Arthroscopic Acetabular Labral Repair
Table of Contents
- The patient is taken to the operating room and positioned supine on the operating table.
- The patient is placed under general anesthesia with endotracheal tube intubation.
- The patient is then placed against a silicone-padded perineal post, in foam boots and placed in traction.
- A positive vacuum sign is noted after which traction is let off.
- The patient is then draped and prepped in usual sterile manner using aseptic technique.
- The anterolateral portal is established using fluoroscopic guidance with the gauge cannulated needle and the joint insufflated.
- A 5-0 obturator and cannula are then placed.
- The anterior portal is established next under direct arthroscopic viewing.
- This is followed by the mid anterior portal and Dienst portal.
- A diagnostic arthroscopy is performed to assess the surrounding structures, including the labrum, Ligamentum Teres, Pulvinar and Femoral head.
Acetabular osteoplasty and Labral Repair
- The acetabular rim is then recessed using fluoroscopic guidance, starting laterally and working medially from approximately the 12 o'clock to the 3 o'clock position using a #4-0 round abrader on reverse.
- Labral repair is undertaken by visualizing the transverse ligament, then cleaning the inferior recess and acetabular notch of any loose bodies.
- Accessory mid-anterior and Dienst portals are then used to introduce the Smith and Nephew knife rasp to elevate the capsule approximately 5-8 mm above the capsulolabral junction, then cut down to the acetabular brim.
- Anchors are then placed with 2.3 osteoarticular Smith and Nephew anchors.
- The sutures are shuttled through the labrum using vertical mattress sutures and each anchor and suture is passed the same under direct fluoroscopic guidance along with direct viewing.
- Knots are tied on the capsular recess side using a modified Weston with multiple half hitches, using vertical mattresses.
- Sutures are shuttled using wire suture shuttle relay and the anchors are composite 2.3 osteoarticular anchors loaded with #2 FiberWire sutures, again knots were kept on the capsular recess side.
- In addition, the labrum is tensioned down with the traction let off so as not to evert the labrum and also to reconstitute the labrum back to its newly recessed acetabular rim.
- Tissue is then tested for stability of repair by probing.
- The hip joint is put through range of motion to assess stability.
- Traction is then let off.
- The instruments are removed and the scope is placed in the peripheral compartment.
- Medial and lateral gutters are assessed for presence of loose bodies.
- The medial and lateral synovial folds are assessed for lesion.
- The Zona orbicularis is assessed for lesions.
- The capsular reflection is assessed for separation off of the femoral neck.
- The scope and instruments are removed.
- The portals are closed using 3-0 nylon sutures with interrupted stitches and then covered with Adaptic along with sterile gauze along with Op-Site dressings.
- The patient is awakened, extubated, and transferred to recovery room bed and checked post-operatively for any surgical complications.