Maximizing the Benefits of Postless Hip Arthroscopy: On‐Off Traction Technique During Labral Repair to Restore the Labral Suction Seal

Figures

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  Fig 1. Diagnostic evaluation of the right hip in supine position, viewing from the anterolateral portal with a 70° arthroscope. After initial entry to the central compartment with approximately 70 lbs of traction, the labral tear (LT), femoral head (FH), and acetabular (A) cartilage are visualized, being probed (represented by the arrow) from the midanterior portal. Demonstrated is a labral tear with disruption of the chondrolabral junction, with evaluation of the extent of the tear in preparation for repair.

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  Fig 2. Global arthroscopic view of a right hip labral tear from an anterolateral portal, demonstrating its extent. After addressing central compartment pathology including pincer and subspine anatomy, and acetabular rim decortication in the area of planned resection, anchors are placed. Anchor placement is performed in a lateral-to-medial fashion adjacent to the labrum, with care taken to avoid intra-articular penetration. The arrow in the image represents placement of the first anchor. Traction can be partially released or lowered to help relax the proximal capsule and assist with angulation of the guide as needed while anchors are placed. (C, capsule; CLJ, capsulolabral junction; FH, femoral head; L, labrum.)

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  Fig 3. Viewing of a right hip labral repair from the mid anterior portal. After placement of each anchor, suture passage of the repair suture is passed through the damaged chondrolabral junction (represented by the arrow above) with the hip in traction to reduce risk for damage to the hip joint cartilage. (FH, femoral head; L, labrum.)

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  Fig 4. Viewing of a right hip labral repair after suture passage from the midanterior portal. After passage of suture per the technique chosen by the surgeon, traction is released (represented by the arrow on the right) while the arrow on the left represents tying at the anchor to ensure anatomic labral position, and restoration of the labral suction seal is achieved. The process is repeated for each anchor as the repair is progressed medially, ensuring anatomic repair and restoration of the suction seal. (FH, femoral head; L, labrum.)

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  Fig 5. Intra-articular viewing from the midanterior portal and extra-articular viewing of a right hip in a supine positioning on the postless traction table while the surgical team is operating. Gross and fine traction is re-established (represented by the arrow in the photo) after tying each anchor, allowing for evaluation of the suction seal restoration. (FH, femoral head; L, labrum.)