Hip Problems + TreatmentsThere are three different treatment options for labral tears: debridement, repair, and reconstruction.
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Debridement
The first and most commonly used treatment has been debridement, or simple removal of damaged tissue. Debridement is performed with electrocautery, which burns away damaged tissue, or with a shaver, which cuts and sucks away damaged tissue. This is the easiest and quickest treatment, but has been reported to have lower success rates than the other two treatment options detailed below. Dr. Carreira performs debridement alone in hip arthroscopy in less than 5% of cases.
Repair
The arthroscopic repair technique was developed in the past 10 years and has coincided with considerable advance in the field. Instead of simply removing tissue (debridement), the labrum can be repaired by reattaching it to the acetabulum, where it normally is firmly attached, by using suture anchors and by passing sutures around the labrum to secure it. Dr. Carreira performs this procedure in over 85% of cases.
Reconstruction
The graft used for allograft reconstruction. This iliotibial cadaver graft has been ntubularized (sutured in the shape of a cigarette) prior to being inserted and sutured into place in the hip joint.
The reconstruction is the latest generation treatment for labral tears, and is performed only in cases where the labrum tissue is not reparable. The labrum can be damaged in many ways, and similar to a rope, it can be injured to the point that there is little to no substance to repair. In these situations, replacement of the tissue is often recommended. This decision is made at the time of surgery after viewing it (3x magnified with arthroscopy) and after probing it.
Fascia lata from the iliotibial band has been used most commonly by the few surgeons across the country who are performing this procedure. Dr. Carreira has access to cadaver fascia lata and this tissue is extensively tested for any diseases.
Dr. Carreira’s results in this subgroup of patients with advanced labral damage have been very encouraging. Dr. Carreira has developed an all-arthroscopic surgical technique that he had presented at an international conference. Dr. Carreira has published his successful outcomes of this surgery.
Along with treatment of the labrum at the time of arthroscopy, comprehensive treatment of other injuries in and around the joint help to ensure best results.
All Arthroscropic Allograft Labral Reconstruction of the Hip
In the spring of 2014, Dr. Carreira presented to the American Academy of Orthopedic Surgeons, talking about his own surgical approach for using a shuttle technique using allograft fascia lata in cases where acetabular labrum tears are irreparable.
All Arthroscropic Allograft Labral Reconstruction of the Hip
Photos of Allograft Labral Reconstruction of the Hip
In this patient who underwent surgical treatment elsewhere, the labrum has been treated with electrocautery and does not appear healthy, with darkened and discolored appearance. This teenager underwent an allograft reconstruction.
This picture from the time of arthroscopic hip surgery demonstrates calcification of the labrum, with a white speckled appearance on the tissue itself. The calcification is a form of labrum degeneration, and reconstruction was performed.
The tubular structure is the graft introduced into the joint and prior to refixation along the rim of acetabular bone
The tissue along the right and bottom side of this arthroscopic picture is the reconstructed allograft iliotibial band after having been refixated with suture
