Circumferential and Segmental Arthroscopic Labral Reconstruction of the Hip Utilizing the Knotless Pull-Through Technique with All-Suture Anchors

ABSTRACT: Appropriate labral tear management is one of the principal priorities of hip-preservation surgery. The labrum’s role in the stability and biomechanics of the hip and preservation of the suction seal has been thoroughly demonstrated. Favorable patient-reported outcomes with labral reconstruction and, more recently, labral augmentation have shown that these are viable reconstructive procedures in the setting of irreparable labra. A wide variety of grafts have been used for these advanced labral restoration techniques. The present Technical Note will describe a detailed arthroscopic circumferential labral reconstruction using the pull-through technique with knotless all-suture anchors. The benefits of such can be applied to both segmental and circumferential labral reconstruction procedures, as well as labral augmentation, based on the intraoperative findings and preference of the surgeon. Technique Video Video 1 The video presents a labral reconstruction using a posterior tibialis tendon allograft and the pull-through technique to treat irreparable labral tears. With the patient in the supine position under traction, the joint is accessed from the anterolateral portal and visualized using a 70° arthroscope. After completing the diagnostic arthroscopy, nonviable circumferential labral fibers are evidenced and the inner circumferential labral fibers are found to be intact. The rim is prepared using a radiofrequency device and a 5.5-mm burr, from the distal anterolateral accessory (DALA) portal. From the DALA portal, the Knotless 1.8 FiberTak anchors are placed sequentially from anterior to posterior. A 6- to 7-mm single-stranded posterior tibialis tendon allograft is used for labral reconstruction. The graft is passed from the mid-anterior portal to the posterolateral portal using the pull-through maneuver. Graft fixation is performed from anterior to posterior, following the order in which the all-suture anchors were placed. The graft end is introduced through the MA portal. Tension is applied through the FiberLoop suture until the graft is inserted into the hip joint and brought adjacent to the anchor. The front end of the graft is brought into the position of the most anterior anchor, the loop end of “shuttle” suture is retrieved from the MA portal and assembled with the “repair” suture. The surgeon then pulls the contralateral limb of the “shuttle” suture until desired tension is achieved to the “repair” suture, securing the graft to the first anchor. Next, moving sequentially from anterior to posterior, the repair limb of each knotless suture is passed around opposite end of the graft from the looped end of the “shuttle” stitch. The contralateral end of “shuttle” suture is again tensioned until the graft is fixated to the acetabular rim. Finally, the excess graft is amputated using a radiofrequency device. The final scene of the video reveals the reconstructed labrum restoring the suction seal of the joint. (MA, mid-anterior.)

SUBMITTER: Sabetian P 

PROVIDER: S-EPMC8556550 | biostudies-literature |

REPOSITORIES: biostudies-literature