Editorial Commentary: Arthroscopic Treatment for Diminutive Hip Labral Size: Go Big or Go Home?

The diminutive (or hypoplastic or hypotrophic) hip labrum presents a unique surgical challenge in the setting of femoroacetabular impingement syndrome for many hip arthroscopists. Insufficient labral tissue leads to increased risk for suture cutout or overeversion, with resulting loss of suction seal when attempting arthroscopic repair. Although some surgeons have demonstrated clinical improvement after performing primary refixation of the diminutive labrum, others have reported inferior outcomes for patients with labral width <4 mm compared with patients having normal or larger labral width. Alternative treatment methods, including labral reconstruction or labral augmentation with autograft or allograft, may be effective, based on select single-surgeon studies. As further research is needed to fully evaluate outcomes of these techniques, hip arthroscopists should recognize the difficult task at hand and be prepared to use assorted treatment options to augment a diminutive labrum. Larger labra can maintain contact with the femoral head after repair, and techniques such as labral base fixation can help to preserve this interaction and recreate the suction seal.