Labral Reconstruction via Capsular Augmentation Maintains Perfusion to the Acetabular Labrum and Locally Transferred Autograft: An in Vivo Laser Doppler Flowmetry Analysis

Nathan J Cherian; Christopher T Eberlin; Michael P Kucharik; Paul F Abraham; Mark R Nazal; Michael C Dean; Scott D Martin

doi:10.2106/JBJS.OA.23.00026

Labral Reconstruction via Capsular Augmentation Maintains Perfusion to the Acetabular Labrum and Locally Transferred Autograft: An in Vivo Laser Doppler Flowmetry Analysis

JB JS Open Access. 2023 Sep 26;8(3):e23.00026. doi: 10.2106/JBJS.OA.23.00026. eCollection 2023 Jul-Sep.

Authors

Nathan J Cherian^{1

2}, Christopher T Eberlin^{1

3}, Michael P Kucharik^{1

4}, Paul F Abraham^{1

5}, Mark R Nazal^{1

6}, Michael C Dean¹, Scott D Martin¹

Affiliations

¹ Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
² Department of Orthopaedic Surgery, University of Nebraska, Omaha, Nebraska.
³ Department of Orthopaedic Surgery, University of Iowa, Iowa City, Iowa.
⁴ Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida.
⁵ Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California.
⁶ Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky.

Abstract

Background: The purpose of the present study was to examine the effects of arthroscopic labral repair with capsular augmentation on blood flow in vivo with use of laser Doppler flowmetry (LDF) to measure microvascular perfusion of the labrum and autograft tissue.

Methods: The present prospective case series included patients ≥18 years old who underwent arthroscopic acetabular labral repair with capsular augmentation; all procedures were performed by a single surgeon between 2018 and 2022. The LDF probe measured microvascular blood flow flux within 1 mm³ of the surrounding labral and capsular tissue of interest. Mean baseline measurements of flux were compared with readings immediately following capsular elevation and after completing labral augmentation. Blood flux changes were expressed as the percent change from the baseline measurements.

Results: The present study included 41 patients (24 men [58.5%] and 17 women [41.5%]) with a mean age (and standard deviation) of 31.3 ± 8.4 years, a mean BMI of 24.6 ± 3.4 kg/m², a mean lateral center-edge of angle 35.3° ± 4.9°, a mean Tönnis angle of 5.8° ± 5.8°, and a mean arterial pressure of 93.7 ± 10.9 mm Hg. Following capsular elevation, the mean percent change in capsular blood flow flux was significantly different from baseline (-9.24% [95% confidence interval (CI), -18.1% to -0.04%]; p < 0.001). Following labral augmentation, the mean percent change in labral blood flow flux was significantly different from baseline both medially (-22.3% [95% CI, -32.7% to -11.9%]; p < 0.001) and laterally (-32.5% [95% CI, -41.5% to -23.6%]; p = 0.041). There was no significant difference between the changes in medial and lateral perfusion following repair (p = 0.136).

Conclusions: Labral repair with capsular augmentation sustains a reduced blood flow to the native labrum and capsular tissue at the time of fixation. The biological importance of this reduction is unknown, but these findings may serve as a benchmark for other labral preservation techniques and support future correlations with clinical outcomes.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.