A Novel Technique for Capsular Repair and Labrum Refixation in Hip Arthroscopy Using the SpeedStitch  Omer Mei-Dan, M.D., David A. Young, F.R.C.S.  Arthroscopy Techniques  Volume 1, Issue 1, Pages e107-e112 (September 2012) DOI: 10.1016/j.eats.2012.05.001 Copyright © 2012 Arthroscopy Association of North America Terms and Conditions

Figure 1 (A) SS device. (B) Management is performed with a single hand and is straightforward. It should be noted that a stay suture comes out through each of the 2 portals. These sutures are used in the corners of the trapdoor capsulotomy for retraction and improved visualization of the femoral neck. Arthroscopy Techniques 2012 1, e107-e112DOI: (10.1016/j.eats.2012.05.001) Copyright © 2012 Arthroscopy Association of North America Terms and Conditions

Figure 2 The peripheral compartment of the right hip after cam resection is completed and capsular repair is obtained. The camera is positioned at the anterolateral portal under the capsule. Repair work, as shown, is performed through an anterolateral portal in an “inside-out” manner. (A) The SS is grasping the medial capsule stump overlying the labrum and passing a suture with a “good enough” bite of tissue. (B) The SS is pulled out of the joint to reload with the “free” side of the suture. The medial capsule suture can be seen on the left. (C) The SS is brought back into the joint to pass the “other” side of the suture through the corresponding lateral (L) side of the capsule. The first capsular repair stitch can be seen in the background (arrow). (D) Arthroscopic knot tying is performed, bringing both medial and lateral capsule stumps together. A knot pusher can be seen (inside-out view) at the upper part of the picture. (E) Capsular stumps are now approximated and tied. (F) The dashed line presents the capsular repair line. A capsular repair stitch can be seen (arrow): 2 to 3 consecutive stitches commonly are used to repair the anterior and mid part of the “trapdoor” capsulotomy (which runs diagonally, lateral from the anterior extension of the intraportal capsulotomy), corresponding with the IFL. (H, femoral head; L, lateral capsule stump; M, medial capsule stump; N, femoral neck; S, SpeedStitch; Z, zona orbicularis.) Arthroscopy Techniques 2012 1, e107-e112DOI: (10.1016/j.eats.2012.05.001) Copyright © 2012 Arthroscopy Association of North America Terms and Conditions

Figure 3 Central-compartment labral repair in a left hip. The camera is positioned at the anterolateral portal. SS and anchoring work is performed through an anterolateral portal. (C, capsule; H, femoral head; S, SpeedStitch.) (A) The SS is being positioned between the labrum (asterisks), which was taken down for rim trimming, and the acetabular rim. The surgeon judges the point where he or she wants to penetrate with the suture to achieve optimal fixation. (B) The labrum is then being grasped by the SS from both sides, so a very accurate and controlled suture penetration can be achieved, without “pushing” it further down into the joint or scratching the femoral head with the penetrating device. (C) The SS is retrieved out of the joint, all in a quick single step. (D) The suture is then used to refix the labrum using a knotless anchor. (The dashed arrow shows the anchor tip, and the dashed circle shows the anchor-drilled hole.) (E) According to surgeon preference, the suture can also be placed around the labrum (not through the labral tissue). (F) Labral reconstruction with ITB autograft (right hip, same portals as described earlier). When the labrum is to be refixated without a complete takedown (separation of labrum from rim), the SS can penetrate it from the “joint side” (in this case, however, suture retrieval should follow, to prevent labral eversion). (Cr, cartilage [acetabular cartilage]; ITB, ilio tibial band; R, rim [acetabular rim].) Arthroscopy Techniques 2012 1, e107-e112DOI: (10.1016/j.eats.2012.05.001) Copyright © 2012 Arthroscopy Association of North America Terms and Conditions

Figure 4 Several pitfalls of the technique should be noted. Often, when the capsular tissue is very thick, the needle will not be able to penetrate through and grasp the stitch with it, resulting in a need for multiple attempts. At times, when “releasing” the needle, it may stay “stuck” in the thick capsular tissue, and when pulling the SS out of the joint, the cartridge may come off the SS. The cartridge can then be retrieved easily by rotating it clockwise and counterclockwise, to release the needle grab. (A) The SS is grasping the lateral capsule stump, passing a suture with a “good enough” bite of tissue. (B) The needle of the SS is seen passing through to the other side of the capsule tissue. The surgeon now releases the SS handle, and the needle will be drawn back, taking the loaded stitch with it, to the other side of the capsule. (C) Close-up view of the needle showing the recess designed to grab the stitch. If this recess is filled/blocked with soft tissue, the needle would not be able to grab the stitch, resulting in a failed attempt. Arthroscopy Techniques 2012 1, e107-e112DOI: (10.1016/j.eats.2012.05.001) Copyright © 2012 Arthroscopy Association of North America Terms and Conditions