title: Psoas tunnel perforation-an unreported complication of hip arthroscopy.
abstract: The utilization of hip arthroscopy is rapidly increasing due to improved arthroscopic techniques and training, better recognition of pathology responsible for non-arthritic hip pain and an increasing desire for minimally invasive procedures. With increasing rates of arthroscopy, associated complications are also being recognized. We present a series of six patients who experienced psoas tunnel perforation during anchor insertion from the distal anterolateral portal during labral repair. All patients underwent prior hip arthroscopy and labral repair and presented with persistent symptoms at least partly attributable to magnetic resonance imaging (MRI)-documented psoas tunnel perforation. Their clinical records, operative notes and intra-operative photographs were reviewed. All patients presented with persistent pain, both with an anterior impingement test and resisted hip flexion. MRI imaging demonstrated medial cortical perforation with anchors visualized in the psoas tunnel, adjacent to the iliopsoas muscle. Four patients have undergone revision hip arthroscopy, whereas two have undergone periacetabular osteotomies. All patients had prominent anchors in the psoas tunnel removed at the time of surgery, with varying degrees of concomitant pathology appropriately treated during the revision procedure. Care must be utilized during medial anchor placement to avoid psoas tunnel perforation. Although this complication alone was not the sole cause for revision in each case, it may have contributed to their poor outcome and should be avoided in future cases. This can be accomplished by using a smaller anchor, inserting the anchor from the mid-anterior portal and checking the drill hole with a nitinol wire prior to anchor insertion.
authors.affiliation: Center for Hip Preservation, Hospital for Special Surgery, 541 East 71st Street, New York, NY 10021, USA.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Degen
authors.affiliation: Center for Hip Preservation, Hospital for Special Surgery, 541 East 71st Street, New York, NY 10021, USA.
authors.forename: Eilish
authors.initials: E
authors.lastname: O'Sullivan
authors.affiliation: Center for Hip Preservation, Hospital for Special Surgery, 541 East 71st Street, New York, NY 10021, USA.
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Sink
authors.affiliation: Center for Hip Preservation, Hospital for Special Surgery, 541 East 71st Street, New York, NY 10021, USA.
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Kelly