Hip Labral Reconstruction

Why this approach — at MOS

The decision between repair and reconstruction is made with the full benefit of arthroscopic visualization — not solely on MRI findings. Dr. Christoforetti's approach preserves every bit of viable native tissue, using it as an anchor for the graft if possible in a hybrid construct, or proceeding to complete reconstruction when the tissue is truly beyond salvage.

For patients who have already had prior labral debridement (a procedure that was once commonly performed instead of repair), reconstruction offers a meaningful opportunity to restore labral function in a joint that might otherwise progress to arthroplasty. Published outcomes show that reconstruction produces durable results at 5-year follow-up comparable to repair — even in patients with more severe pre-operative labral damage and older age at surgery.

FAI correction is almost universally performed alongside reconstruction: if the underlying bony impingement is not addressed, the graft is exposed to the same mechanical environment that destroyed the native labrum. Capsular repair is performed routinely.

Patients considering labral reconstruction who have seen other surgeons and been told their options are limited or that hip replacement is their only path are encouraged to seek a consultation at our Germantown or Bethesda offices for an independent assessment.

Who is a candidate?

Indications

• Labral tissue that is too thin, calcified, degenerated, or attenuated to hold suture anchors and heal (confirmed intraoperatively)
• Prior hip arthroscopy with labral debridement, leaving an absent or significantly deficient labrum
• Failed prior labral repair with irreparable re-tear
• Severely hypotrophic labrum on pre-operative MRI arthrogram in a symptomatic patient
• Continued or worsening hip pain in a patient without significant arthritis after failed conservative management

Contraindications

• Advanced hip osteoarthritis (Tönnis grade 3) — reconstruction does not reverse established cartilage loss and joint space narrowing
• Significant dysplasia requiring periacetabular osteotomy
• Active infection
• Insufficient motivation for the extended rehabilitation required

Conservative Treatment First

As with all hip preservation procedures, non-operative care precedes surgery. Physical therapy focuses on hip strengthening, core stability, and activity modification. Intra-articular cortisone injection may provide temporary relief and confirms the intra-articular source of pain. If pain is functionally limiting, imaging documents labral deficiency, and conservative measures have not provided lasting improvement, reconstruction is considered.

The procedure

What Is Hip Labral Reconstruction?

Hip labral reconstruction is an arthroscopic procedure that recreates the acetabular labrum using a tissue graft — from the patient's own body (autograft) or a donor (allograft) — when the native labrum is too damaged, degenerated, or absent to be repaired with suture anchors. It is the preferred alternative when repair is not possible.

Labral reconstruction is distinct from labral repair. Repair reattaches the patient's own labral tissue using suture anchors — always the first choice when tissue quality allows. Reconstruction is reserved for cases where the native labrum is so severely degenerated, calcified, attenuated, or simply absent (as after prior labral debridement or failed prior repair) that repair is not feasible. In these cases, a graft — shaped into a tube or ring — is used to recreate the labrum in its normal anatomic position.

The acetabular labrum performs several functions that make its presence important for long-term hip health: it seals the joint fluid inside the hip (the suction-seal mechanism), distributes load across the articular cartilage, stabilizes the femoral head within the socket, and provides proprioceptive feedback. Without a functioning labrum, the hip experiences abnormal mechanics and accelerated cartilage wear. Reconstruction aims to restore as much of this function as possible.

Graft options include iliotibial band allograft, gracilis tendon autograft or allograft, semitendinosus allograft, and other soft tissue grafts. The graft is tubularized and sutured to the acetabular rim using suture anchors, reconstructing the labrum's normal ring architecture.

What Happens During Hip Labral Reconstruction?

The procedure is performed at an ambulatory surgery center under general anesthesia with a nerve block. The patient is positioned on a hip arthroscopy traction table with controlled distraction applied to open the joint.

The surgeon enters the central compartment arthroscopically and thoroughly inspects the labrum. If the tissue is found to be irreparably damaged on intraoperative assessment, the plan shifts from repair to reconstruction. The remnant labral tissue is carefully debrided while preserving any viable tissue that can anchor the graft. The acetabular rim is prepared with a burr to create a bleeding surface that will support graft-to-bone healing.

Suture anchors are placed along the acetabular rim — typically spaced 5–7 mm apart, covering the full arc of reconstruction needed. The graft (pre-soaked and tubularized to approximate normal labral cross-section dimensions) is then sutured to the rim anchor by anchor, recreating the labral ring in its anatomic position. FAI correction (osteoplasty) is performed if cam or pincer morphology is present, which is the case for the majority of reconstruction patients. Capsular repair is performed at conclusion.

Operative time is typically 90–120 minutes, slightly longer than repair cases due to graft preparation and the greater number of anchors required.

Recovery timeline

Frequently Asked Questions