video: hip arthroscopy icl 301: femoroacetabular impingement thursday, february 17 th, 2011 bryan t....
TRANSCRIPT
![Page 1: Video: Hip Arthroscopy ICL 301: Femoroacetabular Impingement Thursday, February 17 th, 2011 Bryan T. Kelly, MD Co-Director Center for Hip Pain and Preservation](https://reader038.vdocument.in/reader038/viewer/2022103005/56649cfa5503460f949cbe01/html5/thumbnails/1.jpg)
Video: Hip Arthroscopy
ICL 301: Femoroacetabular Impingement
Thursday, February 17th, 2011
Bryan T. Kelly, MDCo-DirectorCenter for Hip Pain and Preservation
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Bryan T. Kelly, MD
Hospital for Special Surgery
Disclosure: I DO NOT have a financial interest in any commercial products or service presented in this lecture AND
DO NOT INTEND to discuss off label or investigational use of products or
services.
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Types of financial relationships and the companies with whom I have relationships are as follows:
Pivot Medical, Inc.: Consultant
Smith & Nephew: Educational Consultant
A2 Surgical: Consultant
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Arthroscopic FAI
1. Set up
2. Access
3. Capsule Cut
4. Rim Prep / Resection
5. Labral Refixation
6. Cam Decompression
7. Capsular Repair
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1. Patient Set Up
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1. Patient Set Up
• Adequate traction requires approximately 10mm of distraction across the joint.
• Careful attention to padding is critical.
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2. Access – Portals
1.Anterior
2.Anterolateral
3.Posterolateral
Greatest Risk →→ Anterior Portal
– Avg. 3 mm from a branch of the lateral femoral cutaneous nerve
Primal Pictures Limited
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2. Access: Expanded Portal Placement• Palpate and Outline:
– Greater Trochanter– Anterior Superior Iliac Spine (ASIS)
• Portal Placement– Anterolateral Portal (AL)
• 1cm superior and anterior to GT
– Posterolateral (PL)• 1cm superior and posterior to GT
– Anterior Portal (AP)• In line with AL portal• 1 cm lateral to ASIS
– Mid-Anterior Portal (MAP)
– Proximal Mid-Anterior Portal (PMAP)
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Portal Safety
1. The Mid-Anterior and Anterior portals pass in close proximity to a small terminal branch of the ascending LCFA
2. Greatest risk still comes from the proximity of the anterior portal to the LFCN
– A slightly more lateral location may provide some
protective benefit
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Safe ZoneRobertson et al, Arthroscopy 2008.
• The findings from this study seem to support the concept of a relative neurovascular safe zone for arthroscopic access to the hip joint within the outlined parameters.
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2. Access / Visualization
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2. Access / Visualization
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2. Access / Visualization
Transition zone injury Contra-Coup injury
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3. Capsule Cut
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3. Capsule Cut – IA EvaluationCam Injury• Cam delamination• Loss of normal attachment of labrum to transition zone.
Rim Injury• Capsular sided injury to the labrum / capsule against the rim lesion
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4. Rim Preparation
Rim Exposure
• Severe rim inflammation around the rim lesion
Rim Decompression
• Outline the rim lesion prior to decompression
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4. Rim Preparation
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3. Rim Resection
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Pre Post
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4. Labral Refixation
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4. Labral Refixation
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Entry into peripheral compartment
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Reposition patient and fluoro for peripheral compartment work.
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5. T-Cut and Visualization
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6. Cam Decompression
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7. Capsule Closure and Assessment
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Pre and post fluoro shots of a patient with primary cam impingement
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Pre and post fluoro shots of a patient with combined subspine / rim / and cam impingement
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Thank You