Editorial Commentary: Safe Insertion of Acetabular Labral Anchors-Preventing and Detecting Subchondral and Far Cortical Perforations.

Hip arthroscopy is a rapidly expanding and extremely technically challenging field used to manage mechanical hip derangement. Subchondral and far cortical perforations during anchor insertion are known complications of labral fixation, and evidence-based guidelines on anchor insertion are lacking. The use of curved drill guides 1 to 1.5 mm off the acetabular rim through a distal anterolateral accessory portal gives the lowest chance of both subchondral and far cortical perforations. We always use a flexible wire for portals anterior to the 1-o'clock position; this allows the detection of far cortical perforation prior to anchor insertion. We have found that the routine use of these guidelines minimizes the risk of inserting anchors into the subchondral area or through the far cortex.