Document Detail


The safe zone for hip arthroscopy: a cadaveric assessment of central, peripheral, and lateral compartment portal placement.
MedLine Citation:
PMID:  18760209     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: This study evaluated 11 arthroscopic portals (4 central, 4 peripheral, and 3 peritrochanteric) with regard to their proximity to neurovascular structures and the extra-articular path taken before entering their intended compartments. METHODS: We established 11 standard portals in 10 cadaveric hips, under arthroscopic and fluoroscopic visualization, using 3/16-inch Steinmann pins. Each hip was dissected, and the relation of the pins to the pertinent anatomy was recorded to the nearest 1 mm. RESULTS: Only 2 of the 11 portals, the anterior and midanterior portals, came within 2 cm of a neurovascular structure before entering their respective compartments. The anterior portal placed the lateral femoral cutaneous nerve at risk, lying at a mean of 15.4 mm (range, 1 to 28 mm) away. The midanterior portal lies a mean of 19.2 mm (range, 5 to 42 mm) from the ascending branch of the lateral circumflex femoral artery. In addition, a small terminal branch of this artery courses a mean of 14.7 mm (range, 2 to 33 mm) and 10.1 mm (range, 1 to 23 mm) from the anterior portal and midanterior portal, respectively. CONCLUSIONS: This study showed that 11 arthroscopic portals can be safely inserted into the central, peripheral, and peritrochanteric compartments of the hip. The midanterior and anterior portals pass in close proximity to a small terminal branch of the ascending lateral circumflex femoral artery. The greatest risk still comes from the proximity of the anterior portal to the lateral femoral cutaneous nerve. However, a slightly more lateral location seems to provide substantial benefits. CLINICAL RELEVANCE: This study investigated 11 arthroscopic hip portals inserted in a standardized fashion. This knowledge should help surgeons place the necessary portals both safely and accurately.
Authors:
William J Robertson; Bryan T Kelly
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Publication Detail:
Type:  Journal Article     Date:  2008-06-24
Journal Detail:
Title:  Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association     Volume:  24     ISSN:  1526-3231     ISO Abbreviation:  Arthroscopy     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-09-01     Completed Date:  2008-11-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8506498     Medline TA:  Arthroscopy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1019-26     Citation Subset:  IM    
Affiliation:
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA. Robertsonw@hss.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Arthroscopy / methods*
Cadaver
Femoral Nerve / anatomy & histology,  injuries
Hip / anatomy & histology*
Hip Joint / surgery*
Humans
Iatrogenic Disease / prevention & control
Middle Aged
Traction / methods

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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