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Hip Videos: Other
Endoscopic Proximal Adductor Lengthening for Chronic Adductor-Related Groin Pain
Proximal adductor injuries are relatively common groin injuries in athletes. Various tenotomy techniques have been described including open, partial, and percutaneous approaches. Current techniques help most athletes return to sport; however, many develop adductor weakness. Moreover, the procedures lack full visualization of the tendon and do not allow for return to athletes' preinjury level of play. We describe an endoscopic z-lengthening of the proximal adductor tendon with the potential to minimize complications associated with open procedures such as incisional pain and neurovascular injury while affording a more complete tenotomy than current percutaneous techniques.Endoscopic Gluteus Medius and Minimus Repair With Allograft Augmentation Using Acellular Human Dermis
Recently, attention has been given to recalcitrant lateral hip pain, also known as greater trochanteric pain syndrome. Although, historically, this has been attributed to greater trochanteric bursitis, the literature has shown that many patients will have a lesion of the gluteus medius and minimus tendons. Endoscopic hip abductor tendon repair has been shown to provide good outcomes with decreasing overall morbidity and is becoming more popular. However, failure rates have been reported to be as high as 35%, likely due to the poor tissue quality in this older population.Laparoscopic Treatment of Pubic Symphysis Instability With Anchors and Tape Suture
Patients with pubic symphysis instability who had failed nonoperative treatments may benefit from surgical repair. This disease process is rare, most commonly seen in postpartum women and athletes, and its surgical treatment is invasive and nonphysiological. Currently described surgical interventions, although limited, include plating, which provides an overly rigid construct with the risk of failure and possibly poor long-term outcomes particularly in athletes, and treatments such as curettage, more commonly used in the treatment of osteitis pubis.Comprehensive Clinical Evaluation of Femoroacetabular Impingement: Part 1, Physical Examination
A thorough evaluation of the hip must include a comprehensive medical and surgical history focused on the hip joint, surrounding soft tissues, and the associated structures of the spine, pelvis, and lower extremities. These details can guide the physical examination and provide insight into the cause of the patient's chief complaints. A proper examination includes physical examination while the patient is in the upright, supine, prone, and lateral position, as well as an evaluation of gait. Guided by a thorough history, the physical examination enables the surgeon to distinguish between intra-articular and extra-articular contributors to hip pain, selection of appropriate imaging modalities, and ultimately supports medical decision making.Comprehensive Clinical Evaluation of Femoroacetabular Impingement: Part 2, Plain Radiography
The use of hip arthroscopy to treat various forms of hip pathology continues to grow. As part of a standard evaluation for eligibility for hip arthroscopy, we routinely obtain standard radiographs to assess the hip joint. These include orthogonal projections of the acetabulum and proximal femur, which can be obtained with a standing false profile, supine anteroposterior pelvis, and a lateral view of the proximal femur (either Dunn 45° or 90°, frog-leg lateral, or cross-table lateral). A comprehensive analysis of the radiographs is of utmost importance in order to indicate a patient for hip arthroscopy, for preoperative planning, and to determine prognosis.Comprehensive Clinical Evaluation of Femoroacetabular Impingement: Part 3, Magnetic Resonance Imaging
Radiologic imaging is an essential supplement to the physical examination in the evaluation of a patient with femoroacetabular impingement. Plain radiographs are the initial modality of choice for the evaluation of bony anatomy and pathology. Magnetic resonance imaging supplements the physical examination and standard radiographs by enabling qualitative and quantitative evaluation of both articular cartilage and soft tissues about the hip. Magnetic resonance imaging also provides improved 3-dimensional characterization of the bony anatomy owing to the multiplanar nature of this technique.Right Versus Left Hip Arthroscopy for Surgeons on the Learning Curve
Hip arthroscopy is a technically demanding procedure that is currently characterized by a “steep” learning curve. Therefore, achieving an advanced technical level is often challenging, especially for the amateur hip arthroscopist. Hand laterality when training in hip arthroscopy is an aspect that has been omitted. In addition, the technical differences regarding the handling of the surgical instruments when performing hip arthroscopy on the left versus right hip can influence the technical excellence.Arthroscopic Excision of an Osteoid Osteoma of the Lesser Trochanter of the Femoral Neck
Osteoid osteoma frequently requires surgical treatment, especially among young, active patients. However, surgeons are reluctant to perform open surgery for an osteoid osteoma of the femoral neck area because the conventional surgical approach requires a large incision in muscular patients, and percutaneous resection with a trephine has the attendant risk of subsequent fracture. Recently, arthroscopic excision of an osteoid osteoma has been reported as a less invasive, safer procedure than traditional open curettage.Simultaneous Bilateral Hip Arthroscopy
Many patients are afflicted with painful conditions affecting both hips, most commonly femoroacetabular impingement. Some patients prefer the advantage of undergoing a single surgical procedure and anesthetic followed by a single postoperative rehabilitation program. We present a Technical Note on single-stage bilateral hip arthroscopy. This Technical Note reports on key steps enabling safe and efficient performance of bilateral arthroscopic acetabuloplasty, labral refixation, femoroplasty, and dynamic testing while limiting traction times and facilitating rapid transition to the second hip arthroscopic surgery.Osseoscopy: Direct Visualization to Assist Core Decompression and Debridement of Necrotic Bone Defects
Free vascularized fibular grafting after core decompression and debridement of necrotic lesions is an effective surgical treatment of avascular necrosis of the femoral head. A technical challenge encountered in performing this procedure is ensuring adequate debridement of necrotic parts while preserving healthy bone. A previously described method accomplishes this indirectly using radioactive contrast media and fluoroscopy, increasing the risk of radiation exposure. We propose a surgical technique using standard arthroscopic equipment to visualize inside the femoral head, facilitating precise and accurate debridement without additional radiation exposure.Repair of Proximal Hamstring Tears: A Surgical Technique
Proximal hamstring tears are among the most common sports-related injuries. These injuries often occur as strains or partial tears at the proximal muscle belly or the musculotendinous junction, with avulsion injuries of the proximal attachment occurring less frequently. Regardless of the mechanism, they produce functional impairment and negatively affect an athlete's performance. Various classifications for these injuries are reported in the literature. Early surgical treatment is recommended for patients with either a 2-tendon tear/avulsion with more than 2 cm retraction or those with complete 3-tendon tears.Arthroscopic Shoelace Capsular Closure Technique in the Hip Using Ultratape
Hip arthroscopy is promising tool for assessing and treating intra-articular pathologies including labral tears, cartilage injuries, and ligamentum teres tears of the hip. Interportal capsulotomy allows for better visualization and accessibility of the arthroscope and working instruments. The hip capsule has been defined as a crucial stabilizer of the hip joint. Thus, capsular closure is recognized as an important procedure to prevent postoperative instability after hip arthroscopic surgery. Despite the routine capsular closure during hip arthroscopy, there is a small subset of patients who complain of hip pain and dysfunction after surgery most likely because of disruption of hip closure site after routine complete capsular closure with strong suture for treating hip instability.Endoscopic Rectus Abdominis and Prepubic Aponeurosis Repairs for Treatment of Athletic Pubalgia
Review of the English orthopaedic literature reveals no prior report of endoscopic repair of rectus abdominis tears and/or prepubic aponeurosis detachment. This technical report describes endoscopic reattachment of an avulsed prepubic aponeurosis and endoscopic repair of a vertical rectus abdominis tear immediately after endoscopic pubic symphysectomy for coexistent recalcitrant osteitis pubis as a single-stage outpatient surgery. Endoscopic rectus abdominis repair and prepubic aponeurosis repair are feasible surgeries that complement endoscopic pubic symphysectomy for patients with concurrent osteitis pubis and expand the less invasive options for patients with athletic pubalgia.Vascular Coloration for Anatomical Study of the Pelvis and Hip: Implications in Hip Preservation Surgery
Hip preservation surgical techniques have steadily increased in the recent past. Therefore, precise knowledge of the vascular system of the hip and pelvis is critical for avoidance of possibly devastating complications during surgery. A colored latex injection in the common iliac artery of cadavers allows for a complete staining of the hip and pelvis vascular system. This technique creates more resilient vessels, whereas coloration with dye causes the vessels to be highly visible in comparison with the surrounding tissue.The Quebec City Slider: A Technique for Capsular Closure and Plication in Hip Arthroscopy
Biomechanical and clinical studies have shown that the hip joint capsule plays an important role in maintaining stability and hip mechanics, including rotation and translation. The recent literature has shown that capsule closure after hip arthroscopy helps to restore stability. Without restoration of the native anatomy, the hip joint may translate when patients engage in activities that place force across the hip, leading to either microinstability or frank dislocation. The purpose of this note is to describe our preferred technique of capsular closure or plication during hip arthroscopy.Endoscopic Gluteus Medius Repair Augmented With Bioinductive Implant
Patients with gluteus minimus and medius tears that fail nonoperative management may be indicated for surgical repair; however, structural failure after gluteal tendon repair remains unacceptably high. This is likely related to the limited healing potential of tendinous tissue, which is poorly vascular and heals by formation of fibrocartilaginous scar tissue rather than histologically normal tendon. An emerging option to augment tendon healing is the use of a bioinductive implant that is designed to amplify the host healing response and induce the formation of healthy tendon tissue.Ultrasound-Guided Portal Placement for Hip Arthroscopy
Over the past 2 decades, hip arthroscopy has developed as a surgical technique, with more orthopaedic surgeons attempting to become proficient in performing this surgical procedure as indications and surgical skills evolve. The hip joint presents unique arthroscopic challenges because of its anatomic location, and it can be challenging to safely and confidently establish portal sites. Ultrasound-guided hip arthroscopy portal placement is not yet common practice for orthopaedic surgeons. The potential advantages of ultrasound-guided hip arthroscopy portal placement are the lack of radiation exposure to the patient and operating room personnel, direct visualization of the hip joint and surrounding soft-tissue structures, and lack of bulky fluoroscopic equipment in the operative field.Pendulum Exercises After Hip Arthroscopy: A Video Technique
Advanced hip joint–preserving arthroscopic techniques have been shown to improve patient-reported functional outcomes with low rates of postoperative complications. Prior work has shown that formation of adhesive scar is a potential source of persistent pain and cause for revision surgery. As resources for postoperative in-studio physical therapy become scarce, a home-based strategy to avoid scar formation without adding formal therapy cost may be beneficial. The purpose of this technical note is to introduce a patient-centered educational video technique for home-caregiver delivery of manual hip pendulum exercises in the postoperative setting.Arthroscopic Juvenile Allograft Cartilage Implantation for Cartilage Lesions of the Hip
Cartilage lesions in the hip are of high prevalence. Most of these lesions are treated with microfracture. Microfracture has relatively good subjective outcomes for smaller lesions; however, it is limited by the ability to reproduce hyaline cartilage, especially in older patients. For larger chondral defects, we present a technique using juvenile allograft cartilage implantation implanted arthroscopically to treat cartilage lesions in the hip. The purpose of this technical note is to describe the arthroscopic technique for treating chondral lesions in the hip with allograft juvenile cartilage.Core Decompression Augmented With Autologous Bone Marrow Aspiration Concentrate for Early Avascular Necrosis of the Femoral Head
Lack of necessary perfusion to the femoral head can lead to necrosis of the underlying bone (avascular necrosis) and result in femoral and acetabular surface changes in advanced stages. Numerous treatments have been reported in the literature, including nonoperative and surgical procedures. In addition to the standard core decompression, we describe the use of bone marrow aspirate to stimulate a healing response and bone grafting, allowing for immediate weight bearing postoperatively. The purpose of this article was to describe our method of core decompression augmented with bone marrow aspirate concentrate and bone grafting for the treatment of early avascular necrosis of the femoral head.Endoscopic Sciatic Nerve Decompression in the Prone Position—An Ischial-Based Approach
Deep gluteal syndrome is described as sciatic nerve entrapment in the region deep to the gluteus maximus muscle. The entrapment can occur from the piriformis muscle, fibrous bands, blood vessels, and hamstrings. Good clinical outcomes have been shown in patients treated by open and endoscopic means. Sciatic nerve decompression with or without piriformis release provides a surgical solution to a difficult diagnostic and therapeutic problem. Previous techniques have used open methods that can now performed endoscopically.Proximal Rectus Femoris Avulsion Repair
Proximal rectus femoris tendon avulsions are rare and occur mostly in male athletes. Currently, the standard of care for complete tendinous avulsions of the direct arm of the rectus femoris is nonoperative treatment. However, surgical repair may be considered in high-level athletes who have a high demand for repetitive hip flexion performed in an explosive manner or in patients in whom nonoperative treatment has failed. The purpose of this technical note is to describe the method for surgical repair of the proximal direct arm of the rectus femoris to its origin at the anterior inferior iliac spine using suture anchors.Hip Capsular Reconstruction Using Dermal Allograft
Because hip arthroscopic procedures are increasing in number, complications related to the operation itself are starting to emerge. Whereas the capsule has been recognized as an important static stabilizer for the hip, it has not been until recently that surgeons have realized the importance of its preservation and restoration. Disruption of the capsule during arthroscopic procedures is a potential contributor to postoperative iatrogenic hip instability. In cases of a symptomatic deficient capsule, a capsular reconstruction is mandatory because instability may lead to detrimental chondral and labral changes.Endoscopy-Assisted Periacetabular Osteotomy
Minimizing soft tissue dissection and improving visualization of vital structures during periacetabular osteotomy (PAO) is of paramount importance to improve patient outcome and minimize complications. The endoscopy-assisted PAO was introduced to accomplish this objective. It involves an initial hip arthroscopy, for treatment of central compartment pathology, followed by a mini-open Bernese periacetabular osteotomy under fluoroscopic and endoscopic guidance, and completed by final dynamic hip arthroscopy to assess acetabular reorientation and fixation and to perform femoroplasty in relation to the new acetabular rim position, if needed.Basic Hip Arthroscopy: Anatomic Establishment of Arthroscopic Portals Without Fluoroscopic Guidance
Hip arthroscopy has gained popularity in recent years for diagnostic and therapeutic hip preservation management. This article details the establishment of arthroscopic portals of the hip, specifically the anterolateral and modified anterior portals without fluoroscopic guidance. The anterolateral portal is established anatomically, and the modified anterior portal is then established under arthroscopic guidance. A through understanding of the hip anatomy allows for these portals to be made both safely and reliably for hip arthroscopies in the modified supine positioned patient.
