. 2012 Feb 23;1(1):e15–e21. doi: 10.1016/j.eats.2011.12.001

Table 2.

Pearls and Pitfalls of Hip Labral Reconstruction With Gracilis Autograft

Pearls	Pitfalls
• Surgical consent and sterile preparation and draping of ipsilateral knee in case of unsuspected severe labral insufficiency undetected on preoperative workup • Intentional overlap of graft ends immediately adjacent to capsular side of native labral margins^⁎ • Partial insertion of graft free ends so that an interference fit into anchor site allows desired graft tensioning and theoretic osteointegration (arthroscopic blunt obturator tip may be used to widen suture anchor site entrance if needed) • Graft fixation commencing furthest away from arthroscopic lens, progressively working toward lens to optimize arthroscopic visualization • Femoral osteoplasty (if cam component of FAI) with dynamic surveillance ensures optimal impingement-free environment for successful labral graft incorporation	• Harvesting excessively short autograft^† (one should allow approximately 2 cm of additional graft length beyond estimated labral defect to permit overlapped graft positioning with labral margins and partial seating of terminal ends into suture anchor sites) • Straying too deep may endanger medial collateral ligament or too superficial may endanger saphenous nerve during graft harvest

Pearls

Pitfalls

•
Surgical consent and sterile preparation and draping of ipsilateral knee in case of unsuspected severe labral insufficiency undetected on preoperative workup
•
Intentional overlap of graft ends immediately adjacent to capsular side of native labral margins^⁎
•
Partial insertion of graft free ends so that an interference fit into anchor site allows desired graft tensioning and theoretic osteointegration (arthroscopic blunt obturator tip may be used to widen suture anchor site entrance if needed)
•
Graft fixation commencing furthest away from arthroscopic lens, progressively working toward lens to optimize arthroscopic visualization
•
Femoral osteoplasty (if cam component of FAI) with dynamic surveillance ensures optimal impingement-free environment for successful labral graft incorporation

•
Harvesting excessively short autograft^† (one should allow approximately 2 cm of additional graft length beyond estimated labral defect to permit overlapped graft positioning with labral margins and partial seating of terminal ends into suture anchor sites)
•
Straying too deep may endanger medial collateral ligament or too superficial may endanger saphenous nerve during graft harvest

^⁎

Permit an immediate fluid seal restoration.

^†

Compromising fluid seal restoration.