Hip Labral Repair and Reconstruction in Athletes

The acetabular labrum is an important anatomic structure that provides stability to the hip joint and possesses a complex neurologic innervation making it a significant pain generator when injured. In athletes, repetitive hip flexion or pivoting movements may also contribute to the development of labral tears, and sports in which these movements are predominant have been associated with an increased risk of labral tears. Another cause of labral tears is femoroacetabular impingement (FAI) with CAM-type FAI resulting in a separation between the labrum and articular cartilage due to abutment of the CAM lesion on the inner acetabulum while PINCER-type lesions result in intrasubstance labral tears secondary to crushing of the labrum between the acetabular rim and femoral neck. Overall, the factors associated with the decision to perform labral repair include patients with chondrolabral junctional unstable tears and viable appearing labra that are greater than 3–4 mm in thickness with an intact labral suction seal. Conversely, labral reconstruction is best suited for patients with intrasubstance unstable tears and nonviable appearing labra that are less than 3–4 mm in thickness with a loss of the labral suction seal and who have minimal osteoarthritis of the hip. Treatment options include arthroscopic selective labral debridement, labral repair using various suture anchor techniques, or reconstruction which is either segmental or circumferential. It is critically important to address any concurrent bony pathology at the time of labral surgery. Rehabilitation compliance is key for optimal outcomes with recent studies demonstrating return-to-sport rates ranging from 84 to 92% in patients undergoing labral repair and 66 to 86% in patients undergoing reconstruction.