Vascularity of the hip labrum: A cadaveric investigation

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Purpose: The purpose of this study was to define the vascularity of the hip labrum and to identify regional differences in vascular penetration that may have implications for the healing potential of this structure. Type of Study: Injection study of human cadavers to investigate the vascularity of the hip labrum. Methods: Twelve hips from 6 human frozen cadavers devoid of severe articular pathology were used. High-resolution surface-coil magnetic resonance imaging (MRI) was performed in both sagittal and coronal planes to better define anatomic planes in 2 dimensions and to correlate Spalteholz sections with the surrounding joint and labral anatomy. Each pelvis was injected with intra-arterial India Ink and frozen; 3-mm sagittal or coronal sections were then cut and processed using a modified Spalteholz technique, yielding anatomic zones of the labrum. Six specimens were cut in the sagittal plane and 6 were cut in the coronal plane. Specimens were examined at ×10 magnification with transillumination. Anatomic zones with regional variations in vascularity were defined. Results: The anterior and superior aspects of the labrum showed degenerative changes on MRI and under direct manual transillumination in 75% of specimens. Overall, there was a relatively poor vascular supply to the labrum; however, there were regional differences between anatomic zones. Zone I (capsular contribution) had significantly more vascularity than zone II (articular side) (P < .01). Zone IA (the portion of the zone not attached to bone) showed the most consistent source of vessels across all specimens (smallest variation between specimens); however, zone IB (the portion of the zone attached to bony acetabulum) had the greatest overall mean vascularity score. These differences were not statistically significant. Furthermore, vascularity patterns were not significantly different in the anterior, superior, posterior, and inferior labral regions, nor were they different in torn versus intact specimens. Conclusions: The cadaveric specimens evaluated in this study had a relatively avascular hip labrum. However, the increased vascularity seen in zone I (capsular side) may have implications for treatment, similar to that described in the meniscus of the knee. Clinical Relevance: A better understanding of the vascularity of the hip labrum will guide treatment of labral pathology and may have implications for the healing potential of this structure. Labral tears occurring in the vascular zone may be amenable to arthroscopic repair rather than debridement.

Section snippets

Methods

Twelve hips from 6 human fresh-frozen cadavers were used (International Biological Inc, Detroit, MI). All specimens were female with a mean age of 68 years (range, 65 to 80 years). It was not possible to obtain a history regarding abnormalities of function of the hip, but there were no severe arthritic changes in the specimens on gross inspection.

High-resolution surface-coil magnetic resonance imaging (MRI) was performed in sagittal and coronal planes on a clinical 1.5-Tesla unit for anatomic

Results

Table 1 shows the mean subjective grading for each zone, as well as the standard deviations and medians. Blood supply to the labrum was minimal (Fig 5), but there were relative differences between zones. For all labral regions (anterior, superior, posterior, and inferior), the subjective grading scale showed significantly greater vascularity in the capsular zones (zone I) compared with the articular zones (zone II) (P < .01). The overall mean vascularity grade was greatest in the subdivision IB

Discussion

The acetabular labrum is a fibrocartilaginous rim attached to the acetabular margin, which increases the acetabular depth. It is strongly fixed with the transverse acetabular ligament.12, 13 The labrum is able to exert a high tensile force on the rim of the acetabulum and thus plays a very important role in the stability of the hip joint.14, 15, 16 Alterations in the labrum have been suggested to predispose hips to osteoarthrosis.1, 4, 5, 17, 18 Dorell and Catterall19 and, subsequently, Ganz et

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