Abstract
Technique Video
Pearls of successful hip arthroscopy. This video describes the key aspects of a successful hip arthroscopy in a left hip. Pearl 1 is proper patient positioning in slight Trendelenburg with the foot on the operative side secured with Coban, the leg adducted, and the foot internally rotated. The pink pad positioning device may be used to provide post-free distraction. After initial traction is confirmed with fluoroscopy, an air arthrogram is performed to disrupt the suction seal. Pearl 2 is perfect portal placement to allow for adequate access to the joint for central and peripheral compartment procedures. The modified mid-anterior portal (mMAP) is made at the 2-o'clock position under direct visualization to ensure atraumatic entry into the joint into the arthroscopic triangle. Pearl 3 is minimal interportal capsulotomy creation through first creating the anterolateral (AL) periportal capsulotomy and second the mMAP periportal capsulotomy. The interportal capsulotomy is performed through the mMAP. Pearl 4 is placement of traction stitches to assist in creation of a defined plane between the capsule and labrum and for preservation of capsular tissue during closure. The first traction stitch is placed through the MAP, and the second through the AL. Pearl 5 is performing rim trimming and subspinal decompression where labral pathology exists. Pearl 6 is balanced labral repair, beginning at the 12 o'clock position through the AL portal, and finishing on the anterior portion of the labrum through the distal anterolateral accessory. Pearl 7 is atraumatic labral repair through cartilage visualization during anchor placement and use of small instrumentation during labral repair. Pearl 8 is proper osteochondroplasty through accessing the peripheral compartment with fat pad debridement, iliocapsularis, and gluteus minimus dissection off of the capsule, and T-capsulotomy. Pearl 9 is ensuring proper cam lesion resection through use of intraoperative commercial tools such as the Stryker HipCheck, which allows for real-time assessment of resection under fluoroscopy. Pearl 10 is creation of a watertight seal during capsular closure, which is started at the portion of the T-capsulotomy parallel to the femoral neck.
Surgical Technique (With Video Illustration)
Set-Up
Pearl 1. Proper Positioning

Access
Pearl 2: Perfect Portals

Central Compartment Arthroscopy
Pearl 3: Minimal Interportal Capsulotomy

Pearl 4: Traction Stitches

Pearl 5: Acetabuloplasty

Pearl 6: Balanced Labral Repair

Pearl 7: Atraumatic Labral Repair

Peripheral Compartment Arthroscopy
Pearl 8: Osteochondroplasty

Pearl 9: Proper Cam Resection

Pearl 10: Capsular Closure

Discussion
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Supplementary Data
- https://www.arthroscopytechniques.org/cms/asset/5f16ce83-c1c8-4538-bc00-c2c480440f88/mmc1.mp4Loading ...Video 1
Pearls of successful hip arthroscopy. This video describes the key aspects of a successful hip arthroscopy in a left hip. Pearl 1 is proper patient positioning in slight Trendelenburg with the foot on the operative side secured with Coban, the leg adducted, and the foot internally rotated. The pink pad positioning device may be used to provide post-free distraction. After initial traction is confirmed with fluoroscopy, an air arthrogram is performed to disrupt the suction seal. Pearl 2 is perfect portal placement to allow for adequate access to the joint for central and peripheral compartment procedures. The modified mid-anterior portal (mMAP) is made at the 2-o'clock position under direct visualization to ensure atraumatic entry into the joint into the arthroscopic triangle. Pearl 3 is minimal interportal capsulotomy creation through first creating the anterolateral (AL) periportal capsulotomy and second the mMAP periportal capsulotomy. The interportal capsulotomy is performed through the mMAP. Pearl 4 is placement of traction stitches to assist in creation of a defined plane between the capsule and labrum and for preservation of capsular tissue during closure. The first traction stitch is placed through the MAP, and the second through the AL. Pearl 5 is performing rim trimming and subspinal decompression where labral pathology exists. Pearl 6 is balanced labral repair, beginning at the 12 o'clock position through the AL portal, and finishing on the anterior portion of the labrum through the distal anterolateral accessory. Pearl 7 is atraumatic labral repair through cartilage visualization during anchor placement and use of small instrumentation during labral repair. Pearl 8 is proper osteochondroplasty through accessing the peripheral compartment with fat pad debridement, iliocapsularis, and gluteus minimus dissection off of the capsule, and T-capsulotomy. Pearl 9 is ensuring proper cam lesion resection through use of intraoperative commercial tools such as the Stryker HipCheck, which allows for real-time assessment of resection under fluoroscopy. Pearl 10 is creation of a watertight seal during capsular closure, which is started at the portion of the T-capsulotomy parallel to the femoral neck.
- Pearls Merged ICMJE
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Footnotes
The authors report the following potential conflicts of interest or sources of funding: S.J.N. reports other from Stryker , Arthrex , Linvatec, and Smith & Nephew, outside the submitted work; and AlloSource: research support; American Orthopaedic Association: board or committee member; American Orthopaedic Society for Sports Medicine: board or committee member; Arthrex: research support; Arthroscopy Association of North America: board or committee member; Athletico, DJ Orthopaedics, Linvatec, and Miomed: research support; Ossur: IP royalties; Smith & Nephew: research support; Springer: publishing royalties, financial, or material support; and Stryker: IP royalties; paid consultant; research support. J.C. reports other from Arthrex, CONMED Linvatec, and Smith & Nephew, outside the submitted work; and American Orthopaedic Society for Sports Medicine: board or committee member Arthrex: paid consultant; Arthroscopy Association of North America: board or committee member; CONMED Linvatec: paid consultant; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: board or committee member; and Ossur and Smith & Nephew: paid consultant. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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