Arthroscopic Psoas Management: Techniques for Psoas Preservation and Psoas Tenotomy  Andrea M. Spiker, M.D., Ryan M. Degen, M.D., Christopher L. Camp, M.D., Struan H. Coleman, M.D.  Arthroscopy Techniques  Volume 5, Issue 6, Pages e1487-e1492 (December 2016) DOI: 10.1016/j.eats.2016.08.030 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 Intraoperative findings consistent with the diagnosis of psoas impingement include focal erythema of the labrum at the 3-o'clock position. In this view from the anterolateral portal of a right hip in the supine position, the asterisk marks the area of maximal labral impingement, in proximity to the psoas tendon (PT). (FH, femoral head.) Arthroscopy Techniques 2016 5, e1487-e1492DOI: (10.1016/j.eats.2016.08.030) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 (A) While viewing from the anterolateral portal of this right hip in the supine position, the arthroscopic scalpel is inserted through the midanterior portal and a capsulotomy is performed, after which the scalpel can be used in a fanning motion to separate the proximal limb (PL) and distal limb (DL) of the capsulotomy to expose the psoas tendon. (B) A shaver is then used to remove any remaining tissue to allow full visualization of the psoas tendon before proceeding with the tenotomy. (C) A radiofrequency ablation device is introduced from the midanterior portal to perform a release of the tendinous portion of the psoas at the level of the labrum. (D) Care is taken to perform only a tenotomy and to avoid injury to the muscular fibers immediately medial to the tendon. (FH, femoral head.) Arthroscopy Techniques 2016 5, e1487-e1492DOI: (10.1016/j.eats.2016.08.030) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 If psoas impingement exists but psoas tenotomy is contraindicated, the psoas tunnel can be deepened. (A, B) While viewing from the anterolateral portal of this right hip in the supine position, with instruments inserted through the midanterior portal, the soft tissue is first cleared from the acetabular rim in the subspine region medial to the anterior inferior iliac spine (AIIS) with the radiofrequency device. (C) The psoas tunnel is defined next with the arthroscopic shaver. (D) The arthroscopic burr is used to deepen this tunnel. (E) The widened psoas tunnel allows for increased excursion of the psoas tendon. (L, lateral; M, medial.) Arthroscopy Techniques 2016 5, e1487-e1492DOI: (10.1016/j.eats.2016.08.030) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 If psoas tenotomy is indicated, the electrocautery device can be used to perform the arthroscopic tenotomy. (A) While viewing from the anterolateral portal of this right hip in the supine position, the arthroscopic cautery device is inserted through the midanterior portal and brought medial to lateral, from posterior to anterior across the tendon. (B) The entire tendon should undergo tenotomy, but care is taken to leave the muscle fibers of the psoas intact in their position adjacent to the tendon that has undergone tenotomy. (FH, femoral head.) Arthroscopy Techniques 2016 5, e1487-e1492DOI: (10.1016/j.eats.2016.08.030) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions