Author Reply to ”Regarding ‘Arthroscopic Fixation of Os Acetabuli and Labral Repair: Suture-on-Screw Technique’”

We would like to thank Dr. Carro for bringing the similarities between the two techniques to our attention. We agree with the similarities and recognize not citing Dr. Carro’s article was an oversight. The purpose of our article was to highlight the senior author’s current technique in performing this operation, as it has evolved over the course of his practice. While similar in technique, there is a notable difference between the technique expertly demonstrated by Carro et al. Their technique involves fixation of the os acetabuli with a Kirschner wire, followed by cannulated drilling of the fragment. They then fix the fragment with a cannulated screw, as we also describe in our technique.

At our institution, we do not typically carry the proper cannulated drill; thus, the senior author has developed a technique using the guide for an arthroscopic anchor and drill, as well as an anterior cruciate ligament guide wire to allow for cannulated screw placement without the need for a cannulated drill. In addition, using the cannulated screw driver from the ACL set provides the proper length for screw insertion, as well as the ability to provide leverage when inserting the screw. The cannulated screw driver set can be too short for screw fixation into an arthroscopic acetabular os fixation; therefore, the use of the ACL guidewire and screwdriver can be advantageous.

Our technique aims to highlight the specific usage of this instrumentation, as we feel that having the proper set-up is crucial, especially in the absence of a dedicated cannulated system. Specifically, the senior author operates at various stand-alone surgery centers, as opposed to a hospital setting, where resources and special instrumentation may not always be present. Our specific technique relies on the usage of the Stryker CinchLock drill guide (Stryker, Kalamazoo, MI), as well as the solid 2.4-mm drill for this system. Following drilling, we remove the drill and keep the guide in place, allowing us to thread the disposable guidewire from the Stryker anterior cruciate ligament tray into the predrilled hole to then allow for placement of a cannulated screw. In our practice, these instruments are outside of our typical hip arthroscopy set-up and could potentially be unavailable if not specifically requested by the surgeon. Additionally, there have been other studies reporting varying techniques for arthroscopic fixation of os acetabuli,^{,  ,} including an article written by Pascual-Garrido et al. in 2016 that described a similar suture-on-screw technique, which was cited in our article. While these other techniques are clearly effective, and no single technique has been found to be superior, we believe that our described technique allows for a relatively low cost and reproducible method of fixation, particularly for surgeons who operate at surgery centers that may not have access to a dedicated cannulated system. Once again, we apologize for the oversight in not referencing the technique put forth by Carro et al.