Name: Use of LabralTape™ Suture for Knotless Labral Refixation in the Hip
Uploaded: 2015-07-22T00:00:00Z
Channel: Arthrex

<p>Craig Mauro, MD, (Pittsburgh, PA) presents his knotless acetabular labral refixation technique using LabralTape™ suture and a 2.9 mm Hip PushLock® anchor to create a strong and low profile knotless construct. He outlines his suture passing technique using the Hip Length Crescent SutureLasso™ suture passer and discusses pearls for using the LabralTape to adequately position the labrum against the femoral head and maintain the suction seal of the joint.</p>

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VID1-00481-EN | A | Use of LabralTape™ Suture for Knotless Labral Refixation in the Hip

Craig Mauro

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Use of LabralTape™ Suture for Knotless Labral Refixation in the Hip

As we all probably know, LabralTape is a smooth, low profile polyethylene suture, which really is complemented well with 2.9 PushLock and around the hip. That's what I primarily use. But it can also be used with 3.5mm swivel locks. It provides a very wide footprint for a knotless suture, and it distributes the load over a wide area. It's been shown to have 39% higher tensile strength than FiberWire. And John Cristoforetti had a paper, as well as Arthrex white paper showing the tissue tear through risk with LabralTape and FiberWire has really been shown to be about 37% stronger with in comparison to FiberWire and with pull out and tear through tissue strength. So really is a strong construct. Its first been was used in the shoulder. It's been used for shoulder instability. It's been used for slap repairs to get rid of the knot stack below the rotator cuff. And really has been effective for shoulder surgeons as well. So in the hip, some of the some of the discussion points that I want to talk about, which Tim started getting into was some of the suture configurations where we can use LabralTape, as well as its considerations of it being a better biologic scaffold. And I'm going to show some pictures of that, its use in reconstruction. And then we'll talk through a case with a few technical pearls. So this figure was just shown the primary issue in my practice. I really like to try to achieve a labral base repair if I can, but I'm going to show some examples. For example, the LabralTape can be used in a simple stitch configuration, and we've probably all done this and seen it particularly for small labrum for a labral tear with a lot of intra substance tearing. As Tim was saying, that's when I'll use a simple stitch, and it really provides excellent fixation. And we can still achieve that suction seal effect between the femoral head and the the labrum using a simple stitch configuration. Typically base refixation techniques, as we've all seen here today, rely on either sutures and knots to to refix the refix the base in a more AnaToemic situation. The LabralTape can be used, and I'll show an example of this in our case, to restore that same suction seal type of alignment between the labrum and the femoral head. With with using the tape as well. So, so I think this is the goal that I'm trying to achieve most often with the, with the LabralTape is a fixation using a base fixation technique. And and we'll go through that. So I think one of the other interesting things about the LabralTape, Peter Millett, showed some pictures a couple of years ago at the faculty forum of the FiberTape and the rotator cuff, where the basically had revascularized and was completely covered by by the host tissue within 6 to 8 weeks after after the rotator cuff. And I had an initial experience with this from a case a couple of years ago where I had just first started using LabralTape. I had fixed it in a simple fashion around the labrum. And this patient, you know, a year later, was still having some symptoms. We ultimately went back for revision arthroscopy and saw that the did a small capsule capsule scar release. But basically she had completely overgrown with synovial tissue that that that LabralTape. So I think provides a nice biologic scaffold because of the, the way the LabralTape is configured. So I think it's also really helpful for reconstruction. And when you're faced with this situation where you have, you know, labral deficiency, I've been really happy with LabralTape in this situation, fixing first the ends of the reconstruction down using FiberWire stitches and PushLock. But then in a simple circumferential loop construct, fixing the graft down using LabralTape. For me, you know, it provides that very strong. Fixation, which I think you can achieve the labral seal and still get that biologic component that we just talked about there. So for me, those are kind of some of the some of the main issues I think of with the LabralTape. And I'm going to use one case to illustrate how I use it in my practice. So this is a 28 year old male soccer player. Typical FAI. I had treated him with a right hip arthroscopy about a year ago, and recently we went through his left hip. Had large cam deformity. So a pretty classic case. On initial inspection, he's got a large chondrolabral injury. Delaminated cartilage detachment of his anterior-superior labrum. Typical cam fashion. So I think in using LabralTape and knotless fixation techniques, some of the keys are that you really need to be especially fastidious with your rim preparation because the visualization visualization is paramount with with knotless fixation. So I think that really clearing the the bony rim impingement lesion is key with, with this type of technique. Decorticating the bone. And then as we talked about in the earlier session, adjusting your rim resection as needed based on your preoperative planning, but this really can't be done. I don't think adequately without visualizing your your rim. So I do a peel back technique, which we've talked about earlier, and I think this is really key with the with the LabralTape and PushLock configuration is to really get good exposure in this area. This is viewing from mid anterior portal back onto a left hip. We prepare our bed. And then at this point I like to look at the labrum and decide what type of suture configuration is best for the for the type of labrum. So if there's a lot of intra substance tearing, I also will do a simple suture configuration. If the labrum itself is is healthy and strong enough, then I think it's appropriate for a base fixation technique using the LabralTape. So I'll initially usually begin at the 12:00 position. Here's using a crescent suture passer to pass through the chondrolabral junction. And you can, you know, use a number of different techniques. You can use a Penetrator and just pass the LabralTape. In this case, I like the crescent because it pokes a small hole through the labrum or through the chondrolabral junction without disrupting it. Here we've still got a lesion, which I usually deal with after we've refixed the labrum. We pass our LabralTape in a simple fashion, and at this point, you can fix it back to the acetabulum and standard circumferential loop fashion or proceed with your mattress fixation. So I again am using a crescent suture passer here to poke through the labrum. There are a number of different commercial devices. You can just use a penetrating suture passer and grab the labrum. And then we shuttle the LabralTape back up through to create that vertical mattress type of configuration. For me at this point I like to then identify I'm viewing through the mid anterior and I'm passing through the anterolateral portal. I like to shuttle to the distal anterolateral portal because I think that gives me better, a better drilling angle. So this is just an example from viewing from the mid anterior portal. What we get with trajectory from the distal anterolateral portal versus the anterolateral. So we'll shuttle this LabralTape out the distal anterolateral portal. And then I'll start drilling once I have my tape in place immediately adjacent to the contralateral junction. If you're coming from the distal anterior lateral portal, I think you have a nice trajectory and you don't have to worry about coming out in the surface. You really want to make sure that your your drill hole is freed of soft tissue and that you can visualize it well for placing your PushLock. And then we advance to the PushLock basically, pull the fixation back down to the acetabular rim where we want it just in the last half of the anchor. So we got our 12:00 anchor and then we move medially. And the thing I like about it with the LabralTape is there's no suture wad. You know, I don't think it decreases scarring between the capsule and labrum. There we move more medially and again achieve some of the same positioning issues. We can look at the the labrum, which has been refixed. There's no suture wad. It's a strong reflection of the refixation of the base there with three anchors recreating an excellent suction seal. And I do a capsule repair on all these. I do a t capsulotomy, and I'm doing 4 or 5 stitches to close the capsule at the end. So my experience with this is over the last couple of years, done 2 or 300 cases with this and really been happy with it. I haven't noticed any anchor pull out tape failure I think, which is the consensus. It seems here it's well suited for large tears. If they're macerated and there's intra substance tearing, I do a simple circumferential configuration. If there's a healthy labrum, I'll do a mattress configuration. And I think the key points are to pay special attention to your rim preparation, your drilling angle as to not torque, and the LabralTape tension, which I think is probably the most important thing to get an anatomic repair.

Use of LabralTape™ Suture for Knotless Labral Refixation in the Hip

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