Table 2.

Pearls and Pitfalls

Pearls

The entry portals should be established through the area of the capsular defect to minimize further damage to the native capsule.

A non-toothed shaver and electrocautery (coagulation setting) should be used to gently remove scarring to identify the remaining competent capsule on both the acetabular and femoral sides. Suture anchors should be used on the acetabular side if the capsule is absent.

The lower extremity should be placed in a neutral position (0° of flexion, toes pointed to ceiling) to minimize capsular over-tensioning.

For suture passage around the capsular defect, sutures of alternating colors should be used.

The defect size should be measured in the medial-to-lateral and proximal-to-distal directions using suture limbs and a knot-pusher technique.

Meticulous suture management is the key to this procedure. It is important to avoid crossing stitches throughout the surgical procedure, especially when retrieving sutures through the cannula during graft passage (although there are multiple sutures at a time within the cannula).

The surrounding soft tissue should be lightly abraded with the shaver to stimulate bleeding to increase biological activity in the area.

Pitfalls

Suture tangling prevents appropriate graft positioning. Meticulous suture management is extremely important.

The working cannula needs to be large enough to adequately pass the graft.