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The os acetabuli is thought to arise from unfused secondary ossification centers or as rim fractures in the setting of dysplastic hips or hips with femoroacetabular impingement. Resection of a large os acetabuli can lead to structural instability of the joint, and in these cases, osteoplasty of the impingement, reduction and internal fixation of the osseous fragment, and labral repair have been described in the literature. Anchor fixation for labral repair in the surrounding zone of the osteosynthesis might bring some technical problems. We aim to describe a technical modification improving labral lesion treatment while addressing the rim fracture. The addition of a suture to the screw addresses both lesions because it simultaneously has the function of a screw and an anchor. A suture-on-screw technique for os acetabuli fixation helps surgeons to gain versatility and is more cost-effective for the patients and health services.

Labral tears are the most common pathology in patients undergoing hip arthroscopy and the most common cause of mechanical hip symptoms. Labral repair techniques have been described in the literature using suture anchors placed as close as possible to the acetabular rim without penetrating the articular surface. Optimal surgical technique for labral repair is very important, and an inappropriate entry point and guide angulation may lead to intra-articular penetration of the anchor, chondral damage, anchor loosening, or inadequate fixation. A shallow dysplastic hip, the drilling trajectory, the narrow width of the acetabular rim, or some specific anatomic variations may generate difficulty during anchor placement. Suture anchors themselves have been associated with several significant complications, including rim fracture, osteolysis, enlargement of drill holes, and infection. The treatment of labral lesions with transosseous suture is an alternative to anchor use, eliminating the need for anchors and avoiding anchor-associated complications. This technique offers versatility to surgeons and is more cost-effective for patients and health services. We aim to describe the indications and technique for transosseous labral repair without anchors.