Tenosuspension of the Reflected Head of the Rectus Femoris in Hip Arthroscopy: Description of a Portal and a Surgical Maneuver

Arthroscopy is a surgical technique useful in the treatment of intra- and extra-articular hip pathologies, including femoroacetabular impingement (FAI). In the arthroscopic treatment of pincer-type FAI, tendon interposition of the reflected head of the rectus femoris frequently hinders acetabular edge resection in the anterior-superior region (acetabuloplasty) and labrum repositioning, even causing tendon injury during the surgical procedure. Many surgeons do not give importance to the reflected head of the rectus femoris, and during the procedure they try to avoid it, giving 30° of flexion to the hip. However, this does not always prevent tendon injury caused by the instruments. Some surgeons even resect part of the tendon to improve visualization or to use it as a labral graft. The objective of this work is to describe a reproducible surgical maneuver that allows to perform the anterior-superior acetabular edge resection and chondrolabral union repair with less damage to the reflected head of the rectus femoris.