Hip Labral and Capsular Repair Are Unable to Restore Distractive Stability in a Biomechanical Model

Alexander J Hoffer; Stefan A St George; Brent A Lanting; Ryan M Degen; K C Geoffrey Ng

doi:10.1016/j.arthro.2024.04.011

Hip Labral and Capsular Repair Are Unable to Restore Distractive Stability in a Biomechanical Model

Arthroscopy. 2024 May 1:S0749-8063(24)00306-2. doi: 10.1016/j.arthro.2024.04.011. Online ahead of print.

Authors

Alexander J Hoffer¹, Stefan A St George¹, Brent A Lanting¹, Ryan M Degen², K C Geoffrey Ng³

Affiliations

¹ Department of Surgery, Western University, London, Ontario, Canada.
² Department of Surgery, Western University, London, Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada.
³ Department of Surgery, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Medical Imaging, Western University, London, Ontario, Canada; Robarts Research Institute, Western University, London, Ontario, Canada. Electronic address: geoffrey.ng@uwo.ca.

PMID: 38697324
DOI: 10.1016/j.arthro.2024.04.011

Abstract

Purpose: To evaluate the change in hip distractive stability after a capsulotomy, labral tear, and simultaneous repair of both the capsule and the labrum in a biomechanical model.

Methods: Ten fresh-frozen human cadaveric hips were analyzed using a materials testing system to measure the distractive force and distance required to disrupt the hip suction seal under the following conditions: (1) native intact capsule and labrum, (2) 2- or 4-cm interportal capsulotomy (IPC), (3) labral tear, (4) T extension, (5) labral repair, (6) T extension repair, and (7) IPC repair. Each specimen was retested at 0° of flexion, 45° of flexion, and 45° of flexion with 15° of internal rotation.

Results: A significantly higher distractive force was required to rupture the suction seal in the intact condition compared with IPC (P = .012; 95% confidence interval [CI], 4.9-42.4); IPC and labral tear (P = .002; 95% CI, 11.3-49.4); IPC, labral tear, and T extension (P = .001; 95% CI, 13.9-51.5); IPC, labral repair, and T extension (P < .001; 95% CI, 20.8-49.7); IPC, labral repair, and T extension repair (P = .002; 95% CI, 12.5-52.4); and IPC repair, labral repair, and T extension repair (P = .01; 95% CI, 5.8-46.1). The IPC condition required a higher distractive force in isolation than when combined with a labral tear (P = .14; 95% CI, 1.2-12.0), T extension (P = .005; 95% CI, 2.8-15.3), or labral repair (P = .002; 95% CI, 4.4-18.8).

Conclusions: The distractive resistance of an intact hip capsule and labrum was not restored once the soft tissues were violated, despite labral repair with a loop technique and capsular repair with interrupted figure-of-8 sutures.

Clinical relevance: Time-zero complete capsular repair with concomitant labral repair may not be adequate to restore distractive hip stability after hip arthroscopy, reinforcing the use of postoperative precautions in the early postoperative period.