Bowtie Technique for Arthroscopic Hip Inversion Labral Repair

Various suture techniques for arthroscopic hip labral repair have been described to address labral pathology. However, optimal restoration of the labral suction seal relies on proper tension and control of the labral tissue during the repair. To enhance the reproducibility and efficiency of labral repair, we describe the Bowtie suture technique that generates an inversion force vector within the repair construct. This suture passing technique reduces the technical complexity of inversion labral repairs by making it significantly easier to pass and retrieve the repair suture. Folding the suture twice and pinching it in the center of the fold forms a Bowtie-like shape. Then, this Bowtie suture configuration is inserted through a cannula using a suture passing device and placed into the central compartment. The Bowtie is released, allowing it to expand like a spring and hold its position, preventing it from falling into the inferior joint. The suture passer is then placed through the chondrolabral junction, and the repair stitch is easily retrieved and secured to an anchor. This technique improves suture management and efficiency while also allowing for improved control of the labrum to compress the chondrolabral junction and restore the suction seal mechanism.