Arthroscopic Subcapital Realignment in Chronic and Stable Slipped Capital Femoral Epiphysis  Bruno Dutra Roos, M.D., Marcelo Camargo de Assis, M.D., M.S., Milton Valdomiro Roos, M.D., Antero Camisa Júnior, M.D., Ezequiel Moreno Ungaretti Lima, M.D.  Arthroscopy Techniques  Volume 6, Issue 3, Pages e667-e672 (June 2017) DOI: 10.1016/j.eats.2017.01.017 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 Preoperative radiographic images of a patient with left-sided chronic and stable slipped capital femoral epiphysis (SCFE). (A) An anterior posterior pelvic radiograph. The site of the slippage (growth plate) is shown with the white arrows. (B) A frog-leg lateral view radiograph showing an epiphyseal-diaphyseal angle of 54°. The site of the slippage is shown with the white arrows. The neoformed bone tissue in the posteromedial region of the femoral neck is shown with the yellow arrow. The bump deformity created by progression and chronification of the SCFE is shown with the red arrow. The dashed lines show the epiphyseal-diaphyseal angle measure. Arthroscopy Techniques 2017 6, e667-e672DOI: (10.1016/j.eats.2017.01.017) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 Preoperative photograph of a patient positioned for a left hip arthroscopy showing the portal placement. The mid-anterior portal (MAP—1) is the camera portal. The anterolateral portal (ALP—2) is placed in a location that allows access parallel to the physis (1 cm proximal and anterior to the original site), which is the working portal. The fluoroscopic image shows the projection of the mid-anterior (1) and anterolateral (2) portals. Arthroscopy Techniques 2017 6, e667-e672DOI: (10.1016/j.eats.2017.01.017) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 View of a left hip through a 30° arthroscope in a mid-anterior portal. The extracapsular arthroscopic approach is used for exposure of the slipped capital femoral epiphysis. The arrows indicate the site of the slippage (growth plate) between the femoral head (FH) and the femoral neck (FN). (L, labrum.) Arthroscopy Techniques 2017 6, e667-e672DOI: (10.1016/j.eats.2017.01.017) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 4 View of a left hip through a 30° arthroscope in a mid-anterior portal. Femoral osteochondroplasty of the femoral head-neck junction is performed, which allows resection of the bump deformity created by progression and chronification of the slipped capital femoral epiphysis, and better identification of the physis. In more severe cases of slippage, external rotation of the limb may be necessary to expose the physis. (FH, femoral head; FN, femoral neck.) Arthroscopy Techniques 2017 6, e667-e672DOI: (10.1016/j.eats.2017.01.017) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 5 View of a left hip through a 30° arthroscope in a mid-anterior portal. The cupuliform osteotomy is performed 2 mm distal to the growth plate (to facilitate shortening of the femoral neck later) using a specific curved osteotome inserted through the anterolateral portal. (CO, curved osteotome; P, physis.) Arthroscopy Techniques 2017 6, e667-e672DOI: (10.1016/j.eats.2017.01.017) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 6 View of a left hip through a 30° arthroscope in a mid-anterior portal. After the osteotomy, the hip is rotated externally with slight traction, to allow shortening of the femoral neck and resection of the growth plate using an arthroscopic curette and burr. After shortening, the hip is adducted to remove neoformed bone tissue in the posteromedial region of the femoral neck, which could impede the subsequent reduction. The red asterisk indicates the neoformed bone tissue, and the arrow the epiphysis. (AC, arthroscopic curette; FN, femoral neck.) Arthroscopy Techniques 2017 6, e667-e672DOI: (10.1016/j.eats.2017.01.017) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 7 View of a left hip through a 30° arthroscope in a mid-anterior portal. Bleeding of the epiphysis can be observed after the osteotomy. (B, bleeding of the epiphysis; E, epiphysis; FN, femoral neck.) Arthroscopy Techniques 2017 6, e667-e672DOI: (10.1016/j.eats.2017.01.017) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 8 Transoperative frog-leg lateral fluoroscopic view of a left hip after the reduction of the epiphysis and stabilization with 2 guidewires. The dashed lines show a step between the epiphysis and the femoral neck, suggesting the reduction of the epiphysis. Arthroscopy Techniques 2017 6, e667-e672DOI: (10.1016/j.eats.2017.01.017) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 9 Postoperative photograph of a patient after a left hip arthroscopy for subcapital realignment in chronic and stable slipped capital femoral epiphysis, showing the aspect of the wound closure. X indicates the portal sites and the asterisk the percutaneous fixation site. Arthroscopy Techniques 2017 6, e667-e672DOI: (10.1016/j.eats.2017.01.017) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 10 Three-year and two-month postoperative radiographic images of a left-sided slipped capital femoral epiphysis. (A) An anterior posterior pelvic radiograph showing the postoperative correction of the slippage. (B) A frog-leg lateral view radiograph showing an epiphyseal-diaphyseal angle of 4°. The white arrow indicates the correction of the deformity. The dashed lines indicate the epiphyseal-diaphyseal angle measure. Arthroscopy Techniques 2017 6, e667-e672DOI: (10.1016/j.eats.2017.01.017) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions