Hip Arthroscopy Portals

Alwattar, Basil J.; Bharam, Srino

doi:10.1053/j.otsm.2010.12.003

Cited by 6 publications

(3 citation statements)

References 23 publications

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“…23,24 In arthroscopy of the hip, certain variant positions result in the SN being situated closer to the placement of the posterolateral portal than the usual ±3 cm, increasing the risk of iatrogenic injury. 10,11 Awareness of the position of the SN and careful positioning of the lower limb during procedures have been shown to decrease the incidence of iatrogenic injury by up to 50%. 25 Piriformis syndrome (PS), although difficult to diagnose, is characterised by the following main symptoms: buttock pain that is aggravated during sitting, and external tenderness near the greater sciatic notch.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 In arthroscopy, the joint is visualised with an arthroscope and instruments are introduced from one of several portals or standardised points of access to avoid critical structures. 10 One of these portals, the postero-lateral portal, lies 2 cm posterior to the tip of the greater trochanter and has been associated with occasional injury to the SN, especially if the limb is positioned in external rotation. 11 An abnormal course of the SN in relation to the PM may cause entrapment and compression, resulting in piriformis syndrome (PS), an extra-spinal cause of sciatic nerve pain.…”

Section: Introductionmentioning

confidence: 99%

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Surgical anatomy of the sciatic nerve and its relationship to the piriformis muscle with a description of a rare variant

et al. 2020

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Aims: Variation of the sciatic nerve may increase the risk of iatrogenic injury during total hip arthroplasty or arthroscopy, result in failure of peripheral blocks, or be associated with piriformis syndrome. Studies from Africa are scarce, with none to date from South Africa. Thus, the aims were to document the relationship between the sciatic nerve and piriformis muscle, variation in the bifurcation level and in the length of the nerve. Any significant differences between sexes and sides were also investigated. Methods: The lower limbs of 42 cadavers (84 limbs) were dissected and the relationship between the sciatic nerve and piriformis classified according to the patterns described by Beaton and Anson. The region of sciatic nerve bifurcation was documented, and the length of the nerve was measured in individuals with bifurcation in the thigh. Results: The normal relationship between the sciatic nerve and piriformis muscle was present in 64 limbs (76.2%). The bifurcation level of the nerve was variable in more than half the sample. No significant differences occurred in any of the variant patterns or bifurcation regions between side or sex; however, variations were more common in females than in males. The mean length of the sciatic nerve was 133.30±19.33 mm, with no differences in length between sex or side. Conclusion: Variations in the anatomy of the sciatic nerve occurred in up to half of the sample, which may have implications for increased risk of iatrogenic injury in total hip arthroplasty and arthroscopy, piriformis syndrome or sciatic block failure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical anatomy of the sciatic nerve and its relationship to the piriformis muscle with a description of a rare variant

et al. 2020

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“…The anterior portal passes through the lateral aspect of sartorius and rectus femoris muscles, the anterolateral portal pierces the gluteus medius muscle, whereas the posterolateral portal passes just behind gluteus medius muscle. 43 A cadaveric study demonstrated that the mean distance between the anterior portal and the LFCN was only 5 mm (range, 0-28 mm), and 24 mm (range, 5-48 mm) from the femoral nerve, whereas that for the posterolateral portal (passing posterior to the greater trochanter to enter the hip joint) was 40 mm (range 16-70 mm) from the sciatic nerve. 44 Laceration and permanent injury to the LCFN secondary to insertion of the anterior portal has been described.…”

Section: Hip Arthroscopymentioning

confidence: 99%