Hip Impingement: Repair of Hip Labral Tear/Soft Tissue Using Soft Anchors

Hip Impingement: Repair of Hip Labral Tear/Soft Tissue Using Soft Anchors

This is a surgical demonstration on a cadaver of an arthroscopic hip labral repair using anchors that are made of all suture. This is a right cadaver hip as if a patient were on their back. The patient's head would be up here, and their feet would be down here.

The surgeon has already placed cannulas through the skin portals and capsule to get down to the joint easily. This is an inside view of the surgeon looking down at the back of the hip joint, essentially looking down at the floor. This is the ball, here is the socket, and here is the labrum going around the rim of the socket. As the surgeon moves the camera, the front of the hip joint comes into view.

The area where most hip labral tears happen is right about here, near the front and top of the joint. If the socket was a clock face, most labral tears are in this 11 o'clock to 2 o'clock range. The first step is to use a drill guide to make a small hole in the bone for the suture anchor. A narrow drill bit comes down through the guide and makes the hole in the bone. The surgeon brings the anchor down the drill guide and inserts it into the hole.

Next, the surgeon will grab the blue and white suture, called the repair suture, and pull it out of the joint, so it is not tangled around anything. They will use the suture passer to put the repair suture between the labrum and the edge of the bony socket from the top down. Then it is grabbed from the other side of the labrum and pulled out of the joint. The repair suture is now going around the labrum.

When the surgeon goes back into the joint, you can see there are 2 sutures that are black and white striped. It is actually 1 long suture that goes down into the anchor and back out again. In this next step, the repair suture, along with the skinny black and white suture, are pulled out of the joint together. The skinny one has the loop at the end of it. Once these are pulled out of the joint, the end of the repair suture is placed through the loop of the black and white suture.

The other suture that was left in the joint, the flat black and white one, now gets pulled all the way out. This pulls the repair suture down into the anchor and back out again. The end of the repair suture now gets pulled and the loop that was created around the labrum gets smaller and smaller. The surgeon pulls until that loop is nice and tight around the labrum, holding it against the bone while it heals. The long tail of the repair suture is cut.

This is what a labral repair looks like with 1 anchor. The surgeon will place as many anchors as necessary to fix the entire tear.