EP3.16 An Extra-Capsular and Tractionless Approach for Combined Acetabular and Femoral Resection for Severe Coxa Profunda
Abstract
Abstract Femoroacetabular impingement (FAI) is a well-recognized cause of hip pain in young and middle-aged adults. Among its morphologic variants, coxa profunda remains one of the least understood entities encountered in hip arthroscopy and presents technical challenges during hip preservation procedures. The deep acetabular morphology makes adequate joint distraction difficult, often requiring traction forces that approach or exceed recommended safety limits. Increased traction can elevate the risk of complications such as neuropraxia, perineal injury, and iatrogenic labral or chondral damage during portal placement. In some cases, these limitations have led to aborted arthroscopic procedures. An extracapsular, tractionless arthroscopic technique may offer a viable alternative in this setting. This approach allows surgeons to address cam deformities, perform controlled acetabular rim recession, and evaluate labral pathology without the need for excessive traction. An extracapsular cutdown approach is used with standard anterolateral and anteromedial portals. Fluoroscopy is used for initial triangulation, followed by arthroscopy to identify the iliofemoral ligament. A truncated “T capsulotomy” is used for visualization of the femoroacetabular articulation. The labrum is sacrificed from the 3 to 11 o’clock position. A burr is then used to perform combined debridement of both the acetabulum and femoral head/neck junction. Fluoroscopy is used to confirm resection. The resulting bony morphology has a complementary concentricity. An additional distal anterolateral portal is established, and labral reconstruction is performed to restore the sacrificed labrum. Anterior Tibialis allograft is tubularized and passed from anterior to posterior utilizing a posterior shuttle anchor at 11 o’clock. A total of four additional anchors are used to tie the allograft from posterior to anterior. A series of simple sutures is used to close the capsulotomy. By reducing traction-related morbidity while enabling comprehensive management of bony and soft tissue pathology, this approach may expand the role of hip arthroscopy in patients with complex acetabular morphology.