Dr. Andrew Wolff

1. Labral Reconstruction
Arthrex Hip Symposium
Newport Beach, CA
April 25, 2014
Andrew B. Wolff, MD
Washington Orthopaedics and Sports Medicine
Washington, DC

2. Indications
• Revision
– Previous labral resection/ aggressive
debridement with persistent pain and no
arthritis
• Primary
– “Hip at risk” with irreparable labrum

3. Revision

4. Primary: “Hip at risk”
25 yo, 12 yrs s/p SCFE pinning in situ

5. Primary: “Hip at risk”
27 yo former NCAA basketball player
8 yrs of hip pain

6. Graft Options
• Autograft
– Iliotibial band
– Hamstrings
• Allograft
– Iliotibial band
– Tibialis anterior
– Tibialis posterior
– Semitendinosus
– Peroneus longus
– Achilles

7. Autograft: ITB
Philippon et al AJSM 2010
• Longitudinal section of IT
Band harvested through 5-7
cm open incision
• Graft is tubularized with 0
vicryl on back table

8. Literature
Philippon et al AJSM 2010
• 47 pts minimum 1 yr f/u
• 49% previous hip surgery
• Avg age 37
• Mean MHHS improved from
62 to 85
• 4 pts went on to THA
– 3 of them had < 2mm jt space
pre-op
Sierra, Trousdale CORR 2009
• Open dislocation
• Ligamentum teres autograft
• 5 patients
• 1 went on to THA

9. Literature
Domb et al. AJSM 2013
•Compared segmental labral resection to
reconstruction with gracilis autograft
•Min 2 yr f/u
•Statistically significant improvement in HOS-
ADL and NAHS

10. Labral recon case
• 47 year old female
• Degenerative labral tear repaired on
contralateral side, revised to reconstruction
with good results
• Requested primary labral reconstruction

12. Thank You!
andywolffmd@gmail.com
cell: 202-276-9834
www.andrewwolffmd.com
www.wosm.com