Endoscopic Shelf Acetabuloplasty Combined With Labral Repair, Cam Osteochondroplasty, and Capsular Plication for Treating Developmental Hip Dysplasia  Soshi Uchida, M.D., Ph.D., Takahiko Wada, M.D., Shinsuke Sakoda, M.D., Akihiro Ariumi, M.D., Ph.D., Akinori Sakai, M.D., Ph.D., Hirokazu Iida, M.D., Ph.D., Toshitaka Nakamura, M.D., Ph.D.  Arthroscopy Techniques  Volume 3, Issue 1, Pages e185-e191 (February 2014) DOI: 10.1016/j.eats.2013.09.013 Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 1 (A) Diagnostic preoperative anteroposterior pelvic radiograph of patient showing dysplastic acetabulum and femoral head. The center-edge angle is 13° and the Sharp angle is 48°, suggestive of lateral acetabular shallowness. (B) Preoperative false-profile radiograph of patient showing anterior acetabular shallowness. The ventral center angle is 18°. (C) Three-dimensional computed tomography scan showing a bump at the femoral head-neck junction. (D) T2-weighted magnetic resonance image after arthrography of patient showing torn anterior labrum (arrow). Arthroscopy Techniques 2014 3, e185-e191DOI: (10.1016/j.eats.2013.09.013) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 2 (A) Arthroscopic view from anterolateral portal showing acetabular labral-chondral delamination (Multicenter Arthroscopic Hip Outcome Research Network grade II). (B) Arthroscopic finding from anterolateral portal showing suture anchor placement at rim recess for labral repair. (C) Repaired labrum as viewed from anterolateral portal, with traction. No suture knot faced the femoral head. (D) Peripheral compartment view from anterolateral portal, without traction, showing cam osteochondroplasty. (E) Endoscopic extra-articular findings: image-intensified monitoring showing that the arthroscope was switched to the extracapsular space. (F) Optimum visualization was obtained with a shaver and VAPR (DePuy Mitek, Raynham, MA). The reflected head of the femoris was identified arthroscopically. (AC, acetabulum; CP, capsule; FH, femoral head; L, labrum; RH, reflected head of rectus femoris.) Arthroscopy Techniques 2014 3, e185-e191DOI: (10.1016/j.eats.2013.09.013) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 3 (A) Arthroscope view from the anterolateral portal at the extra-articular space showing that after debridement of the reflected head of the rectus femoris, 2.4-mm guide pins were introduced along the capsule (CP). (B) With image intensifier monitoring showing the tip of the 2.4-mm guidewires, the pins are brought against the lateral border of the iliac wing at the site just above the capsule. (C) Endoscopic extra-articular finding from the anterolateral portal showing that the osteotome was introduced along with the 2 guidewires to make the slot for shelf grafts. (IL, ilium.) (D) Free bone graft harvested from ipsilateral iliac crest, with 2 parallel 2.0-mm Kirschner wires. (E) Endoscopic finding showing the skewer with guidewires drilled in parallel that introduces accurate placement of the shelf graft (BG). (F) The free bone autograft was inserted into the slot through the guidewires with press-fit fixation. Arthroscopy Techniques 2014 3, e185-e191DOI: (10.1016/j.eats.2013.09.013) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 4 Surgical instruments for shelf acetabuloplasty. (A) A dilator is used to make a slot for the shelf graft. (B) A custom-made cannula is used to pack corticocancellous bone chips above the new shelf. Arthroscopy Techniques 2014 3, e185-e191DOI: (10.1016/j.eats.2013.09.013) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 5 Pelvic radiographs of patient showing acetabulum and femoral head (A) preoperatively, (B) postoperatively, and (C) 10 months after surgery. Arthroscopy Techniques 2014 3, e185-e191DOI: (10.1016/j.eats.2013.09.013) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions