Medial hip arthroscopy portals and their relation to the extra-articular structures: A cadaveric study

Abstract

IntroductionThe present study was to study the relationship of medial hip portals with important neurovascular structures present in this region and to investigate safety zone for medial compartment. Materials and methodsThirty specimens from 15 adult cadavers were suitably positioned and anteromedial (AMP), posteromedial portal (PMP) and distal posteromedial (DMP) portals were marked and inserted along the anterior and posterior borders of adductor longus and then dissections were done. The distances were measured from point of entry of portal to femoral bundle, obturator nerve, saphenofemoral junction and profunda femoris artery. The depths of the above given structures were noted from the level of the respective portals. The transverse and sagittal angles of portal insertions were measured. ResultsIn our study AMP and DMP were in greater proximity to the profunda femoris artery (2.5cm and 2.8cm, respectively), whereas obturator nerve was the closest structure in PMP (2.6cm). Depth wise the nearest structure in all the portals was obturator nerve (1.1–1.3cm). The mean values of transverse angle for AMP, PMP and DMP were17°, 18° and 15°, respectively, whereas the sagittal angle were 16°, 18° and 15°, respectively. Profunda femoris artery and obturator nerve were present on an average distance of 2.5cm from the portal entry point, and depth wise these structures lie about 1cm from the portal level. DiscussionThese structures are at the risk of getting damaged with misdirected portal. Thus the knowledge of angles of portal insertion is critical for avoiding iatrogenic damage.