as athletic pubalgia and lumbar radiculopathy

• Radiographic evaluation

• Identify cam, pincer, or mixed-type FAI

• High-quality supine AP pelvic radiograph to measure joint space, acetabular version, lateral center edge angle, and weight-bearing surface angle (Fig. 31-2)

Figure 31-2 | High-quality supine AP pelvic radiograph to measure joint space, acetabular version, lateral centeredge angle, and weight-bearing surface angle.

• Dunn view to measure the alpha angle to assess the offset of the anterior femoral head-neck junction for a CAM lesion (Fig. 31-3)

Figure 31-3 | Dunn view to measure the alpha angle to assess the offset of the anterior femoral head-neck junction for a CAM lesion.

• 3T noncontrast MRI to evaluate the quality of the labral tissue and chondral surfaces, rule out concomitant intra- and extra-articular impingement lesions and pathology, and identify periarticular muscle pathology around the hip (Fig. 31-4)

Figure 31-4 | 3T noncontrast MRI evaluating the quality of labral tissue on the coronal plane (A) and the articular cartilage on the obliquesagittal plane where the alpha angle can also be measured (B). The arrow indicates a labral tear at 12 o’clock on the acetabular rim.

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