2025年05月 保髋进展 JCR Q1

PURPOSE: To evaluate the change in hip distractive stability after a cam over-resection, labral tear, repair, labrectomy, or circumferential 6- or 10-mm labral reconstruction in a biomechanical model. METHODS: Ten fresh-frozen matched-pair human cadaveric hips were analyzed using a materials testing system to measure the force and distance required to disrupt the suction seal of the hip (1) with an intact capsule and labrum; (2) after a capsulectomy and labral repair; (3) after a capsulectomy, 5-mm cam over-resection and labral repair; (4) after a capsulectomy, 5-mm cam over-resection and labral tear; (5) after a capsulectomy, 5-mm cam over-resection and labrectomy; and (6) after a capsulectomy, 5-mm cam over-resection and a 6- or 10-mm circumferential labral reconstruction with iliotibial band (5 hips each). Each specimen was retested at 0° flexion, 45° flexion, and 45° flexion and at 15° internal rotation and analyzed using nonparametric statistical methods. RESULTS: The Friedman test of differences was significant among structural conditions and hip positions (P = .001). In all positions, the resistive force that opposed the disruption of the suction seal in an intact hip was significantly greater compared with all other conditions. The resistive force for the capsulectomy, 5-mm cam over-resection and labrectomy condition was significantly less compared with almost all other conditions and hip positions. A qualitative suction seal was achieved in 20% of hip specimens with a 6-mm labral reconstruction, whereas a seal was in achieved 60% of specimens with a 10-mm labral reconstruction. CONCLUSIONS: After a cam over-resection, a circumferential labral reconstruction improves the distractive stability of a labral deficient hip, comparable to a labral repair or tear in a biomechanical model. CLINICAL RELEVANCE: Circumferential labral reconstruction may be a viable treatment option for patients with ongoing symptoms after hip arthroscopy with evidence of a cam over-res

Hip arthroscopy technique and innovation has revolutionized the surgical approach to femoroacetabular impingement syndrome (FAIS). Arthroscopic labral reconstruction is the gold-standard treatment for irreparable acetabular labral tears in FAIS surgery and backed by robust long-term clinical data. However, cam over-resection has become a prevalent complication, often co-occurring with irreparable labral tears in revision FAIS surgery. Revision circumferential labral reconstruction is a promising solution, particularly from a biomechanical perspective, in restoring the suction seal. Larger graft width is indicated in these cases.