Posterolateral Acetabular Labral Repair: Drilling Using a Percutaneous Posterolateral Portal

Acetabular labral tears are commonly diagnosed in patients with hip or groin pain, most of which occur anterosuperiorly. In some cases, operative intervention in the form of arthroscopic labral repair may be necessary to restore labral function. Posterolateral tears can be technically challenging when using traditional modified anterior portal and anterolateral (AL) portal access owing to a suboptimal drill trajectory. In this article, we describe the establishment of a posterolateral (PL) portal 1 to 2 cm posterior to the tip of the greater trochanter, mirroring the distal-to-proximal trajectory of the AL portal and entering the capsulotomy at the 10-o’clock position. This method highlights that the PL portal is used for drilling and anchor placement, whereas the remaining work is performed through the AL portal. This avoids the use of any shavers or burrs in the PL portal near important neurovascular structures, including the sciatic nerve. Addressing posterolateral labral tears in the 9- to 11-o’clock position using a PL portal can enhance labral fixation, thereby mitigating the risk of suboptimal repairs that can negatively impact postoperative outcomes.