Page 11 - ISAKOS Newsletter 2016 Volume 1

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02a 02b 02c
02d 02e 02f
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Current methodologies used to treat labral tears may be limited in their efficacy in some patients with hip dysplasia and would result in unnecessary capsule-labral detachment and rim exposure/roughening in patients whose acetabulum doesn’t require acetabular rim trimming. The intra-articular placement of the ‘inside-out’ technique allows the surgeon to place the anchor in bone with ample substance while the anchor position allows the forces to pull the labrum inferiorly, instead of superiorly, helping to ensure a more natural anatomical function. Also, when performing a labral repair from the articular surface, the need to separate the capsule from the labrum, as well as to trim the rim, is eliminated. Philippon established that labral adhesions were the major factor necessitating revision hip arthroscopy. By implementing this method of repair, the risk of developing adhesions is minimized, thereby decreasing the need for potential revisions in the future.
In addition, in cases of anatomic variations, where the labrum does not create an adequate suction seal due to superior deviation of the labrum, the direction of pull from conventional anchor placement sutures would be unfavorable. Conventional repair could worsen the labrum anatomy, pulling it further from the correct anatomical position, thereby worsening the pathoanatomy. The ‘inside- out’ technique can restore the physiological suction seal while maintaining the native labrum.
The intra-articular anchor placement described here provides an alternative method for anchor placement, utilizing standard approaches and operative techniques, allowing for easier and faster repair. Lastly, further biomechanical and clinical studies need to be performed to validate this technique and to demonstrate safety.
01 The ‘inside-out’ technique is demonstrated on these arthroscopic pictures on a right hip in the supine position with the camera in the midtrochanteric portal and instrument in the anterior portal.
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01 a / b. 01 c. 01 d.
02 02 a. 02 b.
02 c.
A probe is used to demonstrate the labral tear
The guide is placed and medial anchor is drilled
Lateral anchor is drilled
Both suture limbs are seen under the labrum
The first anchor suture limbs are passed through the base of the labrum
Both anchor suture limbs are seen through the base
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of the labrum
02d-f. Stablelabralrepairiscompleteandshowanatomical
labral seal
ISAKOS NEWSLETTER 2016: Volume I 9
PEARLS & PITFALLS – SURGICAL TECHNIQUE
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