ePoster #113 - ISHA Annual Scientific Meeting 2016

Neurovascular Structures At Risk During Medial And Anterolateral Arthroscopic Approaches Of The Hip

Felix Vilchez, MD, PhD, Monterrey, Nuevo Leon MEXICO
Omar Méndez , MD, Monterrey, Nuevo León MEXICO
Victor Peña , MD, Prof , Monterrey , Nuevo Leon MEXICO
Carlos Acosta , MD, Prof , Monterrey , Nuevo Leon MEXICO
Rodrigo Elizondo , Prof, Monterrey, Nuevo Leon MEXICO
Rodolfo Morales, MD, Monterrey, Nuevo Leon MEXICO
Abraham Espinosa, MD, Monterrey , Nuevo Leon MEXICO
Maria Theriot, Prof , Monterrey , Nuevo Leon MEXICO
Alejandro Quiroga , Prof, Monterrey , Nuevo Leon MEXICO
Santos Guzman , Prof, Monterrey , Nuevo Leon MEXICO

Human Anatomy Department, School of Medicine, Universidad Autónoma de Nuevo León (U.A.N.L.), Monterrey, Nuevo León, MEXICO

FDA Status Not Applicable

Summary: Medial portals have a higher risk of injuring the femoral neurovascular bundle as well as the obturator nerve. The lateral portals have a higher safety margin; the portal with the most proximity to a neurovascular structure is the anterior portal, associated laterally with the femoral cutaneous nerve, presenting a higher risk of injury.

Abstract:
Purpose. To describe the safety areas for placement of 3 recently described medial portals (anterior medial, posterior medial and distal posterior medial portals) and 5 anterolateral portals (anterior, anterior lateral, posterior lateral, proximal anterior medial and distal anterior medial portals) to provide topographical description of the safety of each.

Methods. A descriptive, observational and cross-sectional study in which femoral triangle dissection was performed in 12 hips. the 3 medial portals and 5 lateral portals were placed. Clinically relevant neurovascular structures associated with each portal, were identified measured and documented.

Results. The medial portals, the anterior medial portal has the narrowest margin in relation to the femoral artery, 2.14 cm (± 0.35) lateral to the portal and medial to the obturator nerve by 0.87 cm (± 0.62). In the lateral portal with the highest risk of injury to a nearby neurovascular structure was the anterior portal, the most adjacent to the femoral cutaneous nerve, 1.42 cm (± 0.85) lateral to the portal.

Conclusions. Medial portals have a higher risk of injuring the femoral neurovascular bundle as well as the obturator nerve.
The lateral portals have a higher safety margin; the portal with the most proximity to a neurovascular structure is the anterior portal, associated laterally with the femoral cutaneous nerve, presenting a higher risk of injury.

KEYWORDS: anatomy, arthroscopy, safety area, hip, cadaveric, portals.