Combined Hip Arthroscopy and Periacetabular Osteotomy (PAO): Technical Focus on Arthroscopically Elevating the Iliocapsularis and Performing the Open PAO

Spiker, Andrea M.; Turner, Elizabeth H.G.; Gans, Itai; Sisel, Haley I.; Wiseley, Benjamin; Goodspeed, David C.

doi:10.1016/j.eats.2021.07.004

Cited by 8 publications

(5 citation statements)

References 18 publications

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“…For instance, surgeons have identified the significance of first locating and carefully reflecting the ICm to obtain clear visuals of the hip capsule during hip periosteotomies (Siebenrock et al, 2015) and hip joint replacements (Camenzind et al, 2018). Similarly, surgical studies have highlighted the importance of using the ICm to correctly identify soft tissues surrounding the hip joint during hip arthroscopies and capsulotomies (Harris, 2016; Kalhor et al, 2021; Spiker et al, 2021). To help guide presurgical decisions, diagnostic magnetic resonance imaging (MRI) has been utilized to assess fatty infiltrates within the ICm, which are seen around joints with chronic pain and pain‐related disuse, particularly in patients with hip dysplasia (Babst et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

“…ATBs. The surveys suggest that the muscle is rarely appreciated by general clinicians and anatomy educators, while the recent PRL suggests that hip-specific surgeons, who must account for the muscle's presence and functional importance when performing anterior hip procedures, have come to prioritize the muscle over the past decade (Camenzind et al, 2018;Fagotti et al, 2020;Harris, 2016;Konno et al, 2021;Philippon et al, 2014;Siebenrock et al, 2015;Spiker et al, 2021;Xu et al, 2021). In contrast to these conflicting findings, the ICm was a constant in the dissections performed in this study in all previous surgical and dissection studies, Note: A positive result in the educator survey was recorded by including iliocapsularis in the answer to the question "Which of the following structures do you teach to your students?…”

Section: Discussionmentioning

confidence: 99%

“…Of the 28 publications mentioning the ICm, 19 highlighted the morphology and proposed functional roles of the muscle (Babst et al, 2011;Baker et al, 2022;Das & Singh, 1950;Elvan et al, 2019;Haefeli et al, 2015;Hammoud et al, 2014;Keet et al, 2021;Konno et al, 2021;Lawrenson et al, 2017Lawrenson et al, , 2019Lawrenson et al, , 2020Philippon et al, 2014;Pourcho et al, 2015;Retchford et al, 2013;Ricci & Özçakar, 2019;Saito et al, 2021;Walters et al, 2014;Wang et al, 2021;Ward et al, 2000). Nine additional studies reported the presence of the ICm using clinical scenarios consisting of surgical interventions and diagnostic imaging (Agten et al, 2016;Camenzind et al, 2018;Fagotti et al, 2020;Harris, 2016;Kalhor et al, 2021;Siebenrock et al, 2015;Spiker et al, 2021;Wyatt et al, 2017;Xu et al, 2021). To further evaluate the ICm prevalence in the human body, one redundant donor data set was excluded in addition to 14 publications, which were either reviews, technical notes, or case studies.…”

Section: Primary Literature Searchmentioning

confidence: 99%

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Iliocapsularis: An exploration of the muscle and its omission in education

Breckling¹,

Katrikh

Jones

et al. 2022

Journal of Morphology

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Anterior hip joint musculature is classically characterized to include iliacus, psoas major, rectus femoris, and sartorius muscles. A lesser‐known muscle, iliocapsularis muscle (ICm), has made infrequent appearances in the literature for the last ~70 years, but potentially has important functional and clinical value. The purpose of this study is to review the historical prevalence of the ICm in peer‐reviewed literature (PRL), further explore the prevalence of the muscle in current anatomical textbooks (ATBs), characterize the muscle with a new series of dissections, assess the muscle's perceived importance to clinicians and educators, and comment on the possible functional significance of the muscle. The ICm was mentioned in 28 peer‐reviewed articles and the muscle was present in 518 of 521 (99%) dissected hips in 13 publications which assessed prevalence. In an audit of 30 recently published ATBs, three texts mentioned the ICm. In 28 anterior hip dissections performed in the current study, the muscle was present in all hips. Anatomy educators were surveyed to determine if the ICm was presently taught in their curricula, and clinicians of various specialties were surveyed regarding their perceptions of the ICm and its clinical relevance. The ICm inclusivity within anatomical curricula from educators reported 8.5%, while 4% of clinicians reported trainees should have an educational background of the ICm. This study confirms that while the ICm is present within PRL, and is ubiquitous amongst human‐donor dissection, the ICm is not mentioned in most ATBs and is absent in the vast majority of anatomical curricula. Lack of inclusion in curricula may lead to a perceived insignificance to currently practicing clinicians despite the potential functional importance at the hip. This discordance suggests that the ICm should be included in ATBs and anatomical curricula so that future clinicians can consider the ICm when evaluating and treating patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Primary Literature Searchmentioning

confidence: 99%

See 1 more Smart Citation

Iliocapsularis: An exploration of the muscle and its omission in education

Breckling¹,

Katrikh

Jones

et al. 2022

Journal of Morphology

View full text Add to dashboard Cite

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“…For example, combined hip arthroscopic surgery with PAO is the definitive treatment for femoroacetabular impingement with hip dysplasia. 7,28 If dysplasia is inaccurately assessed as borderline, many surgeons may forego more invasive osteotomy in favor of solely addressing the intra-articular abnormality. Indeed, 60% to 85% of patients with dysplasia have concomitant intra-articular abnormalities, the most common being labral tears and chondral defects.…”

Section: Discussionmentioning

confidence: 99%

Use of Anatomic Radiographic Horizons for the Lateral Center-Edge Angle in the Classification of Hip Dysplasia

et al. 2022

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Background: The lateral center-edge angle of Wiberg (LCEA) and Tönnis angle (TA) rely on a “horizon” that functions as a reference point for measurements of hip dysplasia on weightbearing anteroposterior pelvis radiographs. There are 3 different horizons that are currently utilized depending on surgeon preference: (1) a line parallel to the radiographic floor (F), (2) a line that connects the inferior portions of the acetabular teardrops (ATs), or (3) a line that connects the ischial tuberosities (ITs). It is imperative to accurately assess the degree of hip dysplasia on initial workup to select the appropriate surgical intervention. Purpose: To assess how the choice of a radiographic horizon affects the measurements of the LCEA and TA. The secondary purpose was to assess how the horizon affected the classification of hips as either normal, borderline dysplastic, or dysplastic. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The LCEA and TA were measured on all preoperative weightbearing anteroposterior pelvis radiographs for 186 consecutive patients who underwent hip preservation surgery between February 2016 and November 2020 (140 hip arthroscopic procedures, 46 combined hip arthroscopic procedures with periacetabular osteotomy), 3 times per hip, each time using an F, AT, and IT horizon. The Student t test was used to analyze the differences in the measurements of the LCEA and TA, and discordance rates in the dysplasia classification between horizons were quantified. Results: For the entire study population, the mean LCEAF (23.4°± 7.4°) was significantly greater than the mean LCEAIT (23.1°± 7.2°) (95% CI, −0.634 to −0.003; P = .047) and mean LCEAAT (23.0°± 7.1°) (95% CI, −0.723 to −0.139; P = .004). There was no difference between the LCEAIT and LCEAAT (95% CI, −0.305 to 0.080; P = .251). When stratified by hip arthroscopic surgery, the mean LCEAF (26.3°± 5.6°) was significantly greater than the mean LCEAAT (25.8°± 5.3°) (95% CI, −0.845 to −0.162; P = .004). Overall, there was a 17.7% and 18.3% discordance rate in the dysplasia classification using the LCEAIT and LCEAAT compared with the LCEAF, respectively. There were no statistically significant differences between the mean TAIT, TAAT, and TAF for the entire study population, the arthroscopic surgery group, and the combined arthroscopic surgery and periacetabular osteotomy group. Conclusion: There was no statistical difference between the AT and IT horizons for LCEA measurements. The dysplasia classification was in better agreement between the 2 anatomic horizons compared with the F horizon. The TA was not affected by changes in the horizon.

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“…The peripheral-compartment work is now initiated, which begins with the development of a capsular flap on the distal portion of the capsulotomy to release the fascial attachments to the iliocapsularis. 2 This is performed to allow better capsule mobility, which aids in visualization for the planned osteoplasty. The hip is then flexed to 45°, and the C-arm x-ray machine image intensifier is tilted 10° to 15° in the caudal direction to provide the surgeon with a modified Dunn lateral view of the hip.…”

Section: Surgical Techniquementioning

confidence: 99%