Page 19 - ISAKOS 2018 Newsletter Volume 2

Pitfalls
1. In order avoid pushing the broken bit deeper, care should be taken to ensure that the new adjacent hole is parallel to, adjacent to, and in the same orientation as the broken drill hole.
2. Levering with a microfracture awl should be gentle in order to avoid breakage of the awl, creation of a larger defect, or fracture of the bone.
3. Care should be taken when extracting the broken drill bit so that it is not lost in the soft tissue.
Reference
1. Kelly BT, Weiland DE, Schenker ML, Philippon MJ. Arthroscopic labral repair in the hip: surgical technique and review of the literature. Arthroscopy. 2005;21:1496-504. 2. Weigel DP, Callaghan JJ. Use of anchor sutures to repair labral avulsions of the hip: a brief report. Iowa Orthop J. 1997;17:141-3. 3. Stubbs AJ, Andersen JS, Mannava S, Wooster BM, Howse EA, Winter SB. Arthroscopic hip labral repair: the iberian suture technique. Arthrosc Tech. 2014; 27:3:e351-4. 4. Hernandez JD, McGrath BE. Safe angle for suture anchor insertion during acetabular labral repair. Arthroscopy. 2008; 24: 1390–94 5. Park MS, Yoon SJ, Kim YJ, Chung WC. Hip arthroscopy for femoroacetabular impingement: the changing nature and severity of associated complications over time. Arthroscopy. 2014 ;30:957-63. 6. Lertwanich P, Ejnisman L, Torry MR, Giphart JE, Philippon MJ. Defining a safety margin for labral suture anchor insertion using the acetabular rim angle. Am J Sports Med. 2011;39 Suppl:111S-6S. 7. Matsuda DK, Bharam S, White BJ, Matsuda NA, Safran M. Anchor-induced chondral damage in the hip. J Hip Preserv Surg. 2015;29:2:56-64.
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PEARLS & PITFALLS
01 A-F
01 Broken Drill Bit Within Acetabular Rim: White arrow indicates the broken and embedded drill bit within acetabular rim. Black arrows indicate the adjacent labral repair and sutures. White arrow heads indicate the articular side, and black arrow heads indicate the bony labral interface.
02 Broken Drill Bit after Extraction: Broken drill bit after extraction in comparison with an intact one.
03 New Opened Hole for The Extraction: Black arrow shows end on view of the broken and retained drill bit, white arrow shows newly made adjacent drill hole, black arrow heads indicate the circumferentially curetted and shallowed bony area to have a clear view.
01A Broken drill bit embedded in the acetabular rim presented with 2D and 3D illustrations and arthroscopic views of the event. White crescent shaped structure represents the labrum which had already secured with two suture anchors.
01B A adjacent hole is opened slightly deeper than embedded drill bit
01C An open arthroscopic curette is used to enlarge the entrance
of the holes.
01D A 30 degree microfracture pick is used to dislodge the broken drill bit.
01E Tapping for a larger size anchor.
01F Replacement of the broken drill bit hole with a 4.5 suture anchor.
ISAKOS NEWSLETTER 2018: VOLUME II 17