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Allograft Hip Capsulolabral Spacer for the Treatment of Capsulolabral Adhesions

February 01, 2014

Contributors: Marc J Philippon, MD; Jeffrey Nepple, MD; Fernando Ferro, MD; Fernando Ferro, MD

Introduction: We have seen a recent increase in the number of hip arthroscopies as we recognize femoroacetabular impingement as a cause of hip pain in young adults. The increase in primary surgeries comes with a similar increase in revision surgeries, which pose more complicated challenges. Frequent indications for revision hip arthroscopy are residual impingement, hip dysplasia, persistent labral pathology, and adhesions. In this presentation, we will focus on capsulolabral adhesions. Symptoms in patients with adhesions include decreased range of motion and persistent pain in hip flexion. Adolescent girls are at increased risk for adhesions. The presence of suture material in the capsulolabral recess from a prior repair may initiate a biologic response.

Technique: Adhesions are completely released. Preserving native labral tissue is important. The bone bed for the graft is checked and must provide a bleeding surface. An allograft capsulolabral spacer is useful to prevent recurrence of adhesions. The main objective is to create an offset between the labrum and the capsule. The graft is positioned between the capsule and the labrum. The native labrum must remain viable to assure the suction-seal effect. If the labrum is severely damaged, a labral reconstruction is recommended. We use an iliotibial band allograft. The graft is tubularized to a diameter of 7 mm. We use a grasper to position the graft evenly in the recess at the same location at which the adhesions were released at the start of the procedure. Several suture anchors are used to secure the graft in position. The exact number of sutures will vary depending on the size of the graft. The capsule is closed with an absorbable suture.

Rehabilitation: We emphasize the value of circumduction exercises. This is important to prevent adhesions from recurring. We use continuous passive motion and stationary biking. Three weeks of partial weight-bearing with crutches is recommended. We use a hip brace to limit extension.

Conclusion: Capsulolabral adhesions are a common complication after hip arthroscopy. The use of a hip capsulolabral spacer is a safe and effective method to create and offset between the capsule and labrum and prevent the recurrence of adhesions.

Results for "Hip Preservation"

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