Biologic Injections During Hip Labral Reconstruction
The hip labrum is a ring of cartilage that surrounds the socket of the hip joint providing stability and cushioning for the joint. The labrum plays a crucial role hip joint function and health.
The hip labrum can be damaged or torn due to various reasons. Common causes include trauma, repetitive motions in sports, and degenerative changes. Femoroacetabular impingement (FAI) is a structural hip abnormality and a common cause of hip labral tears.
Labral tears can lead to pain, stiffness, and reduced range of motion in the hip. Surgery to treat a labral tear is typically performed arthroscopically.
Arthroscopic hip labral reconstruction is the gold standard surgical treatment to when labral repair is not possible. The goal is to restore labral function to preserve the hip joint. Reconstruction involves the use of tissue grafts to reconstruct the labrum to restore hip function and preserve the hip joint.
Biologics or biologic therapies are biological materials used in the regeneration and repair of bone and soft tissues. They can be implanted or injected.
Biologics or biologic therapies are a class of nondrug treatments that are developed from naturally-derived substances such as sugars, proteins, nucleic acids, and a combination of these substances, or they may be living things such as cells and tissues. They may be used to:
- help accelerate healing of bone, cartilage, muscles, ligaments and tendons damage
- improve healing after surgery
There are blood derived therapies such as such as platelet-rich plasma, and cell-based therapies such as stem cells, and bone marrow concentrate.
- Blood-derived therapies such as platelet-rich plasma, deliver cytokines (proteins) that are crucial in controlling the growth and activity of immune and blood cells and control inflammation and healing substances like platelets. Other blood derived therapies include growth factors that stimulate cell mechanisms like collagen production. They are delivered to the site of injury after the completion of the hip arthroscopic procedure.
- Cellular therapies, such as bone marrow aspirate concentrate (BMAC), have the ability to produce new tissues. They include live cells injected into local tissues. Unlike blood derivatives, cell-based therapies produce a regenerative effect by incorporating them into injured tissues.
Studies have examined the use of biologics during arthroscopic hip surgery. They have found that the application of platelet-rich plasma during surgery resulted in reduced pain and reduced inflammation following hip arthroscopy.
In addition to PRP, Bone Marrow Aspirate Concentrate (BMAC) has been used intra-operatively for hip arthroscopy procedures.
- A 2020 study found that BMAC injections at the conclusion of the arthroscopy procedure improved outcomes of both pain and function at 1- and 2-year follow-up. Moreover, BMAC is ideal because it has the ability to differentiate into cartilage. BMAC is a safe and effective option for augmentation of labral healing during labral reconstruction.
- A 2023 study reports that intraoperative platelet-rich plasma and cell-based therapies found that cell-based therapy demonstrated more favorable patient-reported outcomes defining success in hip labral repair.
Biologics like stem cells and growth factors can be used in procedures aimed at repairing or regenerating damaged hip labral cartilage, especially in young patients or athletes with cartilage injuries.
Biologics that are harvested from your own body and used to treat you are safe. They are not used in people with malignancies or recent remissions.
Schedule a hip consultation
You can rely on experience and qualifications of clinicians at LALL Orthopedics +. Our team aims to provide safe and effective biologics treatments to improve your healing. When you or a loved one is suffering with an orthopedic problem, you have options. Contact the team at LALL Orthopedics + to schedule a consultation to receive the correct diagnosis and modern cutting-edge treatment options. We have offices in New Jersey, Manhattan, Philadelphia, and West Palm Beach, FL.
References
- Maldonado DR, Lall AC, Walker-Santiago R, Rosinsky P, Shapira J, Chen JW, Domb BG. Hip labral reconstruction: consensus study on indications, graft type and technique among high-volume surgeons. J Hip Preserv Surg. 2019 Mar 1;6(1):41-49. doi: 10.1093/jhps/hnz008. PMID: 31069094; PMCID: PMC6501441.
- Lall AC, Walsh JP, Maldonado DR, Pinto LE, Ashberg LJ, Lodhia P, Radha S, Correia APR, Domb BG, Perez-Carro L, Marín-Peña O, Griffin DR. Teamwork in hip preservation: the ISHA 2019 Annual Scientific Meeting. J Hip Preserv Surg. 2020 Oct 9;7(Suppl 1):2-21. doi: 10.1093/jhps/hnaa037. PMID: 33072394; PMCID: PMC7546541.
- Rafols C, Monckeberg JE, Numair J, Botello J, Rosales J. Platelet-Rich Plasma Augmentation of Arthroscopic Hip Surgery for Femoroacetabular Impingement: A Prospective Study With 24-Month Follow-up. Arthroscopy. 2015 Oct;31(10):1886-92. doi: 10.1016/j.arthro.2015.03.025. Epub 2015 May 15. PMID: 25980923.
- Stelzer JW, Martin SD. Use of Bone Marrow Aspirate Concentrate with Acetabular Labral Repair for the Management of Chondrolabral Junction Breakdown. Arthrosc Tech. 2018 Sep 1;7(10):e981-e987. doi: 10.1016/j.eats.2018.06.003. PMID: 30377577; PMCID: PMC6203226.
- Kruel AVS, Ribeiro LL, Gusmão PD, Huber SC, Lana JFSD. Orthobiologics in the treatment of hip disorders. World J Stem Cells. 2021 Apr 26;13(4):304-316. doi: 10.4252/wjsc.v13.i4.304. PMID: 33959220; PMCID: PMC8080542.
At a Glance
Ajay C. Lall, MD, MS, FAAOS
- Board Certified – Orthopedic Surgery
- Triple Fellowship Trained
- Performs over 750 Surgeries Per Year
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