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Modified anterior portal for hip arthroscopy.

ABSTRACT: Routine portal placement for the central compartment should be based on minimizing iatrogenic injury and maximizing access. Anchor placement for labral repair/refixation requires a more distal entry position to accomplish sufficient divergence to avoid perforating the articular surface of the acetabulum. If a standard portal for joint access is moved more distal, this can compromise its utility for addressing intra-articular pathology. In addition, it can be difficult to position this portal sufficiently distally to ensure adequate divergence. Moving the anchor away from the rim to avoid perforation, due to suboptimal portal placement, can result in nonanatomic labral repair. Thus a percutaneous anchor delivery system is advantageous in ensuring adequate divergence without compromising routine portal placement for the central compartment.

SUBMITTER: Thomas Byrd JW

PROVIDER: S-EPMC3882686 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Modified anterior portal for hip arthroscopy.

Thomas Byrd J W JW

Arthroscopy techniques 20130908 4

Routine portal placement for the central compartment should be based on minimizing iatrogenic injury and maximizing access. Anchor placement for labral repair/refixation requires a more distal entry position to accomplish sufficient divergence to avoid perforating the articular surface of the acetabulum. If a standard portal for joint access is moved more distal, this can compromise its utility for addressing intra-articular pathology. In addition, it can be difficult to position this portal suf ...[more]

PMID: 24400178

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Project description:BackgroundThe anterocentral portal is not a standard portal in anterior ankle arthroscopy due to its proximity to the anterior neurovascular bundle. However, it provides certain advantages, including a wide field of vision, and portal changes become redundant. The purpose of this study was to evaluate the neurovascular complications after anterior ankle arthroscopy using the anterocentral portal.MethodsWe retrospectively identified patients who had undergone anterior ankle arthroscopy with an anterocentral portal at our institution from 2013 to 2018. Medical record data were reviewed and patients were invited for clinical follow-up, where a clinical examination, quantitative sensory testing for the deep peroneal nerve, and ultrasonography of the structures at risk were performed. A total of 101 patients (105 arthroscopies) were identified and evaluated at a mean follow-up of 31.5 ± 17.7 months.ResultsLeading indications to surgery were heterogeneous and included anterior impingement (48.6%), osteochondral lesions of the talus (24.8%), chronic ankle instability (14.3%), and fractures (8.6%). The overall complication rate was 7.6%, and no major complications were observed. In 1.9% (2/105) of the cases, the complications were associated with the anterocentral portal and included injury to the medial branch of the superficial nerve (1/105) and to the deep peroneal nerve (1/105). Injury to the deep peroneal nerve was associated with a loss of detection and nociception. There were no injuries to the anterior tibial artery. In 41.9% (44/105) of the cases, only 1 working portal was used in addition to the anterocentral portal, and in 19% (20/105) the anterolateral portal could be avoided. Ultrasonography confirmed the integrity of the deep peroneal nerve, the medial branch of the superficial peroneal nerve, and the anterior tibial artery in all patients. Patients with nerve injuries associated with the anterocentral portal showed no signs of neuroma or pseudoaneurysm.ConclusionUsing a standardized technique, the anterocentral portal in ankle arthroscopy is safe with a low number of neurovascular injuries and can be recommended as a standard portal. The anterolateral portal remains associated with a high number of injuries to the superficial peroneal nerve.Level of evidenceLevel III, retrospective cohort study.

Dataset Information

Modified anterior portal for hip arthroscopy.

Publications

Modified anterior portal for hip arthroscopy.

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