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 83 years). 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 (4.5/2.7 mm) 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 15-20 s and a dose area product between 100 and 120 cGy cm(2). 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.
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 83 years). 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 (4.5/2.7 mm) 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 15-20 s and a dose area product between 100 and 120 cGy cm(2). 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.
Authors: Keith S Hechtman; John E Zvijac; Charles A Popkin; Gregory A Zych; Angie Botto-van Bemden Journal: Sports Health Date: 2010-05 Impact factor: 3.843