Hip labrum surgery, typically performed using arthroscopy, is a common procedure used to repair tears in the hip joint. The hip labrum is a ring of cartilage that lines the rim of the acetabulum, or hip socket. This structure helps stabilize the joint and maintain a fluid seal. When the labrum tears, it causes pain and instability, often requiring surgical intervention to reattach the torn tissue to the bone using specialized medical devices called suture anchors.
How Suture Anchors Secure the Hip Labrum
A suture anchor is a miniature implant designed to fix soft tissue, like the labrum, back to the underlying bone. The anchor is a small screw-like or barb-like device drilled directly into the acetabulum. Each anchor comes pre-loaded with strong surgical threads, called sutures. The anchor provides a solid point of fixation within the bone. Once placed, the surgeon uses the attached suture to capture the torn labral tissue, pulling the labrum firmly against the acetabular rim so it can heal properly.
Factors That Determine the Required Anchor Count
The precise number of anchors used in a hip labrum repair is not standardized but is customized to the patient’s specific injury. While there is no fixed count, the typical range for most procedures is between two and five anchors. The primary factor influencing the anchor count is the total size and length of the tear.
Tears that span a greater circumference of the acetabulum require more fixation points to ensure the entire detached segment is securely reattached. A tear that spans a larger area, often measured using the clockface method, typically requires a minimum of two anchors for adequate stabilization. Tears spanning more than two hours on the clockface generally necessitate more than two anchors to restore the labrum’s function.
The location of the tear also influences anchor placement and number, as the anatomy of the acetabular rim varies. Tears in the anterior region are the most common and may require a specific arrangement of anchors. The quality of the labral tissue itself also plays a role, since poor-quality tissue may require more closely spaced anchors to achieve a durable repair. The surgeon’s decision on the final number of anchors is based on a detailed assessment of the tear during the arthroscopic procedure, combined with pre-operative imaging.
Different Anchor Materials and Placement Techniques
Suture anchors are manufactured from different materials, primarily falling into two categories: bioabsorbable and non-absorbable. Bioabsorbable anchors are designed to gradually dissolve and be absorbed by the body over time as the labrum heals. These materials, often composed of polymers or calcium-based components, provide temporary support before disappearing completely.
Conversely, non-absorbable anchors, often made of PEEK plastic or metal, are permanent implants that remain in the bone indefinitely. The choice between these materials is based on the surgeon’s preference, the characteristics of the patient’s bone, and the desired mechanical properties of the repair. Both types of anchors are designed to be minimally intrusive within the acetabulum.
The anchor placement is performed using arthroscopy, which uses small incisions and specialized instruments. The surgeon uses a drill guide to create a pilot hole in the acetabular rim before inserting the anchor through an arthroscopic portal. This precise technique allows the anchor to be positioned close to the articular cartilage, securing the labrum firmly to the bone edge without causing damage to the joint surface. Knotless anchors are frequently used because they allow the surgeon to tension the suture and secure the labrum without tying a physical knot inside the joint space.