The arthroscopic anatomy of the hip
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ABS TRA CTS 133 Average distance of structures frorn portals (mm) Anterolateral portal peroneus ext dig ext hal deep peroneal tertius long long N next to 12 14 18 Anteromedial portal ant tib ant rib deep peroneal saph T A N V/N next to 18 21 19 24 ant rib sup peroneal sural small A DLCN DICN N saph V 20 1 13 6 65 Posterolateral portal TA post tib sural small peroneal portal N/A/T N saph N T 17 31 35 35 15 18 10 structures and remain parallel with the knife blade to avoid laceration; (b) only penetrate the skin with the knife to avoid laceration of superficial nerves in the subcutaneous tissues; (c) pre- and postneuro- vascular examination is essential; (d) anterocentral and posteromedial portals are dangerous secondary to the neurovascular bundles; (e) the TA approach appears anatomically safe and offers the advantage of an additional posterior portal; (f) arthroscop- ically, the TA approach offers an excellent, unob- structed view of the posterior ankle joint and, in selected ankles, the ability to view the anterior cap- sule. In conclusion, knowledge of the detailed anatomy of the ankle presented in this study is mandatory to minimize the risks of damage to vital structures during ankle arthroscopy. The Arthroscopic Anatomy of the Hip. Marcel F. S. Dvorak, C. P. Duncan, and Brian Day. Vancouver, British Columbia, Canada. Arthroscopy of the hip joint has not been prop- erly assessed with respect to the technique, the normal arthroscopic anatomy, and the indications for its clinical application given the expectations and limitations of the technique. The objective of this paper is to describe the normal arthroscopic anatomy of the hip joint and in the process to evaluate the technique and suggest possible clinical indications. Fifteen hips were arthroscoped in eight cadavers. Anatomical dissections were carried out after each arthroscopy to verify the arthroscopic anatomy. Three separate portals were used--anterolateral, anterior paratrochanteric, and posterior paratro- chanteric. The femoral head, acetabular labrum, and both articular surfaces were seen. The ilio- femoral, pubofemoral, and ischiofemoral ligaments as well as the zona orbicularis were accentuated and then relaxed as the position of the hip was changed intraoperatively. The neck of the femur with its folds of synovium covering the retinacular vessels was also seen. Using the three portals de- scribed, 80% of the femoral head could be visual- ized and 50% of the circumference of the acetabular labrum was seen. Significant distraction is required to view the acetabular articular surface. An appreciation for the arthroscopic anatomy of the normal hip is necessary before the surgeon pro- ceeds to clinical applications of hip arthroscopy. The use of multiple portals increases the amount of the joint visible to the surgeon. Both distraction and intraoperative repositioning are necessary for insertion of the instruments, orientation of the sur- geon to the intraarticular anatomy, and for expo- sure and accentuation of the relevant anatomical structures. Due to the narrow field of view within the hip and the depth of soft tissues, positioning probes and instruments within the joint is very difficult. Possible operative indications may include removal of loose bodies or cement fragments, synovial biopsy, and excision of labral tears. Osteochondral lesions, most often anterolateral, could be easily seen. The femoral articular surface could be assessed for erosions prior to osteotomy or synovectomy. Patients with Legg Perthes disease and chondrolysis could be assessed in a similar manner. Isometric Placement of an ACL Graft Using a Single Tunnel Technique. Robert C. Hendler. Goshen, New York, U.S.A. An arthroscopic technique using a single tunnel has been developed for placing an anterior cruciate ligament (ACL) graft along the anatomic axis of the normal ACL. By varying the tunnel diameter and the depth of penetration into or through the lateral femoral condyle, any type of graft can be used with this technique. A loop of semitendinosis tendon, the middle one-third of the patella tendon, freeze- Arthroscopy, Vol. 4, No. 2, 1988
Transcript of The arthroscopic anatomy of the hip
ABS TRA CTS 133
Average distance o f structures frorn portals (mm)
Anterolateral portal peroneus ext dig ext hal deep peroneal tertius long long N
next to 12 14 18
Anteromedial portal ant tib ant rib deep peroneal saph
T A N V/N
next to 18 21 19 24
ant rib sup peroneal sural small A DLCN DICN N saph V
20 1 13 6 65
Posterolateral portal TA post tib sural small peroneal
portal N/A/T N saph N T
17 31 35 35 15 18 10
structures and remain parallel with the knife blade to avoid laceration; (b) only penetrate the skin with the knife to avoid laceration of superficial nerves in the subcutaneous tissues; (c) pre- and postneuro- vascular examination is essential; (d) anterocentral and posteromedial portals are dangerous secondary to the neurovascular bundles; (e) the TA approach appears anatomically safe and offers the advantage of an additional posterior portal; (f) arthroscop- ically, the TA approach offers an excellent, unob- structed view of the posterior ankle joint and, in selected ankles, the ability to view the anterior cap- sule. In conclusion, knowledge of the detailed anatomy of the ankle presented in this study is mandatory to minimize the risks of damage to vital structures during ankle arthroscopy.
The Arthroscopic Anatomy of the Hip. Marcel F. S. Dvorak, C. P. Duncan, and Brian Day. Vancouver, British Columbia, Canada.
Arthroscopy of the hip joint has not been prop- erly assessed with respect to the technique, the normal arthroscopic anatomy, and the indications for its clinical application given the expectations and limitations of the technique.
The objective of this paper is to describe the normal arthroscopic anatomy of the hip joint and in the process to evaluate the technique and suggest possible clinical indications.
Fifteen hips were arthroscoped in eight cadavers. Anatomical dissections were carried out after each arthroscopy to verify the arthroscopic anatomy.
Three separate portals were used--anterolateral, anterior paratrochanteric, and posterior paratro- chanteric. The femoral head, acetabular labrum, and both articular surfaces were seen. The ilio- femoral, pubofemoral, and ischiofemoral ligaments as well as the zona orbicularis were accentuated and then relaxed as the position of the hip was changed intraoperatively. The neck of the femur
with its folds of synovium covering the retinacular vessels was also seen. Using the three portals de- scribed, 80% of the femoral head could be visual- ized and 50% of the circumference of the acetabular labrum was seen. Significant distraction is required to view the acetabular articular surface.
An appreciation for the arthroscopic anatomy of the normal hip is necessary before the surgeon pro- ceeds to clinical applications of hip arthroscopy.
The use of multiple portals increases the amount of the joint visible to the surgeon. Both distraction and intraoperative repositioning are necessary for insertion of the instruments, orientation of the sur- geon to the intraarticular anatomy, and for expo- sure and accentuation of the relevant anatomical structures.
Due to the narrow field of view within the hip and the depth of soft tissues, positioning probes and instruments within the joint is very difficult. Possible operative indications may include removal of loose bodies or cement fragments, synovial biopsy, and excision of labral tears.
Osteochondral lesions, most often anterolateral, could be easily seen. The femoral articular surface could be assessed for erosions prior to osteotomy or synovectomy. Patients with Legg Perthes disease and chondrolysis could be assessed in a similar manner.
Isometric Placement of an ACL Graft Using a Single Tunnel Technique. Robert C. Hendler. Goshen, New York, U.S.A.
An arthroscopic technique using a single tunnel has been developed for placing an anterior cruciate ligament (ACL) graft along the anatomic axis of the normal ACL. By varying the tunnel diameter and the depth of penetration into or through the lateral femoral condyle, any type of graft can be used with this technique. A loop of semitendinosis tendon, the middle one-third of the patella tendon, freeze-
Arthroscopy, Vol. 4, No. 2, 1988
