Abstract
PURPOSE: Labral advancement is a surgical technique used to reposition an everted or diminutive labrum closer to the chondrolabral junction and femoral head, thereby restoring the suction seal between the acetabulum and femoral head. Currently, there is a lack of quantitative in-vivo evidence directly comparing the suction force before and after restoration of this seal via labral advancement surgery, particularly in cases involving diminutive or everted labra. This study aims to quantitatively assess and compare the suction forces generated before and after labral advancement procedures in patients with diminutive or everted labra. METHODS: This is a single-center prospective cohort study of patients undergoing primary hip arthroscopy with labral advancement between 2023 and 2025. Everted and diminutive labra were identified intraoperatively. Axial traction forces were measured to the point of suction seal disruption using fine traction on the Pivot Guardian Hip Distraction System immediately following diagnostic arthroscopy and measured again after labral advancement conclusion. Traction forces before and after the advancement were compared. To account for effects of instability, participants were subcategorized into two groups based on pre-operative radiographic measures. RESULTS: Ninety patients undergoing primary labral repair were enrolled during the study period, of which 33 hips in 32 patients met intraoperative inclusion criteria. Mean patient age was 31.4 years, with 27 females (84.4%) and 5 male (15.6%) participants. Hip instability was identified in 18 patients (56.3%). Traction force significantly increased following labral advancement in all patients, increasing from a mean pre-advancement measurement of 36.2±15.8 lbf to a post-advancement measurement of 63.2±25.9 lbf, representing an average increase of 27±22.7 lbf (p<0.001). There were no significant differences in the initial, final, or delta axial distraction force measurements between hips with and without instability (p>0.1 for all). CONCLUSION: The axial distraction force required to disrupt the suction seal significantly increased with labral advancement compared to native, pre-advancement labral status. In hips with everted labra, labral advancement restores the suction seal, comparable in strength to that of a healthy native joint. This effect occurs regardless of hip stability status, supporting its use in managing pathological labral variants.