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We read with great interest the recent article by Badylak and Keene1 regarding iatrogenic labral puncture during hip arthros- copy. This study reported that the labrum was penetrated in 20% of cases and concluded that the iatrogenic labral injury did not affect the 1- and 2-year clinical results. We applaud the authors' candor in reporting this complication in a total of 50 patients and value the contribution of this article to the nascent body of literature on safe procedures in hip arthroscopy

Indeed, labral injuries are reported as a complication of hip arthroscopy in the literature and may occasionally occur during hip arthroscopy despite the surgeon's best efforts to achieve safe access 2-4. However, we fear that this article may uninten- tionally convey to the reader that a high rate of labral penetra- tion is not a cause for concern. For this reason, we would like to emphasize to the readers that labral injury is not a normal part of hip arthroscopy and should be avoided when possible.

According to our experience, it is possible to perform hip arthroscopy with a low incidence of labral penetration by following a simple safe technique for portal establishment during hip arthroscopy. Using this technique in a series of 300 consecutive cases, we have reported 2 labral penetrations (rate of labral injury, 0.67%). 5 One injury occurred during revision arthroscopy, whereas the second involved a hyperplastic labrum in a dysplastic hip.

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