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Arthroscopy. 2014 Jan;30(1):55-9. doi: 10.1016/j.arthro.2013.09.004. Epub 2013 Nov 26.

Medial hip arthroscopy portals: an anatomic study.

Author information

1
Hip Group, Department of Orthopedic Surgery and Traumatology, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Electronic address: giancarlopolesello@hotmail.com.
2
Hip Group, Department of Orthopedic Surgery and Traumatology, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil.
3
Arthroscopy Laboratory, Faculdade de Ciências Médicas da Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil.

Abstract

PURPOSE:

The main objective of this study was to investigate medial hip portals and evaluate their relation with anatomic structures in a cadaveric model.

METHODS:

Placement of 3 medial arthroscopic portals was simulated in 10 fresh human paired cadaveric hip specimens by placing Steinmann pins into the joint under fluoroscopic control. Two portals were made at the groin, 1 anterior and 1 posterior to the adductor longus muscle, and the third portal was placed posterior to the adductor longus muscle, 5 cm distal to the groin. The specimens were then dissected, and the relation of the portals to the following structures was recorded: pectineus, adductor longus, gracilis, adductor brevis, adductor magnus, iliopsoas tendon, obturator nerve, femoral nerve, femoral artery, femoral vein, and profunda femoris artery.

RESULTS:

Regarding the anteromedial portal, the closest neurovascular structure was the profunda femoris artery, which was 10.4 ± 2.7 mm (range, 6 to 14 mm) distal to the portal. Regarding the posteromedial portal, the nearest neurovascular structure was the obturator nerve, which was 6.0 ± 3.6 mm (range, 2 to 13 mm) posterior to the portal. Regarding the distal posteromedial portal, the nearest neurovascular structures were the obturator nerve, which was 4.6 ± 3.0 mm (range, 1 to 9 mm) distal to the portal, and the profunda femoris artery, which was 10.5 ± 3.9 mm (range, 6 to 17 mm) distal to the portal.

CONCLUSIONS:

The use of the medial portals did not cause any damage to the neurovascular structures evaluated. Despite this, the portals are in close relation to the obturator nerve and profunda femoris, and care should be taken.

CLINICAL RELEVANCE:

This study investigated 3 medial hip portals in a cadaveric model and also defined safety parameters for this approach. Medial hip portals may be useful to directly approach medial hip pathologies.

PMID:
24290433
DOI:
10.1016/j.arthro.2013.09.004
[Indexed for MEDLINE]
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