Arthroscopic Inverting Repair Technique for Inside‐Out Hip Labral Tears

Figures

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  Fig 1. Anteroposterior pelvis radiograph of the patient with hip dysplasia. (LCEA, lateral center-edge angle.)

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  Fig 2. Arthroscopic image of a left hip from the anterolateral portal with the yellow arrow pointing to the patient’s inside-out labral tear pattern.

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  Fig 3. Patient positioning on a traction table with the operative extremity secured into a well-padded boot and utilization of a padded perineal post.

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  Fig 4. Fluoroscopic image of a left hip under traction showing needle localization and performance of an air arthrogram.

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  Fig 5. Arthroscopic image of a left hip from the anterolateral portal during diagnostic arthroscopy showing labral tearing and chondrolabral delamination.

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  Fig 6. Arthroscopic view of a left hip from the anterolateral portal of the femoroacetabular articulation after traction is released, showing a poor suction seal in the region labeled by the yellow arrow.

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  Fig 7. Arthroscopic image of a left hip from the anterolateral portal establishing the distal anterolateral accessory portal under arthroscopic visualization. A suspension suture is visualized in the medial capsule leaflet.

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  Fig 8. Arthroscopic image of a left hip from the anterolateral portal. The inside-out labral repair is performed by first inserting a curved drill guide through the distal anterolateral accessory portal over a nitinol guidewire, positioned between the labrum and articular cartilage.

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  Fig 9. Fluoroscopic image of a left hip confirming adequate drilling trajectory on the acetabular rim prior to anchor placement.

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  Fig 10. Arthroscopic image of a left hip from the anterolateral portal showing placement of the anchor with suture limbs on the articular side of the labrum.

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  Fig 11. Arthroscopic image of a left hip from the anterolateral portal showing a suture-passing device passed through the mid-anterior portal and under the labrum in an outside-in fashion.

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  Fig 12. Arthroscopic image of a left hip from the anterolateral portal depicting the use of the curved drill guide to aid in suture retrieval. The guide is left in the distal anterolateral accessory portal so that the suture limbs are within the drill guide and can be easily controlled. This minimizes movement required by the suture-passing device, which is underneath the labrum.