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(a) There are different designs of arthroscopic awls with diverse angles to compensate the mechanical difficulty performing microfractures in the reduced space of the hip joint. (b) When making the impact with the mallet on the “arthroscopic awl” there is a risk of sliding forward creating grooves instead of perforations. To prevent this, it is beneficial to use the supplementary support on a hemi-cannula (arrow). (c) This protects the cartilage from the femoral head and allows pressuring against the acetabular surface, achieving a greater penetration of the awl at the moment of impact preventing the creation of grooves on the surface. (d) Once the microfractures have been completed, articular irrigation can be suspended to verify adequate bleeding from the perforations (white arrow) and to further deepen the perforations where there is still no bleeding (black arrow).
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