Technical Pearls for Arthroscopic Labral Augmentation of the Hip

Figures

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  Fig 1. Patient positioning. The patient is placed supine on a post-free distraction table, and the operative leg (left leg in photograph) is put into traction in a neutral position. The perineum and all bony prominences are appropriately padded.

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  Fig 2. Intraoperative photograph of a left hip, in the supine position, showing the location of the portals and their relation to the greater trochanter. (ALP, anterolateral portal; DALA, distal anterolateral accessory portal; MAP, midanterior portal; PMAP, proximal midanterior portal.)

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  Fig 3. Intraoperative photograph showing the placement of the anterior, midbody, and posterior anchors along the acetabular rim in a left hip, in the supine position, with the arthroscope in the anterolateral portal. The anchors are sequentially placed approximately 8 mm apart along the acetabular rim, just proximal to the hypoplastic labrum.

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  Fig 4. Illustrated diagram (A) and intraoperative photograph (B) showing intraoperative suture organization in a left hip in the supine position. The anchor sutures are organized with the anterior anchor sutures (red) stored in the midanterior portal (MAP), midbody sutures (black) within the proximal midanterior portal (PMAP), and posterior anchor sutures (green) within the anterolateral portal (ALP), adjacent to the arthroscope. One suture strand from the anterior and posterior anchors is then retrieved via the distal anterolateral accessory portal (DALA) cannula for the kite measurement technique.

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  Fig 5. Intraoperative photograph showing the suture bridge formed between the anterior and posterior suture anchors during the kite measurement technique viewed through the anterolateral portal in a left hip in the supine position. The hash marks in 5-mm increments placed along the posterior strand are counted for accurate and reproducible measurement for graft preparation.

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  Fig 6. Intraoperative image showing the prepared tibialis anterior allograft. After thawing and measurement to the appropriate length, as noted from the kite measurement technique, the tibialis anterior allograft is tubularized to 4 to 5 mm in diameter and whipstitched with several No. 2-0 Vicryl sutures. A free needle is used to pierce 1 suture strand from both the anterior and posterior suture anchors into their respective ends of the graft. Multiple half-hitches are thrown to create a knot onto each respective suture strand, leaving a tail of approximately 1 cm. The tails of each suture strand are colored to allow for easy identification once the graft is placed into the joint.

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  Fig 7. Illustrated diagram depicting the kite technique for labral augmentation graft passage in a left hip in the supine position. The red and green sutures represent the sutures from the anterior and posterior anchors, respectively. These sutures are tied onto themselves with multiple half-hitches on their respective ends of the graft. The post ends of these sutures, with the anterior ones stored in the midanterior portal (MAP) and the posterior ones stored in the anterolateral portal (ALP), are alternatingly tensioned during the kite technique for graft passage to effectively pull each end of the graft through the distal anterolateral accessory portal (DALA) cannula into position along the rim. The black sutures represent the midbody anchor sutures, which are stored within the proximal midanterior portal (PMAP) for final graft fixation.

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  Fig 8. Intraoperative photograph showing final graft fixation (A) and restoration of the suction seal viewed through the anterolateral portal in a left hip in the supine position.