I'd like to thank my co-authors for their work on this study, and also thanks to the program committee for allowing us to present it. Here are my disclosures, they're also on the website. So suture anchor placement in hip arthroscopy is critical for anatomic acetabular label repair. Iatrogenic injury can occur during the drilling phase for suture anchors. Various factors contribute to this, and this is what we are gonna look at. So the purpose of this study is to evaluate the following variables on the risk of perforation of acetabular subchondral bone, or the outer cortex of the acetabulum. We looked at portal utilized, so we looked at the anterolateral portal, the anterior portal, and the dollar portal. The start point, either on the rim or slightly off the rim by two millimeters, and also the use of a straight versus curved drill guide. We also looked at the position on the acetabular clock face as a risk factor. We used 60 acetabular saw bone models. They were marked at the 11, 12, one, and two and three o'clock positions to represent the most common location of acetabular label tears with femoral acetabular impingement. So we used a clay soft tissue model, and we recreated the anterolateral portal, the anterior portal, and the dollar portal. 12 different variable combinations were used with five trials at each of the five clock face positions. A total of 300 drillings were performed. Overall, there were 12.7% of the drillings that perforated the acetabular subchondral bone, and 15% that perforated the outer cortical bone. Breaking this down further, looking at the portal utilized, the dollar portal, by far, had the least subchondral perforations with zero compared to the anterolateral portal and anterior portal, who had 21% and 17%, so fairly similar. Looking at cortical perforation, the anterior portal actually had the most. However, these were mostly at the 11 o'clock and 12 o'clock position more superiorly and posterior superiorly. Really just showing that the anterior portal just isn't a good place to start from to drill for suture anchors in this position. When we looked at straight versus curved drill guides, we really didn't see a statistically significant difference. However, the curved drill guide did produce less subchondral and cortical breaches. The on-rim versus on-rim position is interesting. So drilling slightly off the rim by two millimeters resulted in less subchondral breaches, but no statistical significant difference with cortical perforation. Clock face for articular perforations, they were most frequently found at the two o'clock and three o'clock positions anteriorly. And looking at cortical perforations, they were most commonly located superiorly and posterior superiorly at the 11 and 12 o'clock positions. The study does have limitations. Saw bones don't account for the variability of the acetabular morphology. The drill guide was positioned using direct visualization, so not by looking arthroscopically. And we only tested one curved drill guide angle. The model also does not account for soft tissue envelope variability, because we used the same clay model for all the drillings. So in conclusion, the use of the DALA portal decreases the risk of the subchondral bone perforation. Use of the anterior portal for superior and posterior superior anchors increases the risk of cortical perforation or breaching. The drill start point slightly off the acetabular rim by two millimeters decreases the risk of perforation. However, this has to be balanced with the risk of excessive eversion or malposition of the labrum if that starting point is off the rim by too much. And finally, the understanding of higher risk locations on the acetabular clock face is important and can help the surgeon take steps to avoid drill perforation. Thank you.

suture anchor placement

hip arthroscopy

risk of perforation

acetabular saw bone models

portal utilized