Hip Chondrolabral Dysfunction: The Road From Excision to Repair, Replacement, and Regeneration

Prior to 2000, hip arthroscopy had been described by Burman but was not widely employed in clinical practice. After the early 2000s, however, hip arthroscopy became of interest to many surgeons, and its utilization has continued to increase over time. From the early days of hip arthroscopy, numerous studies have provided technical, anatomic, and clinical evidence in support of the use of arthroscopic hip surgery, including contributions from our group. This manuscript highlights key developments in the management of labral pathology, including the development of labral repair techniques, improved understanding of acetabular anatomy, and the development of labral reconstruction procedures, along with biomechanical studies to support their use. For the treatment of labral injuries from debridement to reconstruction, clinical outcome investigations and biomechanical studies have helped guide current surgical strategies. Finally, this review also discusses basic science research and ongoing translational clinical trials investigating novel orthobiologic approaches to support the next generation of evidence-based treatments for hip pathology. Research on patient-centered care management has increasingly focused on improving outcomes and avoiding the need for revision surgery, incorporating translational bench-to-bedside as well as bed-to-benchside approaches. This comprehensive research included in this paper spans over a 25-year period and combines four areas of research, including large clinical outcomes studies, biomechanics, biomotion/imaging, and finally novel therapies for regenerative and personalized medicine. The goal of this work is to continue improving outcomes for patients undergoing hip arthroscopy.