Forget the Greater Trochanter! Hip Joint Access With the 12 O’clock Portal in Hip Arthroscopy

Abstract

Most surgeons rely on the greater trochanter as the reference point to establish the anterolateral portal. Nevertheless, we believe that the anterosuperior iliac spine is a more reliable landmark. Unlike the greater trochanter, it is unaffected by leg rotation and is more easily identified by palpation. Abiding by the central tenet of medicine to “do no harm,” the technique described herein presents in detail the concept of the 12 o’clock portal placement, a hip joint access method based on identifying specific anatomic points under fluoroscopy and by palpation. To accomplish this goal, this Technical Note presents a step-by-step approach, including tips and pearls for patient positioning and fluoroscopic guidance. We believe this method ensures a reproducible and safe way to start hip arthroscopy in the supine position.

Hip Arthroscopic Surgery in the Context of Femoroacetabular Impingement Syndrome, Labral Tear, and Acetabular Overcoverage: Minimum 5-Year Outcomes With a Subanalysis Against Patients Without Overcoverage

“…35 At least 2 portals were created: anterolateral and modified midanterior. 41,52 When required, distal anterolateral accessory and posterolateral portals were also created. 64 The hip joint was accessed in an inside-out fashion, starting in the central compartment when possible.…”

Hips With Acetabular Retroversion Can Be Safely Treated With Advanced Arthroscopic Techniques Without Anteverting Periacetabular Osteotomy: Midterm Outcomes With Propensity-Matched Control Group

“…32 Traction was applied and the hip joint vented under fluoroscopy. 16,36 After placement of the anterolateral and midanterior portals and connection by an interportal capsulotomy, a diagnostic arthroscopy of the central compartment was performed to assess the labrum, intra-articular cartilage, and ligamentum teres. Labral tears were classified according to Seldes et al 63 The chondrolabral junction was graded by the acetabular labrum articular disruption, and the acetabular or femoral head chondral damage was recorded per the Outerbridge classifications.…”

Prospective Analysis of Arthroscopic Hip Anatomic Labral Repair Utilizing Knotless Suture Anchor Technology: The Controlled-Tension Anatomic Technique at Minimum 2-Year Follow-up

“…All hip arthroscopic procedures were performed using the anterolateral, midanterior, and distal anterolateral accessory portals with the patient in the modified supine position ( Figures 2 and 3 and Supplemental Video). 16 , 36 , 41 Diagnostic arthroscopic surgery was performed in all cases to assess the overall health of the joint. The Outerbridge, 57 Seldes, 67 and acetabular labrum articular disruption (ALAD) 9 classification systems were used to classify the degree of cartilage damage.…”