Labral tear associated with FAI or dysplasia, failed debridement
Danger Structures
Sciatic nerve - 15-30mm posterior to hip joint depending on approach and position, injury causes foot drop and sensory loss - EXAM KEY: identify and protect, keep hip flexed to relax nerve
Femoral neurovascular bundle - 30-50mm medial to anterior hip joint, injury catastrophic - EXAM KEY: stay on bone with anterior retractors
Superior gluteal neurovascular bundle - 30-50mm proximal to greater trochanter, injury causes abductor weakness - EXAM KEY: avoid proximal dissection, stay in safe zone
Lateral femoral cutaneous nerve - variable position 20-50mm from anterior incisions, injury causes meralgia paresthetica - EXAM KEY: protect when visible
Medial femoral circumflex artery - main blood supply to femoral head, at risk during capsulotomy - EXAM KEY: careful dissection around posterior femoral neck
Visual Atlas
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Step-by-Step Technique
1
Establish standard portals with central compartment access
Surgeon's Tip
EXAM KEY: Critical step in Labral Repair and Reconstruction - ensure proper technique and visualization.
Danger Zone
Iatrogenic injury to adjacent structures
2
Assess labral tear pattern and tissue quality
Surgeon's Tip
EXAM KEY: Critical step in Labral Repair and Reconstruction - ensure proper technique and visualization.
Danger Zone
Iatrogenic injury to adjacent structures
3
Labral repair (if tissue sufficient):
Surgeon's Tip
EXAM KEY: Critical step in Labral Repair and Reconstruction - ensure proper technique and visualization.
Danger Zone
Iatrogenic injury to adjacent structures
4
Debride damaged tissue, preserve healthy labrum
Surgeon's Tip
EXAM KEY: Critical step in Labral Repair and Reconstruction - ensure proper technique and visualization.
Danger Zone
Iatrogenic injury to adjacent structures
5
Prepare acetabular rim with burr to bleeding bone
Surgeon's Tip
EXAM KEY: Critical step in Labral Repair and Reconstruction - ensure proper technique and visualization.
Danger Zone
Iatrogenic injury to adjacent structures
6
Suture anchors along acetabular rim
Surgeon's Tip
EXAM KEY: Critical step in Labral Repair and Reconstruction - ensure proper technique and visualization.
Danger Zone
Iatrogenic injury to adjacent structures
7
Pass sutures through labrum using suture passer
Surgeon's Tip
EXAM KEY: Critical step in Labral Repair and Reconstruction - ensure proper technique and visualization.
Danger Zone
Iatrogenic injury to adjacent structures
8
Tie knots to secure labrum to rim
Surgeon's Tip
EXAM KEY: Critical step in Labral Repair and Reconstruction - ensure proper technique and visualization.
Danger Zone
Iatrogenic injury to adjacent structures
9
Labral reconstruction (if labrum insufficient):
Surgeon's Tip
EXAM KEY: Critical step in Labral Repair and Reconstruction - ensure proper technique and visualization.
Danger Zone
Iatrogenic injury to adjacent structures
10
Graft options: IT band autograft, hamstring autograft, allograft
Surgeon's Tip
EXAM KEY: Critical step in Labral Repair and Reconstruction - ensure proper technique and visualization.
Danger Zone
Iatrogenic injury to adjacent structures
11
Prepare acetabular rim circumferentially
Surgeon's Tip
EXAM KEY: Critical step in Labral Repair and Reconstruction - ensure proper technique and visualization.
Danger Zone
Iatrogenic injury to adjacent structures
12
Secure graft with anchors in chondrolabral junction
Surgeon's Tip
EXAM KEY: Critical step in Labral Repair and Reconstruction - ensure proper technique and visualization.
Danger Zone
Iatrogenic injury to adjacent structures
13
Repair/reconstruct restores suction seal and hip stability
Surgeon's Tip
EXAM KEY: Critical step in Labral Repair and Reconstruction - ensure proper technique and visualization.
Danger Zone
Iatrogenic injury to adjacent structures
14
Perform intraoperative imaging/fluoroscopy to confirm adequate position and alignment
Surgeon's Tip
EXAM KEY: Documentation of intraoperative findings is crucial for Labral Repair and Reconstruction.
Danger Zone
Radiation exposure
Inadequate imaging
15
Irrigate wound thoroughly and achieve meticulous hemostasis
Surgeon's Tip
EXAM KEY: Copious irrigation reduces infection risk. Bipolar for hemostasis near neurovascular structures.