Editorial Commentary: Segmental Hip Labral Reconstruction May Be Superior to Circumferential Reconstruction: Bigger Isn’t Better

Hip arthroscopic segmental and circumferential labral reconstruction show similar outcomes in short-term follow-up. Will bigger (circumferential reconstruction) eventually be largely a historical method? Bigger does not appear to be better, although some argue that segmental techniques inadequately restore the labrum's function, incompletely treat the defect, and result in mismatch at the labral-graft junction, which is also a "weak spot" for future tears. Yet, others show that circumferential reconstruction is without clear benefit and adds additional anchors, complexity and operating room time and costs. The next phase of research on hip labral reconstruction requires evaluation of the numerous variables within the category of "reconstruction." Today, a great number of different reconstruction techniques exist. Measuring a segmental defect can be challenging but is facilitated with methods such as the kite technique, use of a shoulder superior capsular reconstruction guide, or a pull-through method to simply avoid measuring. Graft options include ligamentum teres and iliotibial band, anterior and posterior tibialis, hamstring, fascia lata, autograft and allograft. Graft preparation, passage, and fixation techniques also vary widely. Finally, determining how much overlap with native labrum, ideal graft tension, or integrating the transverse acetabular ligament is more art than science. It's time we begin to critically evaluate the differences in reconstructive techniques.