Hoffer Alexander J, St George Stefan A, Lanting Brent A, Degen Ryan M, Ng K C Geoffrey
Department of Surgery, University of Western Ontario, London, Canada.
Department of Surgery, University of Western Ontario, London, Canada; Fowler Kennedy Sports Medicine Clinic, London, Canada.
Arthroscopy. 2025 May;41(5):1390-1399. doi: 10.1016/j.arthro.2024.07.023. Epub 2024 Aug 10.
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.
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.
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.
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.
Circumferential labral reconstruction may be a viable treatment option for patients with ongoing symptoms after hip arthroscopy with evidence of a cam over-resection and a deficient labrum.
在生物力学模型中评估凸轮过度切除、盂唇撕裂、修复、盂唇切除术或6毫米或10毫米圆周盂唇重建术后髋关节牵张稳定性的变化。
使用材料测试系统分析10对新鲜冷冻的匹配人体尸体髋关节，以测量破坏髋关节吸力密封所需的力和距离：（1）关节囊和盂唇完整时；（2）关节囊切除和盂唇修复后；（3）关节囊切除、5毫米凸轮过度切除和盂唇修复后；（4）关节囊切除、5毫米凸轮过度切除和盂唇撕裂后；（5）关节囊切除、5毫米凸轮过度切除和盂唇切除术后；（6）关节囊切除、5毫米凸轮过度切除和使用髂胫束进行6毫米或10毫米圆周盂唇重建后（每种情况各5个髋关节）。每个标本在0°屈曲、45°屈曲、45°屈曲加15°内旋时重新测试，并使用非参数统计方法进行分析。
结构条件和髋关节位置之间的差异Friedman检验具有显著性（P = .001）。在所有位置，完整髋关节中抵抗吸力密封破坏的阻力明显大于所有其他情况。与几乎所有其他情况和髋关节位置相比，关节囊切除、5毫米凸轮过度切除和盂唇切除情况的阻力明显更小。6毫米盂唇重建的髋关节标本中有20%实现了定性吸力密封，而10毫米盂唇重建的标本中有60%实现了密封。
在凸轮过度切除后，圆周盂唇重建可改善盂唇缺损髋关节的牵张稳定性，在生物力学模型中与盂唇修复或撕裂相当。
对于髋关节镜检查后仍有症状且有凸轮过度切除和盂唇缺损证据的患者，圆周盂唇重建可能是一种可行的治疗选择。
