Combined Arthroscopic Acetabular Labral Reconstruction With Dermal Allograft Hip Capsular Reconstruction

Hip instability after arthroscopy is a rare but challenging complication which can result from iatrogenic capsular deficiency and labral insufficiency. When accompanied by acetabular undercoverage, this combination compromises both the static and dynamic stabilizers of the hip joint, predisposing patients to pain, dysfunction, and progressive joint degeneration. Open reconstruction of these structures can be morbid, particularly in cases requiring a staged periacetabular osteotomy. This report describes an all-arthroscopic technique for simultaneous acetabular labral and hip capsular reconstruction in a patient with recurrent instability after prior arthroscopy. The labrum is reconstructed with a posterior tibialis tendon allograft, whereas a dermal allograft is used to restore the deficient anterior capsule using knotless suture anchor fixation. The technique restores both the suction seal and capsular integrity before a subsequent staged retroverting periacetabular osteotomy, allowing sequential management of soft-tissue and osseous pathology while minimizing morbidity. This combined arthroscopic approach provides a reproducible, minimally invasive method to address soft-tissue instability in patients with labral and capsular insufficiency, optimizing conditions for a later corrective periacetabular osteotomy and potentially delaying or preventing degenerative progression in young, active patients.