Arthroscopic Hip Labral Reconstruction and Augmentation—Retro TAPT: Retrograde Passage, Tie Anterior to Posterior, and Truncate

Figures

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  Fig 1. The patient is positioned supine on a traction table with a well-padded perineal post. Fluoroscopy is brought in from the nonoperative side. Right hip shown.

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  Fig 2. A standard anterolateral (AL) portal is established just off the anterolateral edge of the greater trochanter. While under direct visualization from the AL portal, needle localization is used to establish a modified anterior portal (MAP) via an outside-in technique. A distal anterolateral accessory (DALA) portal is similarly established via outside-in technique. A proximal modified anterior portal (PMAP) ∼2 cm proximal and lateral to the AL portal is used for the reconstruction. A posterolateral portal (PL) is established 1 cm proximal and posterior to the posterolateral edge of the greater trochanter. Right hip shown.

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  Fig 3. Peroneus longus allograft prepared the back table with a Fiberloop (Arthrex, Naples, FL) used to place a whip stitch on one end of the graft. Two rip-stop mattress sutures are placed with Monocryl (Ethicon, Somerville, NJ) on the opposite end of the graft.

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  Fig 4. Right hip viewing from the anterolateral (AL) portal. The diminutive, irreparable labrum and the femoral head articular cartilage are visualized. Suture limbs from the most medial anchor (black arrow) of the reconstruction are seen.

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  Fig 5. Right hip viewing from the modified anterior portal (MAP). Lateral knotless 1.8-mm all-suture anchor limbs (black arrow) (hip FiberTak soft anchor, Arthrex, Naples, FL) are visualized along the acetabular rim.

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  Fig 6. Right hip demonstrating suture limbs from the lateral knotless 1.8 mm all-suture anchors (Hip FiberTak Soft Anchor, Arthrex, Naples, FL) exiting the cannula in the proximal modified anterior portal (PMAP), the arthroscopic camera in the anterolateral (AL) portal, the medial anchor suture limb exiting the cannula in modified anterior portal (MAP), and the sled placed in the posterolateral (PL) portal. The allograft tendon is visualized outside the joint.

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  Fig 7. Right hip viewing from the anterolateral (AL) portal. The graft can be seen being pulled into the joint via an arthroscopic grasper and sled with the “pull-through” technique.

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  Fig 8. Right hip viewing from the modified anterior portal (MAP). Lateral knotless 1.8-mm all-suture anchor limbs (black arrows) (Hip FiberTak Soft Anchor, Arthrex, Naples, FL) are being tensioned along the acetabular rim.

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  Fig 9. Right hip viewing from the modified anterior portal (MAP). The excess graft is being amputated with a radiofrequency device (RF) using the sled as a backstop to protect the femoral head articular cartilage.

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  Fig 10. Right hip viewing from the anterolateral (AL) portal. After completion of the reconstruction, traction is let down, demonstrating restoration of the hip suction seal.

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  Fig 11. Right hip viewing from the modified anterior portal (MAP). A round diamond-tipped arthroscopic burr is used to perform the femoral osteochondroplasty in the peripheral compartment.

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  Fig 12. Right hip viewing from the anterolateral (AL) portal demonstrating the knot stack after capsular closure. Arthroscopic knot-typing techniques are utilized to repair the capsulotomy.