Our Summary

This research paper discusses a technique for treating tears in a part of the hip joint known as the acetabular labrum, which is often the cause of hip or groin pain. These tears tend to occur at the front and top part of the joint and sometimes require surgery to fix. However, tears at the back and side of the joint can be harder to deal with because the usual surgical approach doesn’t offer the best angle for the surgeon to work with.

To overcome this challenge, the authors describe a new technique where the surgeon creates an opening (portal) towards the back and side of the joint, 1 to 2 cm behind a large bone in the hip (the greater trochanter). This new approach, which mirrors the direction of the usual front and side portal, is used for drilling and placing the surgical anchor, while the rest of the work is done through the usual portal.

By using this technique, the surgeon can avoid potentially damaging important nerves and blood vessels, including the sciatic nerve, with surgical instruments. This new method can improve the success of the repair surgery, reducing the chances of poor results that can negatively affect patients after the operation.

FAQs

  1. What are acetabular labral tears and who commonly experiences them?
  2. How does the use of a posterolateral (PL) portal improve labral repair surgery?
  3. What is the role of the PL portal in the process of drilling and anchor placement during labral repair surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about labral repair is to follow post-operative rehabilitation protocols carefully to ensure proper healing and prevent complications. This may include physical therapy exercises to strengthen the hip muscles, avoid excessive stress on the repaired labrum, and gradually return to normal activities. It is important to communicate any concerns or pain during the recovery process to your healthcare provider to ensure the best possible outcome.

Suitable For

Patients who are typically recommended labral repair are those with acetabular labral tears, particularly anterosuperior tears that are causing hip or groin pain. In some cases, operative intervention in the form of arthroscopic labral repair may be necessary to restore labral function. Posterolateral tears can be technically challenging to repair using traditional portals, but the establishment of a posterolateral portal can improve the success of the repair. This method can enhance labral fixation and improve postoperative outcomes for patients with posterolateral labral tears in the 9- to 11-o’clock position.

Timeline

  • Patient experiences hip or groin pain
  • Patient undergoes diagnostic imaging (such as MRI) to confirm acetabular labral tear
  • Patient consults with orthopedic surgeon to discuss treatment options
  • Patient undergoes arthroscopic labral repair surgery
  • Surgeon establishes posterolateral (PL) portal for drilling and anchor placement
  • Remaining work is performed through the anterolateral (AL) portal
  • Labral tear in the 9- to 11-o’clock position is addressed using the PL portal
  • Labral fixation is enhanced to mitigate risk of suboptimal repairs
  • Patient undergoes postoperative rehabilitation and physical therapy
  • Patient experiences improved hip function and reduced pain after surgery.

What to Ask Your Doctor

  1. What is the success rate of labral repair surgery in patients with similar tears?
  2. What are the potential risks and complications associated with labral repair surgery?
  3. How long is the recovery period after labral repair surgery?
  4. Will physical therapy be necessary after the surgery, and if so, for how long?
  5. What restrictions or limitations will I have after the surgery, and for how long?
  6. How soon can I return to my normal activities, such as work or exercise, after the surgery?
  7. Will I need any additional follow-up appointments or imaging studies after the surgery?
  8. Are there any alternative treatment options to consider before proceeding with labral repair surgery?
  9. How many labral repair surgeries have you performed, and what is your experience with this procedure?
  10. Can you explain the specific technique you will use for the repair, including the use of the PL portal described in the article?

Reference

Authors: Meta F, Rudisill SS, Simon KN, Krych AJ, Hevesi M. Journal: Arthrosc Tech. 2024 Apr 16;13(7):102994. doi: 10.1016/j.eats.2024.102994. eCollection 2024 Jul. PMID: 39100270