Table 1.

Pearls for Kite Technique in Labral Augmentation of Hip

Preparation

Traction sutures are placed in the proximal capsular leaflet to preserve capsular integrity for later repair, as well as improve exposure and visualization.

Anchor insertion and the kite measurement technique are performed with the hip in traction.

Suture management

The anterior anchor sutures are stored within the MAP.

The midbody sutures are stored within the PMAP.

The posterior anchor sutures are stored within the ALP adjacent to the arthroscope.

Graft passage and fixation

The dam should be cut out of the DALA cannula to facilitate graft passage.

Retrieval of 1 strand of anterior anchor suture, followed by 1 strand of posterior anchor suture, should be performed via the DALA cannula.

Prior to placing sutures into the graft with a free needle, the surgeon should ensure that the suture strands are not crossed within cannula.

Each end of the graft should be pierced outside of the joint with the respective suture because attempting to pierce the graft after graft passage into the joint may induce iatrogenic damage to the native labrum, graft, or capsule.

Knots should be tied at the end of each suture after the graft is pierced because these knots will be used to “pulley” the graft into the joint via the kite technique.

The graft should be inserted with the hip in 20° of flexion to relax the proximal capsular remnant and allow for excellent visualization.

The suture piercing the graft will be the post suture for tying, while the opposite strand should be passed around the graft and labrum through the chondrolabral junction to secure the graft and labrum to bone.

The remaining midbody sutures should be placed around the graft and/or labrum similarly to standard labral repair.

ALP, anterolateral portal; DALA, distal anterolateral accessory portal; MAP, midanterior portal; PMAP, proximal midanterior portal.