caa a22 4500 605456828 CHVBK 20210128100220.0 cr unu---uuuuu 210128e20150901xx s 000 0 eng 10.1007/s00167-014-3105-3 doi (NATIONALLICENCE)springer-10.1007/s00167-014-3105-3 Arthroscopic debridement of the pubic symphysis: an experimental study [Elektronische Daten] [Sascha Hopp, Ulf Culemann, Ishaq Ojodu, Tim Pohlemann, Jens Kelm] Purpose: Open curettage of the symphysis has shown promising results in patients with recalcitrant osteitis pubis. However, this has been bedevilled with an extended intraoperative morbidity. Aim of this study was to come up with a novel arthroscopic debridement of the pubic symphysis and to bring to the fore the potential risks of soft tissue damage. Methods: This study was conducted on six human cadavers (mean age 83years). CT scans were obtained for measurement of the symphyseal morphology. Consequent upon these measurements, four different potential arthroscopic portals were defined with the intention to gain adequate insight and to reach the whole joint space with instruments: one suprapubic portal and three anterior portals (antero-superior, antero-central and antero-inferior). Soft tissue, except for musculotendinous attachments and neurovascular structures, was dissected. A two-portal arthroscopic debridement under image intensifier control with resection of the symphyseal disc and abrasion of the subchondral bone were performed. Results: Considering the narrow joint space, small instruments/scope (4.5/2.7mm) is recommended. Correct portal placement and debridement procedure can only be reliably performed under fluoroscopic imaging in two radiographic projections (outlet and inlet view) with a mean total fluoroscopic time of 15-20s and a dose area product between 100 and 120cGycm2. Two portals have proved beneficial: the suprapubic portal for instruments and the antero-central portal for the scope. Other portals had several limitations, e.g. potential instrumental conflict (anterior-superior) or damaging of neurovascular and other soft tissue structures (anterior-inferior). Conclusion: With well-defined arthroscopic portals and adherence to basic principles of arthroscopic surgery, debridement of the pubic symphysis can be performed reproducibly without compromising important anatomical structures. This less invasive arthroscopic debridement is a safely applicable procedure and therefore might be a reasonable alternative to open curettage. One may assume that this technique will lead to a shorter rehabilitation time and will provide a successful therapy especially in the treatment of professional athletes in the future. Springer-Verlag Berlin Heidelberg, 2014 Osteitis pubis nationallicence Pubic symphysis nationallicence Anatomy nationallicence Debridement nationallicence Arthroscopic technique nationallicence Hopp Sascha Department of Trauma Hand and Reconstructive Surgery, University of Saarland, Kirrbergerstraße 1, 66421, Homburg, Saarland, Germany aut Culemann Ulf General Hospital, Celle, Germany aut Ojodu Ishaq Cedarcrest Hospital, Abuja, Nigeria aut Pohlemann Tim Department of Trauma Hand and Reconstructive Surgery, University of Saarland, Kirrbergerstraße 1, 66421, Homburg, Saarland, Germany aut Kelm Jens Chirurgisch-Orthopädisches Medizinisches-Versorgungszentrum, Illingen, Germany aut Knee Surgery, Sports Traumatology, Arthroscopy Springer Berlin Heidelberg 23/9(2015-09-01), 2568-2575 0942-2056 23:9<2568 2015 23 167 https://doi.org/10.1007/s00167-014-3105-3 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00167-014-3105-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Hopp Sascha Department of Trauma Hand and Reconstructive Surgery, University of Saarland, Kirrbergerstraße 1, 66421, Homburg, Saarland, Germany aut NATIONALLICENCE 700 1- Culemann Ulf General Hospital, Celle, Germany aut NATIONALLICENCE 700 1- Ojodu Ishaq Cedarcrest Hospital, Abuja, Nigeria aut NATIONALLICENCE 700 1- Pohlemann Tim Department of Trauma Hand and Reconstructive Surgery, University of Saarland, Kirrbergerstraße 1, 66421, Homburg, Saarland, Germany aut NATIONALLICENCE 700 1- Kelm Jens Chirurgisch-Orthopädisches Medizinisches-Versorgungszentrum, Illingen, Germany aut NATIONALLICENCE 773 0- Knee Surgery, Sports Traumatology, Arthroscopy Springer Berlin Heidelberg 23/9(2015-09-01), 2568-2575 0942-2056 23:9<2568 2015 23 167