The purpose of this study is to investigate the outcomes from anchor-induced chondral damage of the hip, both with and without frank chondral penetration. A multicenter retrospective case series was performed of patients with chondral deformation or penetration during initial hip arthroscopic surgery. Intra-operative findings, post-surgical clinical courses, hip outcome scores and descriptions of arthroscopic treatment in cases requiring revision surgery and anchor removal are reported. Five patients (three females) of mean age 32 years (range, 16–41 years) had documented anchor-induced chondral damage with mean 3.5 years (range, 1.5–6.0 years) follow-up. The 1 o'clock position (four cases) and anterior and mid-anterior portals (two cases each) were most commonly implicated. Two cases of anchor-induced acetabular chondral deformation without frank penetration had successful clinical and radiographic outcomes, while one case progressed from deformation to chondral penetration with clinical worsening. Of the cases that underwent revision hip arthroscopy, all three had confirmed exposed hard anchors which were removed. Two patients have had clinical improvement and one patient underwent early total hip arthroplasty. Anchor-induced chondral deformation without frank chondral penetration may be treated with close clinical and radiographic monitoring with a low threshold for revision surgery and anchor removal. Chondral penetration should be treated with immediate removal of offending hard anchor implants. Preventative measures include distal-based portals, small diameter and short anchors, removable hard anchors, soft suture-based anchors, curved drill and anchor insertion instrumentation and attention to safe trajectories while visualizing the acetabular articular surface.

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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.O steitis pubis is a form of athletic pubalgia, and a recent study found a high prevalence in professional football players. 1 It is associated with femoroacetabular impingement and may be caused by transfer stress from constrained range of motion in one or both hips. 2 Endoscopic pubic symphysectomy has been found to be a safe and promising, less-invasive option to open pubic symphysis curettage. 3 Athletic pubalgia may also involve tears of the adductor and/or rectus abdominis tendons. Although open repair has been done, to our knowledge there is no previously published case of endoscopic repairs of the rectus tendon and the prepubic aponeurosis. The purpose of this technical report is to describe the endoscopic techniques used to perform endoscopic rectus abdominis and prepubic aponeurosis repairs after concurrent endoscopic pubic symphysectomy. TechniqueWe describe our techniques for endoscopic pubic aponeurosis reattachment and rectus abdominis repair after endoscopic pubic symphysectomy for the treatment of recalcitrant osteitis pubis and athletic pubalgia. Preoperative radiographs revealed sclerotic bony hypertrophy at the pubic symphysis and a healed right pubic stress fracture (Fig 1), and magnetic resonance imaging revealed detachment of the prepubic aponeurosis from the pubic tubercle (Fig 2) and a tear of the rectus abdominis (Fig 3).The patient was placed in a supine lithotomy position using gynecologic stirrups without traction (Figs 4 and 5). A Foley catheter was used to decompress the adjacent bladder. Endoscopic pubic symphysectomy was performed using our previously described technique, 4,5 first localizing the pubic symphysis under AP pelvic fluoroscopic guidance and marking the midpoint with a 22-gauge needle. The anterior portal was established as the initial viewing portal with the 30 standard arthroscope at a low pump pressure of 40 mm Hg. The suprapubic portal was established and a switching stick was used to locate the previously placed 22-guage needle tip in the pubic symphysis (Fig 6). The overlying bursal tissue was resected with a motorized shaver and radiofrequency ablator (Arthrocare; Smith & Nephew, Andover, MA) followed by incremental resection of the pubic symphysis beginning from anterosuperior to posteroinferior. Initial resection was performed with a 5.5-mm round burr, followed by deeper res...

Osteitis pubis is a common form of athletic pubalgia associated with femoroacetabular impingement. Endoscopic pubic symphysectomy was developed as a less invasive option than open surgical curettage for recalcitrant osteitis pubis. This technical note demonstrates the use of the anterior and suprapubic portals in the supine lithotomy position for endoscopic burr resection of pubic symphyseal fibrocartilage and hyaline endplates. Key steps include use of the suprapubic portal for burr resection of the posteroinferior symphysis and preservation of the posterior and arcuate ligaments. Endoscopic pubic symphysectomy is a minimally invasive bone-conserving surgery that retains stability and may be useful in the treatment of recalcitrant osteitis pubis or osteoarthritis. It nicely complements arthroscopic surgery for femoroacetabular impingement and may find broader application in this group of co-affected athletes.

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. Enabling factors include supine positioning with bilateral mobile leg spars, rapid surgical and hip traction times, and postoperative rehabilitation with immediate weight bearing as tolerated. A rationale for deciding which hip should undergo arthroscopy first is also offered. Concurrent bilateral hip arthroscopy is a viable option for select patients and experienced surgical teams, enabling potentially expedited recovery and return to work or sport with inherent cost savings.

Beyond the recent expansion of extra-articular hip arthroscopy into the peri-trochanteric and subgluteal space, this instructional course lecture introduces three innovative procedures: endoscopy-assisted periacetabular osteotomy, closed derotational proximal femoral osteotomy and endoscopic pubic symphysectomy. Supportive rationale, evolving indications, key surgical techniques and emerging outcomes are presented for these innovative less invasive procedures.