Srino Bharam, M. D. , Priyal V. Bhagat, D. O. , Moshe C. Spira, B. A

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Endoscopic Proximal Adductor Lengthening for Chronic Adductor-Related Groin Pain Srino Bharam, M.D., Priyal V. Bhagat, D.O., Moshe C. Spira, B.A., Devon A. Klein, M.D., M.P.H. Arthroscopy Techniques Volume 7, Issue 6, Pages e675-e678 (June 2018) DOI: 10.1016/j.eats.2018.02.017 Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 1 Patient's left hip is placed in a supine position with operational extremity flexed, abducted, and externally rotated. Surgical-side groin and proximal thigh is prepped and draped with 4 sticky blue towels, Ioban (3M, Maplewood, MN), and lower extremity drapes. Arthroscopy Techniques 2018 7, e675-e678DOI: (10.1016/j.eats.2018.02.017) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 2 Landmarks of the left pubis and proximal adductor longus tendon are identified. A distal portal 6 cm from the inguinal crease is incised using an No. 11 blade. A 4.5-mm obturator cannula (arrow) and 30° scope is introduced in the distal portal. Arthroscopy Techniques 2018 7, e675-e678DOI: (10.1016/j.eats.2018.02.017) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 3 A proximal portal 2 cm from the inguinal crease is incised using a No. 11 blade. A 5-mm plastic cannula is introduced into the proximal portal for instrument use. Arthroscopy Techniques 2018 7, e675-e678DOI: (10.1016/j.eats.2018.02.017) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 4 (A) An arthroscopic 4.5-mm shaver is used in the proximal portal (arrow) to enter the (B) tendon sheath (distal viewing portal). Caution is used not to violate the subcutaneous layer with the motorized shaver. Arthroscopy Techniques 2018 7, e675-e678DOI: (10.1016/j.eats.2018.02.017) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 5 (A) Hemostasis is achieved with a radiofrequency probe (arrow). The length of the proximal adductor tendon is well visualized with the arthroscope. (B) The radiofrequency probe is then used to perform the z-lengthening via the proximal portal from proximal (arrow) to distal. Arthroscopy Techniques 2018 7, e675-e678DOI: (10.1016/j.eats.2018.02.017) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions