Endoscopy-Assisted Periacetabular Osteotomy Dean K. Matsuda, M.D., Hal D. Martin, D.O., Javad Parvizi, M.D.  Arthroscopy Techniques  Volume 5, Issue 2, Pages e275-e280 (April 2016) DOI: 10.1016/j.eats.2016.01.017 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 Representative AP pelvis demonstrating some procedural components of endoscopy-assisted PAO, including intra-articular arthroscopy and extra-articular endoscopy. (AP, anteroposterior; AVN, avascular necrosis; CC dx & rx, central compartment diagnosis and treatment; Femoroplx, femoroplasty; fx, fracture; IA, intra-articular; PAO, periacetabular osteotomy; Post, posterior; THA, total hip arthroplasty.) Arthroscopy Techniques 2016 5, e275-e280DOI: (10.1016/j.eats.2016.01.017) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 Intraoperative photograph of left endoscopy-assisted periacetabular osteotomy in supine position during posterior column osteotomy with osteotome in mini-Hueter incision and endoscopically placed and visualized retractor protecting sciatic nerve (inset) in posterior peritrochanteric space via posterolateral portal as viewed from anterolateral portal with a 70-degree arthroscope. Arthroscopy Techniques 2016 5, e275-e280DOI: (10.1016/j.eats.2016.01.017) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 Intraoperative anteroposterior fluoroscopic image of initial reoriented acetabulum demonstrating large crossover sign above intersection of anterior (red) and posterior (blue) lines. Note K-wires providing transient fixation. Arthroscopy clarified that anterior prominence was caused by anterior inferior iliac spine and not by anterior acetabular rim. Arthroscopy Techniques 2016 5, e275-e280DOI: (10.1016/j.eats.2016.01.017) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 Intraoperative anteroposterior fluoroscopic image of acetabular fragment fixated in a more desirable position with improved anterolateral coverage without pincer or subspine impingement. Note Schanz pin providing acetabular repositioning and fixation with cortical screws. Anterior rim (red line) is medial to the posterior rim (blue line). Arthroscopy Techniques 2016 5, e275-e280DOI: (10.1016/j.eats.2016.01.017) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Arthroscopic and fluoroscopic (inset) image of left hip from anterolateral portal during femoroplasty after endoscopy-assisted periacetabular osteotomy, enabling optimization of concurrent cam decompression in relation to newly oriented acetabular rim. Arthroscopy Techniques 2016 5, e275-e280DOI: (10.1016/j.eats.2016.01.017) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 6 Intraoperative dynamic testing confirms eradication of impingement, stability of endoscopy-assisted periacetabular osteotomy fixation, and retention of labral fluid seal (inset as viewed from anterolateral portal) after arthroscopic femoroplasty. Arthroscopy Techniques 2016 5, e275-e280DOI: (10.1016/j.eats.2016.01.017) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 7 Arthroscopic image of left hip via anterolateral portal showing capsular repair. (C, capsule; FH, femoral head; L, labrum.) Arthroscopy Techniques 2016 5, e275-e280DOI: (10.1016/j.eats.2016.01.017) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 8 Arthroscopic image of cadaveric left hip demonstrating proximity of osteotome during ischial osteotomy and retraction of adjacent sciatic nerve with blunt obturator. Inset shows the periacetabular osteotomy cuts with ischial osteotomy labeled 1. Arthroscopy Techniques 2016 5, e275-e280DOI: (10.1016/j.eats.2016.01.017) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions