ePoster #705 - ISHA Annual Scientific Meeting 2016

Safety of Hip Anchor Insertion from the Mid-Anterior and Distal Anterolateral Portals with a Straight Drill Guide – A Cadaveric Study

Ryan M. Degen, MD, FRCSC, New York, NY UNITED STATES
Lazaros Poultsides, MD, MS, PhD, New York, NY UNITED STATES
Stephanie Watson Mayer, MD, Aurora, CO UNITED STATES
Angela Li, MD, New York, NY UNITED STATES
Struan H. Coleman, MD, PhD, New York, NY UNITED STATES
Anil Ranawat, MD, New York, NY UNITED STATES
Danyal H. Nawabi, MD, FRCS(Orth), New York, NY UNITED STATES
Bryan Talmadge Kelly, MD, New York, NY UNITED STATES

Hospital for Special Surgery, New York, New York, UNITED STATES

FDA Status Not Applicable

Summary: This cadaveric study compares anchor insertion from the mid-anterior and distal anterolateral portal, focusing on accuracy and associated complications rates.

During arthroscopic labral refixation, suture anchors are typically inserted from either the mid-anterior (MA) portal or the distal anterolateral (DALA) portal, however, no studies have previously compared these techniques.

To compare acetabular rim accessibility and associated complication rates of anchor insertion from these portals. We hypothesize that rim access with be better from the DALA portal. Additionally, we hypothesize articular surface perforation will occur more commonly from the MA portal, while psoas tunnel perforation will occur more commonly from the DALA portal.

Sixteen pelvic cadaver specimens (32 hips) were obtained and arthroscopy performed in the supine position. Suture anchors were placed at seven predetermined locations (9, 11, 12, 1, 2, 3 and 4 o’clock). Hips were treated as matched-pairs such that one hip from each specimen had all anchors placed from the MA portal and the other from the DALA portal. Allocation ensured an equal distribution of laterality between groups. Following anchor insertion, specimens underwent CT scan and dissection for further evaluation.

Rim accessibility was similar between groups, with similar access and successful anchor insertion at each location (p=0.1012).
Articular surface perforation occurred in 4.47% of all anchor insertion attempts, most commonly at the 3 o’clock position (p=0.0242). From the MA portal, 4% (4/100) perforated the joint, compared to 4.95% (5/101) from the DALA portal (p=1.0). Further, there were no significant differences in perforation rates at each location between techniques (p=1.0)
Psoas tunnel perforation occurred in 7.7% of all anchor insertion attempts between 2 and 4 o’clock, with equal rates at each location (p=0.6606). From the MA portal, 4.16% (2/48) perforated the psoas tunnel compared with 11.67% (5/43) from the DALA portal (p=0.2486). Further, there were no significant differences at each location between techniques (p=0.4839).
There was no association between acetabular version, femoral version or LCEA and articular or psoas tunnel perforation, regardless of portal use.

Anchor insertion from either the MA or DALA portal appears to confer similar rim access and articular surface or psoas tunnel perforation rates, with a cumulative rate of 4.47% and 7.7%, respectively. Rates of perforation did not differ between portals and were not associated with acetabular or femoral version or LCEA.

Clinical Relevance:
Caution should be employed when inserting anchors for labral refixation, particularly in anterior locations, as articular and psoas tunnel perforation may occur at a rate higher than previously anticipated. Portal selection does not appear to influence these outcomes.