Acetabular Subchondral and Cortical Perforation During Labral Repair With Suture Anchors: Influence of Portal Location, Curved Versus Straight Drill Guides, and Drill Starting Point

2019 ◽  
Vol 35 (8) ◽  
pp. 2349-2354 ◽  
Author(s):  
Guillaume D. Dumont ◽  
Adam J. Money ◽  
Zachary T. Thier
Keyword(s):  
Labral Repair ◽  
Suture Anchors ◽  
Starting Point ◽  
Cortical Perforation

scholarly journals Acetabular Subchondral and Cortical Breach During Labral Repair with Suture Anchors: Influence of Portal Location, Curved vs Straight Drill Guides, and Drill Starting Point

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0037
Author(s):  
Guillaume D. Dumont ◽  
Adam Money ◽  
Zachary Thier
Keyword(s):  
Subchondral Bone ◽  
Articular Surface ◽  
Labral Repair ◽  
Relative Impact ◽  
Suture Anchors ◽  
Drill Guide ◽  
Labral Tears ◽  
Starting Point ◽  
Drill Holes ◽  
Acetabular Rim

Objectives: Acetabular labral tears are commonly treated with arthroscopic repair using suture anchors. Iatrogenic chondral injury has been cited as one of the more common complications during hip arthroscopy, and can occur while pre-drilling for suture anchors. Proposed factors contributing to penetration of the articular subchondral bone or the far cortex of the acetabulum include the portal utilized for drilling; the position of the drill guide relative to the acetabular rim (on rim, ON; off rim, OFF); and the use of straight (ST) versus curved (CU) drill guides. The purpose of this study was to evaluate the relative impact of these variables on drill penetration of the acetabular subchondral bone or the far cortex of the acetabulum. Methods: Sixty sawbone acetabula models were marked at the 3, 2, 1, 12, and 11 o’clock position. A Simulated anterior (AP), anterolateral (AL), and distal anterolateral accessory (DALA) portals were created. Twelve groups of five acetabula were drilled at each clock face position: ST/AP/ON; ST/AL/ON; CU/AP/ON; CU/AL/ON; ST/AP/OFF; ST/AL/OFF; CU/AP/OFF; CU/AL/OFF; ST/DALA/ON; ST/DALA/OFF; CU/DALA/ON; CU DALA/OFF. Perforations of the articular subchondral bone and far cortex of the acetabulum were recorded. Results were tabulated and analyzed to assess the relative impact of each variable both in aggregate and at each position on the clock face. Results: A total of 300 acetabular suture anchor drill holes were created on 60 acetabula 12 combinations of portal utilized (anterior, anterolateral, distal anterolateral accessory), drill guide type (curved or straight), and rim position (on rim, off rim). A total of 38/300(12.7%) drillings perforated the subchondral bone, and 45/300(15%) breach the far cortex. Drilling from the AP, AL, and DALA portal breached the articular subchondral bone 21/100 (21%), 17/100(17%), and 0/100(0%) respectively; and breached the far acetabular cortex 36/100(36%), 1/100(1%), and 8/100(8%) respectively. Drillings using a curved drill guide penetrated the subchondral bone on 14/150(9.3%) attempts and drillings using a straight drill guide penetrated the subchondral bone 33/150(22%) attempts (p=0.0025). Drillings with an “On Rim” start point breached the articular subchondral bone 29/150(19.3%) versus 9/150(6%) for drillings with an “Off Rim” start point; and breached the far acetabular cortex 21/150(14%) times versus 24/150(16%) times. Articular surface penetrations were most frequent at the 2 and 3 o’clock positons, and far cortex perforations were most frequent at the 11 and 12 o’clock positions. Conclusion: This study quantifies the relative impact of portal location, drill guide, and starting point on the acetabular rim on acetabular subchondral bone and far cortex penetration. Portal location had the highest impact, with the DALA portal noted to be the safest. Curved drill guides also reduced the number of acetabular subchondral bone penetrations. These findings can be used to influence arthroscopic technique during acetabular labral repair.

Acetabular Labral Tear Dimensions and Number of Suture Anchors Used to Repair in Patients with Femoroacetabular Impingement Syndrome

2021 ◽  
Author(s):  
Guillaume D. Dumont ◽  
Matthew J. Pacana ◽  
Adam J. Money ◽  
Thomas J. Ergen ◽  
Allen J. Barnes ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Impingement Syndrome ◽  
Labral Tear ◽  
Labral Repair ◽  
Suture Anchors ◽  
Labral Tears ◽  
Femoroacetabular Impingement Syndrome ◽  
The Mean ◽  
Tear Size ◽  
Anterior Extent

AbstractFemoroacetabular impingement syndrome (FAIS) is commonly associated with acetabular labral tears. Correction of impingement morphology and suture anchor repair of labral tears have demonstrated successful early and midterm patient-reported outcomes. The purpose of this study was to evaluate the posterior and anterior extent and size of labral tears in patients with FAIS undergoing arthroscopic labral repair, and to evaluate the number of suture anchors required to repair these tears. The design of this study was retrospective case series (Level 4). A single surgeon's operative database was retrospectively reviewed to identify patients undergoing primary arthroscopic hip labral repair between November 2014 and September 2019. Patient-specific factors and radiographic measurements were recorded. Arthroscopic findings including labral tear posterior and anterior extents, and the number of suture anchors utilized for the repair were recorded. Linear regression was performed to identify factors associated with labral tear size. The number of suture anchors used relative to labral tear size was calculated. Three-hundred and thirteen patients were included in the study. The mean posterior and anterior extent for labral tears were 11:22 ± 52 and 2:20 ± 34 minutes, respectively. Mean tear size was 2 hours, 58 minutes ± 45 minutes. The mean number of suture anchors utilized for labral repair was 3.1 ± 0.7. The mean number of anchors per hour of labral tear was 1.1 ± 0.3. Increased age, lateral center edge angle, and α angle were associated with larger labral tears. Our study found that acetabular labral tears associated with FAIS are, on average, 3 hours in size and centered in the anterosuperior quadrant of the acetabulum. Arthroscopic labral repair required 1.1 anchors per hour of tear size, resulting in a mean of 3.1 anchors per repair. Level of Evidence IV

Sports Activity after Arthroscopic Superior Labral Repair using Suture Anchors in Overhead-Throwing Athletes

2005 ◽  
Vol 33 (4) ◽  
pp. 507-514 ◽  
Author(s):  
Junji Ide ◽  
Satoshi Maeda ◽  
Katsumasa Takagi
Keyword(s):  
Case Series ◽  
Arthroscopic Repair ◽  
Labral Repair ◽  
Suture Anchors ◽  
Level Of Evidence ◽  
Sports Activity ◽  
Baseball Players ◽  
Overhead Athletes ◽  
Trauma Group

Purpose To evaluate the results of arthroscopic repair of type II superior labral anterior posterior lesions of the shoulder in overhead athletes. Hypothesis Such repair is useful for overhead athletes in terms of postoperative sports activity. Study Design Case series; Level of evidence, 4. Methods The study group was composed of 40 patients with a mean age of 24 years (range, 15-38 years); mean follow-up was 41 months (range, 24-58 months). They were divided into an overuse (n = 22) and a trauma group (n = 18). The authors used 2 suture anchors loaded with a nonabsorbable suture at the 11-o'clock and 1-o'clock positions through the anterosuperior and lateral trans-rotator cuff portal. A modified Rowe score and postoperative athletic activities were evaluated. Results After arthroscopic repair, mean modified Rowe scores improved from 27.5 to 92.1 points (P <. 0001). Rated on this scale, the results were excellent in 30 (75%), good in 6 (15%), and fair in 4 (10%) athletes; there were no poor results. Satisfactory outcomes were achieved in 36 (90%) of these patients; 30 (75%) experienced a return to the preinjury level. The complete return rate of baseball players in the overuse group was lower than that of other overhead athletes in the trauma group. Conclusion Arthroscopic superior labral repair is a safe and reliable procedure in overhead athletes.

scholarly journals The Use of Double-Loaded Suture Anchors for Labral Repair and Capsular Repair During Hip Arthroscopy

2012 ◽  
Vol 1 (2) ◽  
pp. e213-e217 ◽  
Author(s):  
William Slikker ◽  
Geoffrey S. Van Thiel ◽  
Jaskarndip Chahal ◽  
Shane J. Nho
Keyword(s):  
Hip Arthroscopy ◽  
Labral Repair ◽  
Suture Anchors ◽  
Capsular Repair

scholarly journals Evaluation of Repair of the Hip Labrum under Simulated Full Weight-Bearing

2017 ◽  
Vol 27 (1) ◽  
pp. 104-109 ◽  
Author(s):  
Jason L. Koh ◽  
Kavish Gupta
Keyword(s):  
Soft Tissues ◽  
Suture Anchor ◽  
Weight Bearing ◽  
Labral Repair ◽  
Full Weight Bearing ◽  
Suture Anchors ◽  
Gap Formation ◽  
Labral Tears ◽  
Axial Cyclic Loading ◽  
Load To Failure

Introduction Repairs of labral tears are performed for unstable tears, hip instability, and after detachment concomitant to the treatment of femoroacetabular impingement (FAI), but limited data is known about the strength of repair. This study evaluated the effect of simulated axial weight-bearing on suture anchor based repair of the acetabular labrum. Methods 3 cadaveric pelvises underwent creation of a 1.5 cm anterior-superior labral tear in each hip. The tears were then repaired using 2 suture anchors per hip. Following repair, the hip joint underwent axial cyclic loading to 756 N, and were inspected for separation of the labrum from the acetabulum. The strength of the suture anchor repair was evaluated by testing load to failure, in-line with insertion. Results Upon visual examination, all 6 repairs remained fully intact following loading with no visible gap formation or damage at the repair site. In all cases an arthroscopic probe could not be inserted under the edge of the repair. The mean failure force of the 12 suture anchors, in-line with insertion, was 154 N ± 44 N. Conclusions Acetabular labral suture anchor repairs may be able to immediately withstand the physiological loads of axial weight-bearing. Labral repair may be able to tolerate axial weight-bearing immediately after repair, preserving the strength and integrity of muscles and soft tissues.

scholarly journals Serial Changes in Perianchor Cysts Following Arthroscopic Labral Repair Using All-Suture Anchors

2021 ◽  
Vol 13 ◽  
Author(s):  
Jae-Hoo Lee ◽  
Jun-Seok Kang ◽  
In Park ◽  
Sang-Jin Shin
Keyword(s):  
Labral Repair ◽  
Suture Anchors

Computed Tomographic Analysis of Arthroscopic Labral Repair Using Absorbable Knotless Suture Anchors

2013 ◽  
Vol 5 (1) ◽  
pp. 44-47
Author(s):  
Lori G. Weiser ◽  
Susan Alexander ◽  
Sughran Banerjee ◽  
Waseem A. Bashir ◽  
David Connell ◽  
...  
Keyword(s):  
Labral Repair ◽  
Suture Anchors ◽  
Computed Tomographic ◽  
Tomographic Analysis

scholarly journals Arthroscopic Bennett Lesion Resection and Posterior Labral Repair Using All-Suture Anchors

2021 ◽  
Author(s):  
Matthew R. Cohn ◽  
Allison K. Perry ◽  
Daniel J. Kaplan ◽  
Steven F. DeFroda ◽  
Harsh Singh ◽  
...  
Keyword(s):  
Labral Repair ◽  
Suture Anchors

Arthroscopic Reverse Bankart Surgical Repair

2021 ◽  
Vol 1 (5) ◽  
pp. 263502542110348
Author(s):  
Robert S. Dean ◽  
Anirudh K. Gowd ◽  
Carson D. Bunker ◽  
Edward C. Becker ◽  
Eric J. Dennis ◽  
...  
Keyword(s):  
Lifestyle Modification ◽  
Return To Sport ◽  
Rehabilitation Program ◽  
Labral Repair ◽  
Suture Anchors ◽  
Shoulder Dysfunction ◽  
Nonsurgical Management ◽  
Labral Tears ◽  
Diagnostic Arthroscopy ◽  
Lateral Decubitus

Background: Posterior glenoid labrum lesions occur in only 2% to 10% of all cases of shoulder instability, yet these injuries may cause significant shoulder dysfunction in an athletic population. Moreover, these injuries frequently require surgical intervention and present a unique surgical challenge. Indications: Indications for arthroscopic posterior labral repair include symptomatic posterior labral tears identified on magnetic resonance imaging with or without contrast, that failed nonsurgical management (ie, lifestyle modification, nonsteroidal anti-inflammatory drug, and physical therapy). Patients may present with a positive posterior load and shift or positive posterior apprehension test. Technique Description: With the patient in the lateral decubitus position, use a standard posterior superior portal, an ancillary anterior superior portal, a posterior-inferior, and the portal of Wilmington. After portal placement and diagnostic arthroscopy, the torn labrum is debrided. The torn portion of the posterior labrum is then mobilized from approximately the 6 o’clock to 10 o’clock positions, and a curette and shaver are used to produce a bleeding margin for fixation. Two double-loaded 2.4-mm suture anchors are placed, passed, and tied; one at the 6:30 o’clock position and the other at the 8 o’clock position. A cinch stich configuration using a 2.9-mm pushlock anchor can be used at the 10 o’clock position. A polydioxanone suture is used to assist with capsular plication and to close the posterior portal. Results: The literature suggests that 90% to 94% of patients are able to return to their desired sport with 5% to 10% reporting recurrent instability by 2 years after operation. Two out of 3 patients report no limitations at 2 years. Discussion/Conclusion: Arthroscopic repair of posterior labral tears with suture anchors can be an effective surgical option for patients with reverse Bankart lesions. Using advanced imaging to identify concomitant pathologies, meticulous surgical technique, direct visualization of the anatomy and anchor placement, and a dedicated rehabilitation program, greater than 90% of patients can expect to return to sport.

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