title: Investigation of the preservation of the fluid seal effect in the repaired, partially resected, and reconstructed acetabular labrum in a cadaveric hip model.
abstract: BACKGROUND
  Debate exists on whether hip labral tears should be surgically repaired, partially resected, or reconstructed. Furthermore, limited data exist regarding the fluid seal properties of hip labrum repair and/or reconstruction with iliotibial band autograft when compared with the labrum-intact condition.  Hypothesis/
  
  
  OBJECTIVE
  The purpose of this study was to investigate the fluid seal properties of hip labral repair and reconstruction techniques. We hypothesized that hip labral repair preserves the acetabular labral fluid seal greater than labral tear, partial-resection, and reconstruction conditions.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Six human cadaveric hemipelvises were dissected of all soft tissue, leaving the hip capsule intact. Fluid efflux was measured under 5 conditions using a custom fluid infusion device: (1) hip labrum intact, (2) labral tear, (3) labral repair with suture anchors, (4) partial labral resection, and (5) labral reconstruction using ipsilateral iliotibial band autograft. Joint fluid expression was measured as flow rate under 3 different pressure settings (2, 3, and 4 psi). Statistical differences between conditions were assessed using 2-way, repeated-measures analysis of variance. The Student-Newman-Keuls (SNK) multiple comparison test was used to determine differences between levels.
  
  
  RESULTS
  There was a significant increase in fluid efflux with a simulated labral tear (0.54 ± 0.3 mL/sec) when compared with the intact hip labrum condition (0.006 ± 0.008 mL/sec, P < .05). The labrum-repaired condition (0.21 ± 0.2 mL/sec) demonstrated significantly less fluid efflux when compared with the labral-tear condition. Hip labral repair significantly prevented greater fluid efflux when compared with partial labral resection (0.60 ± 0.4 mL/sec) and reconstruction with iliotibial band autograft (0.54 ± 0.3 mL/sec; P < .05). Labral repair did not preserve fluid efflux as effectively as in the labrum-intact condition (0.21 ± 0.2 > 0.006 ± 0.008 mL/sec; P < .05). There was no difference observed in fluid efflux between the labral reconstruction, tear, or resection conditions (P > .05).
  
  
  CONCLUSIONS
  In this human cadaveric model, hip labral repair outperforms partial labral resection and reconstruction in preserving the joint fluid seal; however labral repair does not restore fluid seal characteristics as effectively as in the labrum-intact condition.
  
  
  CONCLUSIONS
  Further prospective studies are needed to determine whether hip labral repair outperforms partial labral resection and/or reconstruction in clinical practice.
authors.affiliation: Center for Shoulder, Elbow and Sports Medicine, Columbia University, 622 W 168th St, PH-11, New York, NY 10032, USA. ec2195@columbia.edu
authors.forename: Edwin R
authors.initials: ER
authors.lastname: Cadet
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Chan
authors.forename: George C
authors.initials: GC
authors.lastname: Vorys
authors.forename: Thomas
authors.initials: T
authors.lastname: Gardner
authors.forename: Bob
authors.initials: B
authors.lastname: Yin
mesh_terms: D000077:Acetabulum / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D002358:Cartilage, Articular / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures; D013582:Synovial Fluid; D014182:Transplantation, Autologous; D014945:Wound Healing