The reduction in the incidence of iatrogenic meralgia paresthetica after hip arthroscopy by preoperative mapping of the nerve

Background: The gold standard for treating femoroacetabular impingement (FAI) is hip arthroscopy. The proximity of neurovascular structures makes them susceptible to injury. Among these, damage to the thigh's lateral cutaneous nerve is frequently sustained during the anterior portal hip arthroscopy procedure. The study's main goal was to determine whether ultrasound mapping of the thigh's lateral cutaneous nerve reduced the risk of injury during anterior portal hip arthroscopy. The secondary goal was to determine how traction time and subsequent traction-related complications-of which pudendal nerve injury is the most concerning-were affected by medially positioning the anterior portal to allow direct access to the anterior part of the labrum. Methods: The study included 51 patients who underwent hip arthroscopy for femoral osteoplasty and/or acetabuloplasty, as well as anterior labral repair, between August 2022 to November 2024. Results: The average traction time was 57.1 minutes, with a range of 40 to 85 minutes and an SD of 10.4 minutes. Three patients (5.9%) experienced partial palsy of the lateral cutaneous nerve of the thigh. Following surgery, one patient (2%) experienced complete pudendal nerve palsy, and 8 patients (15.7%) experienced partial palsy. Conclusions: The present study discusses the safety and potential advantages of mapping the lateral cutaneous nerve of the thigh using ultrasound. It also suggests that this method may help to shorten the duration of traction and minimize complications associated with it.