Editorial Commentary: Safe Insertion of Acetabular Labral Anchors—Preventing and Detecting Subchondral and Far Cortical Perforations

Abstract

Hip arthroscopy is a rapidly expanding and extremely technically challenging field used to manage mechanical hip derangement. Subchondral and far cortical perforations during anchor insertion are known complications of labral fixation, and evidence-based guidelines on anchor insertion are lacking. The use of curved drill guides 1 to 1.5 mm off the acetabular rim through a distal anterolateral accessory portal gives the lowest chance of both subchondral and far cortical perforations. We always use a flexible wire for portals anterior to the 1-o'clock position; this allows the detection of far cortical perforation prior to anchor insertion. We have found that the routine use of these guidelines minimizes the risk of inserting anchors into the subchondral area or through the far cortex.

Fixation strength in arthroscopic labral repair of the hip: A head-to-head comparison of the biomechanical performance of a biocompatible vs. all-suture anchor in the setting of acetabuloplasty

“…Anchors were inserted according to the manufacturer’s recommendations. A curved drill guide was used to minimize the risk of subchondral and psoas tunnel perforation [ 9 ]. The anchors were spaced 10 mm apart to ensure the bony bridge between anchors was not compromised by crack propagation during the testing [ 10 ].…”

Fluoroscopy-Guided Suture Anchor Placement Yields Excellent Accuracy for Arthroscopic Acetabular Labral Repair: A Cadaveric Study

“…Intra-articular suture anchor placement and intrapelvic suture anchor placement are known complications of arthroscopic acetabular labral repair. 1 , 2 Technical tips to reduce the risk of these complications have been described, including using small-diameter and short suture anchors, 2 using curved drill guides, 3 performing acetabular rim trimming, 4 starting 1 to 2.6 mm from the acetabular rim, 5 , 6 and using distal portals. 2 , 7 , 8 It has been recommended that the surgeon visualize the central compartment during drilling and anchor placement to ensure that the articular cartilage has not been violated 2 and insert a nitinol wire into drilled holes to confirm they are contained prior to anchor insertion.…”