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Arthroscopic surgery, including implants and advanced techniques, continues to advance in the field of orthopaedics. The evolution of suture anchors has undergone design changes, passing from first-generation metal anchors, biodegradable materials, different plastic polymers, to all-suture constructs. Knotless technology also has been found to be a more reproducible method and have comparable outcomes with those found using knotted anchors. This Technical Note describes the advantages and different ways this tensionable anchor can be used in arthroscopic procedures. This implant and its understanding will be useful in the sports medicine area by simplifying procedures and making them more reproducible. The aim of the present Technical Note is to detail the simplicity and versatility of the anchor and discuss different scenarios in which this technology can be used to address common hip pathologies., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This study was supported by 10.13039/100007307Arthrex funding (IIRR-01609). B.G.D. is supported by the American Orthopedic Foundation. B.G.D. reports a relationship with 10.13039/100007307Arthrex that includes: consulting or advisory, funding grants, nonfinancial support, and speaking and lecture fees; a relationship with 10.13039/100008894Stryker Corporation that includes: funding grants and speaking and lecture fees; a relationship with Medacta USA that includes: nonfinancial support and speaking and lecture fees; a relationship with Orthomerica that includes: nonfinancial support; a relationship with 10.13039/100016178Medwest Associates that includes: speaking and lecture fees; a relationship with HydroCision that includes: consulting or advisory; a relationship with Ossur that includes: nonfinancial support; a relationship with 10.13039/100008894Stryker Endoscopy that includes: funding grants and nonfinancial support; a relationship with the American Hip Institute Research Foundation that includes: board membership; a relationship with AANA Learning Center Committee that includes: board membership; a relationship with Journal of Arthroscopy that includes: board membership; and a relationship with American Hip Institute that includes: equity or stocks. B.G.D. has a patent, “Method and instrumentation for acetabular labrum reconstruction,” with royalties paid to Arthrex; a patent, “Knotless suture anchors and methods of tissue repair,” with royalties paid to Orthomerica; a patent, “Knotless suture anchors and methods of tissue repair,” with royalties paid to DJO Global; a patent, Adjustable multi-component hip orthosis,” with royalties paid to Arthrex; and a patent with royalties paid to Medacta. A.C.L. reports a relationship with 10.13039/100007307Arthrex that includes: consulting or advisory, nonfinancial support, and travel reimbursement; a relationship with 10.13039/100008894Stryker Corporation that includes: consulting or advisory, nonfinancial support, and travel reimbursement; a relationship with Medwest that includes: nonfinancial support and travel reimbursement; a relationship with Smith & Nephew that includes: nonfinancial support and travel reimbursement; a relationship with Vericel that includes: nonfinancial support and travel reimbursement; and a relationship with 10.13039/100012630Zimmer Biomet that includes: nonfinancial support and travel reimbursement. A.C.L. is Medical Director of Hip Preservation at St. Alexius Medical Center and a clinical instructor at the University of Illinois College of Medicine. All other authors (P.A.P., J.S.O., W.T.H., P.W.S.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Anterior iliopsoas (IP) impingement after total hip arthroplasty is an underrecognized and continued cause for postoperative pain. There are multiple etiologies for this impingement from cup positioning and sizing to changes in the leg length, and offset must be evaluated to confirm no need for implant revision. Additionally, tension of the IP tendon can be increased in patients with diminished spinal mobility, either from prior fusion or with increasing age. Managing this surgically after failing conservative treatment options is best done arthroscopically to prevent additional large, open procedures that place the arthroplasty at unnecessary risk of infection and potential instability. In this article, we describe an arthroscopic technique using fluoroscopy to guide the release of the iliopsoas tendon from the peripheral compartment., (© 2022 The Authors.)

Femoroacetabular impingement is recognized as a common cause of hip pain. Cam-type femoroacetabular impingement results from abnormal contact between an aspherical femoral head and the acetabular rim during hip range of motion, leading to labral tearing, cartilage damage, and, eventually, osteoarthritis. Arthroscopic correction of this bony deformity has been well described, particularly in the anterolateral quadrant of the femoral neck. Some deformities extend well beyond this quadrant, involving most or all of the circumference of the femoral neck, making arthroscopic decompression a challenge. We present a post-less, all-arthroscopic technique for performing a circumferential cam decompression using 3-dimensional preoperative planning software and interactive fluoroscopy-integrated computer vision interface., (© 2022 The Authors.)

Numerous studies have analyzed techniques for producing reliable and efficient arthroscopic knots. All aspects have been explored, from the biomechanics and strength to the ability to teach and replicate at all levels of training. This technique article describes an additional maneuver (X-grab) for efficiently marking the post side of the arthroscopic knot without having to do this separately outside of the joint. This is most useful for procedures such as rotator cuff repair and capsular repair or plication in hip arthroscopy in which the location of the knot (i.e., the post) is critical. The aim of this Technical Note is to describe the X-grab maneuver, which shortens this process to a single step, limiting the see-sawing of sutures and over-instrumentation of the joint seen with other techniques., (© 2022 The Authors.)

Appropriate labral tear management is one of the principal priorities of hip-preservation surgery. The labrum's role in the stability and biomechanics of the hip and preservation of the suction seal has been thoroughly demonstrated. Favorable patient-reported outcomes with labral reconstruction and, more recently, labral augmentation have shown that these are viable reconstructive procedures in the setting of irreparable labra. A wide variety of grafts have been used for these advanced labral restoration techniques. The present Technical Note will describe a detailed arthroscopic circumferential labral reconstruction using the pull-through technique with knotless all-suture anchors. The benefits of such can be applied to both segmental and circumferential labral reconstruction procedures, as well as labral augmentation, based on the intraoperative findings and preference of the surgeon., (© 2021 by the Arthroscopy Association of North America. Published by Elsevier.)

Gross hip instability in an active adult with previous normal hip anatomy is usually due to disruption of the static stabilizers of the hip joint. Although such a disruption can result from a high-grade injury, it can be iatrogenic after previous hip arthroscopy. The patient may present with a painful limp and recurrent subluxation sensation in the affected hip joint. Revision hip arthroscopy in this scenario is generally complicated, and it is not uncommon for all the soft-tissue stabilizers to be compromised. The labrum, ligamentum teres (LT), and capsule of the hip joint are often so damaged that reparation is not an option. Reconstruction of the torn LT is an established method to add secondary stability while addressing the labral pathology in the hip joint with microinstability. Concomitant reconstruction of all the static restraints has yet to be described addressing triple instability. This Technical Note presents a stepwise approach, including tips and pearls, for arthroscopic triple reconstruction of the labrum, LT, and capsule. We believe this method is a safe and reproducible way to effectively treat gross hip instability in young patients., (© 2021 by the Arthroscopy Association of North America. Published by Elsevier.)

Treatment of hip joint chondral damage is a well-recognized aspect of the arthroscopic management of femoroacetabular impingement syndrome. Hip chondral resurfacing has evolved from microfracture to different forms of cartilage grafting, all with variable long-term outcomes. Recent literature has focused on techniques using different cartilage sources (native and synthetic products) that are available for clinicians to choose from during hip arthroscopy. None of the published reports on cartilage grafts have commented on hip joint capsular management as part of the procedure. This is likely because of the increased difficulty of capsular closure in the dry arthroscopic environment required for graft stabilization. However, potential iatrogenic hip instability induced by an unrepaired interportal capsulotomy can be detrimental to the existing joint architecture and possibly to the cartilage graft. This article presents a step-by-step approach, including tips and pearls, for capsular closure during arthroscopic acetabular chondral resurfacing with BioCartilage (Arthrex, Naples, FL). This method is a safe and reproducible way to close the joint capsule during chondral resurfacing in patients undergoing hip preservation that can potentially enhance the chances of a successful outcome., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier.)

Gluteus medius (GM) tears are a well-established source of pain and disability. Considering previous studies, which have reported rates of incidental GM tears in 20% of patients undergoing primary total hip arthroplasty (THA) and a 3-fold greater rate in elderly female patients, additional focus should be placed on identifying treatment options. The direct anterior approach (DAA) for primary THA has gained popularity within the past few years. However, there has been a paucity in the literature on how to address symptomatic and partial GM tears through this approach. The purpose of this Technical Note is to describe a method to repair partial GM tears during primary THA using the DAA., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier.)

Intraosseous bioplasty (IOBP), has been previously described for arthroscopic-assisted treatment of subchondral bone cysts in the proximal tibia associated with early stages of knee osteoarthritis (OA). This technique entails combining bone marrow aspirate concentrate or concentrated platelet-rich plasma with demineralized bone matrix as a bone substitute before injecting into a subchondral bone defect under fluoroscopic guidance. The principles of IOBP as a procedure that combines core decompression with biologic bone substitute augmentation can be extended to treat subchondral bone marrow lesions such as acetabular and femoral cysts in degenerative hip OA. Intraosseous bioplasty of the hip, in particular the acetabulum, when done using this technique, is a useful alternative that can be beneficial in treating young patients with early hip arthritis to achieve successful outcomes while delaying more invasive procedures. The Technical Note described here presents a step-by-step approach, including tips and pearls for arthroscopic-assisted IOBP with decompression of the subchondral cyst in the acetabulum followed by bone substitute injection under fluoroscopic guidance. We believe this method is a safe and reproducible way to treat subchondral defects in young patients with signs of early osteoarthritis of the hip joint., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier.)

Femoroacetabular impingement describes a pathologic interaction between the bony femoral head/neck junction and acetabulum. Cam-type femoroacetabular impingement results from an aspherical femoral head architecture, which increases early contact along the acetabular surface during hip range of motion. Errant arthroscopic femoroplasty recently has been discussed within the literature to describe a preventable etiology of failed hip arthroscopy, most notably cam over- and under-resection. We present an arthroscopic surgical technique for achieving the perfectly spherical femoroplasty, meant to minimize complications and improve postoperative outcomes., (© 2019 by the Arthroscopy Association of North America. Published by Elsevier.)

Management of chondral lesions of the femoral head can be challenging. Previously described approaches include arthroscopic surgery for small lesions and open surgical dislocation for larger lesions. In 2001, Ganz popularized the trochanteric flip osteotomy for surgical dislocation, and this remains the workhorse for treatment of large chondral lesions. However, by using a Smith-Peterson (direct anterior) approach and a femoral head allograft, large lesions may be treated while avoiding both trochanteric osteotomy and donor-site morbidity. We present our technique using a Smith-Peterson approach and osteochondral implantation of fresh femoral head allograft for surgical treatment of a femoral head chondral lesion., (© 2019 by the Arthroscopy Association of North America. Published by Elsevier.)

Despite all the advances in hip arthroscopy, microfracture is still the workhorse for treating focal and full-thickness cartilage lesions. The success of this treatment is owed to its reliability and simplicity. Given the structure of the hip joint, however, there are challenges to this procedure using a conventional microfracture pick. This note presents our current and preferred microfracture technique using a curve drill guide and flexible drill. This method offers greater range of access to different regions of the joint with ease, thus ensuring a reproducible and quicker procedure with less risk., (© 2019 by the Arthroscopy Association of North America. Published by Elsevier.)

The importance of the labrum in the biomechanics of the hip joint is well documented. Labral tears are the most common pathology in patients undergoing hip arthroscopy and therefore appropriate labral management is vital. Labral preservation has been advocated as a superior alternative to labral excision in terms of clinical outcomes. While reconstruction of the labrum is recommended for irreparable tears, labral augmentation is a viable alternative for labral function restoration under certain indications. This Technical Note will describe a method for arthroscopic hip labral augmentation using an anterior tibialis tendon allograft and the pull-through technique., (© 2019 by the Arthroscopy Association of North America. Published by Elsevier.)

Once perceived to be a vestigial structure, the ligamentum teres (LT) is now increasingly understood to be critical to providing stability in the adult hip. Surgical treatment with arthroscopic debridement is usually the procedure of choice to treat LT tears. However, reconstruction is a possible alternative in select cases. The authors of a recent systematic review concluded that LT debridement may provide short-term relief of hip pain in patients with partial-thickness tears in whom conservative management has failed whereas reconstruction may be more beneficial in cases of full-thickness tears. This Technical Note describes a method for arthroscopic LT reconstruction using the tension-slide technique to fixate an anterior tibialis tendon allograft to the acetabulum., (© 2019 by the Arthroscopy Association of North America. Published by Elsevier.)

Different techniques have been described to close or plicate the capsule. To perform these procedures, however, the capsule must be preserved, a consideration unfortunately often overlooked. This Technical Note describes in a stepwise manner the initial capsular management necessary to preserve the capsule for further procedures such as closure or plication. Level of Evidence: I (hip), II (impingement, labrum, other)., (© 2019 by the Arthroscopy Association of North America. Published by Elsevier.)

Over the past decade, understanding of disorders compromising greater trochanteric pain syndrome (GTPS) has increased dramatically. Nonsurgical treatment options include physical rehabilitation and activity modification, anti-inflammatory as well as biologic injections into the peritrochanteric compartment, and administration of oral analgesics. Multiple open and endoscopic treatment options exist when nonsurgical management is unsuccessful in patients with refractory lateral-sided hip pain, with or without weakness. No true consensus exists within the literature regarding operative techniques of GTPS or postoperative rehabilitation protocols. We present an endoscopic classification system of GTPS with 5 distinct types, which seems to correlate well with preoperative diagnoses and postoperative rehabilitation protocols. The classification system is intuitive, and the corresponding surgical techniques are reproducible for surgeons treating peritrochanteric pathology. Level of Evidence: I (hip); II (extra-articular, impingement)., (© 2019 by the Arthroscopy Association of North America. Published by Elsevier.)

Most surgeons rely on the greater trochanter as the reference point to establish the anterolateral portal. Nevertheless, we believe that the anterosuperior iliac spine is a more reliable landmark. Unlike the greater trochanter, it is unaffected by leg rotation and is more easily identified by palpation. Abiding by the central tenet of medicine to "do no harm," the technique described herein presents in detail the concept of the 12 o'clock portal placement, a hip joint access method based on identifying specific anatomic points under fluoroscopy and by palpation. To accomplish this goal, this Technical Note presents a step-by-step approach, including tips and pearls for patient positioning and fluoroscopic guidance. We believe this method ensures a reproducible and safe way to start hip arthroscopy in the supine position.

In the setting of true hip dysplasia, the high prevalence of intra-articular pathology may lead to recurrent symptoms and failure after periacetabular osteotomy (PAO). Femoral neck osteochondroplasty, microfracture, removal of loose bodies, and labral repair are examples of procedures that are performed with concomitant arthroscopy. When damage to the labrum is too severe to repair, reconstruction instead of extensive debridement before PAO can be more effective in restoring the labral seal to maintain joint lubrication and chondral protection. This Technical Note describes a method for concomitant hip arthroscopy with circumferential labral reconstruction with allograft and PAO.

The concept of margin convergence for side-to-side strain reduction in massive U-type rotator cuff tears has been used to protect the free margin repair to bone. Data in the literature show favorable outcomes for this method of repair. However, one of the challenges when performing side-to-side repair has been the dog-ear deformity that forms at both the convergence split and marginal ends. We present a method of single-suture convergence using a "shoelace" weaving technique, which seems to decrease the incidence of dog-ear deformity, decreases margin strain, and can be incorporated into current transosseous-equivalent rotator cuff repair configurations. The technique is simple and reproducible for large or massive tear patterns.

Hip dysplasia has been identified as one of the leading causes of osteoarthritis. However, hip arthroscopy alone, in the setting of hip dysplasia, remains controversial. In borderline hip dysplasia, with lateral center-edge angle (LCEA) between 18° and 25°, good outcomes have been reported with appropriate capsular and labral management. However, in severe hip dysplasia, with LCEA below 18°, there is an acetabular bony structural deficiency that must be addressed. Even with the potential benefit of hip arthroscopy in addressing intra-articular injuries related to the instability, it cannot be used for soft-tissue procedures. Periacetabular osteotomy remains the gold standard to address that matter; however, its invasive nature along with the long recovery time leaves some patients unwilling to undergo this procedure. New minimally invasive endoscopic procedures, derived from open techniques, describe acetabular autologous bone grafting as an alternative. Donor-side morbidity is always a concern when using autografts; we believe that the use of bone allograft will decrease this potential issue and make the procedure itself less invasive. This Technical Note will describe a type of endoscopic shelf acetabuloplasty using an allograft iliac bone graft.