Safety of Hip Anchor Insertion From the Midanterior and Distal Anterolateral Portals With a Straight Drill Guide: A Cadaveric Study

Abstract

Caution should be employed when inserting anchors for labral refixation, particularly in anterior and medial locations (2-4 o'clock), as articular surface and psoas tunnel perforation may occur at a rate higher than previously anticipated. Portal selection does not appear to influence these outcomes.

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

“…When comparing anchor drilling from varying portal locations (anterior, anterolateral, and DALA), Dumont et al 1 found subchondral perforation rates of 21% from the anterior portal, 17% from the anterolateral portal, and 0% from the DALA portal. This is in contrast to our study (Degen et al 2 ), which found no significant difference in articular surface perforation rates when comparing anchors drilled from the midanterior (MA) portal with anchors drilled from the distal anterolateral portal. When evaluating outer cortex perforation rates when drilling from the anterior, anterolateral, and DALA portals, Dumont et al found perforation rates of 36%, 1%, and 8%, respectively.…”

“…To this end, we perform most of our anchor insertions from the DALA portal and switch to an MA portal drilling technique with a curved guide when 3-and 4-o'clock anchor holes perforate in a subchondral manner or through the outer cortex. Again, we believe the conclusion of Dumont et al that the DALA portal is safer is more consistent with our clinical experience, and our results (Degen et al 2 ) may have been under-reported owing to cartilage in our cadaveric model. Their anterior portal may be more proximal than our MA portal, which explains the greater rate of subchondral perforation.…”

“…In addition, it would have been nice to use different acetabula of different center-edge angles and see how this variable affected subchondral bone perforations. However, this was not shown to yield a difference in our study (Degen et al 2 ).…”

“…1 Both of these rates are higher than what we have experienced. Two studies evaluating the rate of articular perforation 2,3 and one evaluating the rate of outer cortex perforation 2 found that the rate of articular perforation was between 0% and 4.48% and found a slightly higher rate of outer cortex perforation, at 7.69%.…”

Femoroacetabular Impingement: What the Surgeon Wants to Know

“…To avoid this complication, it is recommended to drill the tunnels from the anterolateral and the distal anterolateral portals. 48 If rim trimming is necessary to resect the anterior acetabular wall and roof, meticulous preoperative planning is recommended to avoid excessive resection. Care must be taken in protrusio hips with a negative acetabular index and a large fossa, where removal of peripheral joint lunate surface can dramatically increase the transarticular contact forces, 25 increasing the risk of degeneration.…”