Dean K. Matsuda, M. D. , Nicole A. Matsuda, Rachel Head, B. S

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Presentation transcript:

Endoscopic Rectus Abdominis and Prepubic Aponeurosis Repairs for Treatment of Athletic Pubalgia Dean K. Matsuda, M.D., Nicole A. Matsuda, Rachel Head, B.S., Tanya Tivorsak, M.D. Arthroscopy Techniques Volume 6, Issue 1, Pages e183-e188 (February 2017) DOI: 10.1016/j.eats.2016.09.022 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 Preoperative modified Dunn lateral view of both hips showing the sclerotic bony hypertrophy at the pubic symphysis (arrows) and a healed right pubic stress fracture. Also note the bilateral cam deformities of the proximal femurs, both of which were asymptomatic. Arthroscopy Techniques 2017 6, e183-e188DOI: (10.1016/j.eats.2016.09.022) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 Sagittal magnetic resonance imaging view demonstrating detachment of prepubic aponeurosis (arrow). Arthroscopy Techniques 2017 6, e183-e188DOI: (10.1016/j.eats.2016.09.022) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 Coronal magnetic resonance imaging view showing the distal rectus abdominis tear (arrow). Arthroscopy Techniques 2017 6, e183-e188DOI: (10.1016/j.eats.2016.09.022) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 Supine lithotomy patient positioning and setup. Note adjacent positioning of arthroscopy and fluoroscopy monitors at head of bed location. Arthroscopy Techniques 2017 6, e183-e188DOI: (10.1016/j.eats.2016.09.022) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Position of the surgeon between the patient legs while performing endoscopic surgery with seamless monitoring of the arthroscopic and fluoroscopic monitors. Arthroscopy Techniques 2017 6, e183-e188DOI: (10.1016/j.eats.2016.09.022) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 6 Anterior (arrowhead) and suprapubic (arrow) portals. A 30° arthroscope is used in the anterior portal. A plastic arthroscopic cannula is later used in the suprapubic portal to aid with suture management and suture anchor fixation. Arthroscopy Techniques 2017 6, e183-e188DOI: (10.1016/j.eats.2016.09.022) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 7 Supine endoscopic view with 30° arthroscope from the anterior portal of endoscopic pubic symphysectomy to address recalcitrant osteitis pubis. Note the unhooded burr (from the suprapubic portal) and the hyaline endplates of the pubic symphysis (*). Arthroscopy Techniques 2017 6, e183-e188DOI: (10.1016/j.eats.2016.09.022) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 8 Supine endoscopic view, with 30° arthroscope, of the detached prepubic aponeurosis complex. Note the bare pubic crests (*). Arthroscopy Techniques 2017 6, e183-e188DOI: (10.1016/j.eats.2016.09.022) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 9 Supine endoscopic view showing reattachment of the detached prepubic aponeurosis using knotless anchor in the pubic crest adjacent to area of previous endoscopic pubic symphysectomy (*). Arthroscopy Techniques 2017 6, e183-e188DOI: (10.1016/j.eats.2016.09.022) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 10 Supine endoscopic view of the distal vertical tear of the rectus abdominis tendon (arrows). Arthroscopy Techniques 2017 6, e183-e188DOI: (10.1016/j.eats.2016.09.022) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 11 Supine endoscopic view during repair of a vertical rectus abdominis tear. Note the suture from the right margin of the torn tendon in the trough made by previous endoscopic pubic symphysectomy being grasped by suture grasper that has passed through the left margin of the tendon to aid safe suture passage. Arthroscopy Techniques 2017 6, e183-e188DOI: (10.1016/j.eats.2016.09.022) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 12 Supine endoscopic view after completion of side-to-side rectus abdominis repair with 3 sets of sutures. Arthroscopy Techniques 2017 6, e183-e188DOI: (10.1016/j.eats.2016.09.022) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 13 Postoperative detail of the anterior-posterior pelvic view showing the widened gap of the pubic symphysis without vertical displacement and the absence of cortical endplates, which were resected during endoscopic pubic symphysectomy. Note the entry sites for suture anchor fixation of the right and left prepubic aponeurotic complex (arrows). Arthroscopy Techniques 2017 6, e183-e188DOI: (10.1016/j.eats.2016.09.022) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions