Hip Pelvis.  2020 Mar;32(1):42-49. 10.5371/hp.2020.32.1.42.

Anatomic Evaluation of the Interportal Capsulotomy Made with the Modified Anterior Portal versus Standard Anterior Portal: Comparable Utility with Decreased Capsule Morbidity

• Weber AE
• Alluri RK
• Makhni EC
• Bolia IK
• Mayer EN
• Harris JD
• Nho SJ

• KMID: 2471130
• DOI: http://doi.org/10.5371/hp.2020.32.1.42

Abstract

PURPOSE
To identify potential differences in interportal capsulotomy size and cross-sectional area (CSA) using the anterolateral portal (ALP) and either the: (i) standard anterior portal (SAP) or (ii) modified anterior portal (MAP).
MATERIALS AND METHODS
Ten cadaveric hemi pelvis specimens were included. A standard arthroscopic ALP was created. Hips were randomized to SAP (n=5) or MAP (n=5) groups. The spinal needle was placed at the center of the anterior triangle or directly adjacent to the ALP in the SAP and MAP groups, respectively. A capsulotomy was created by inserting the knife through the SAP or MAP. The length and width of each capsulotomy was measured using digital calipers under direct visualization. The CSA and length of the capsulotomy as a percentage of total iliofemoral ligament (IFL) side-to-side width were calculated.
RESULTS
There were no differences in mean cadaveric age, weight or IFL dimensions between the groups. Capsulotomy CSA was significantly larger in the SAP group compared with the MAP group (SAP 2.16±0.64 cm2 vs. MAP 0.65±0.17 cm2, P=0.008). Capsulotomy length as a percentage of total IFL width was significantly longer in the SAP group compared with the MAP group (SAP 74.2±14.1% vs. MAP 32.4±3.7%, P=0.008).
CONCLUSION
The CSA of the capsulotomy and the percentage of the total IFL width disrupted are significantly smaller when the interportal capsulotomy is performed between the ALP and MAP portals, compared to the one created between the ALP and SAP. Surgeons should be aware of this fact when performing hip arthroscopy.

Keyword

Hip joint; Arthroscopy; Joint capsule; Cadaver

MeSH Terms

Arthroscopy
Cadaver
Hip
Hip Joint
Joint Capsule
Ligaments
Needles
Pelvis
Surgeons

Figure

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  Fig. 1 Demonstration of the superficial landmarks and common arthroscopic portals used to correct femoroacetabular impingement lesions on a right (R) hip: anterolateral portal (ALP), mid-anterior portal (MAP), and standard anterior portal (SAP), distal anterolateral portal (DALA), greater trochanter (GT), anterior superior iliac spine (ASIS). The line demonstrates the connection between ALP-MAP versus ALP-SAP which is performed during the interportal capsulotomy.

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  Fig. 2 Arthroscopic image demonstrating placement of the spinal needle at the center of the anterior triangle to create the standard anterior portal interportal capsulotomy.

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  Fig. 3 Arthroscopic image demonstrating placement of the spinal needle into the central compartment to create the modified anterior portal interportal capsulotomy. The spinal needle is inserted such that it can touch the arthroscopic camera cannula.

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  Fig. 4 (A) Measurement of the standard anterior portal (SAP) interportal capsulotomy length. (B) Measurement of the SAP interportal capsulotomy width. (C) Measurement of the modified anterior portal (MAP) interportal capsulotomy length. (D) Measurement of the MAP interportal capsulotomy width.

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  Fig. 5 (A) Measurement of the iliofemoral ligament (IFL) side-to-side width at the level of the capsulotomy allowing for the width of the standard anterior portal interportal capsulotomy to be expressed as a percentage of total IFL. (B) Measurement of the IFL side-to-side width at the level of the capsulotomy allowing for the width of the modified anterior portal interportal capsulotomy to be expressed as a percentage of total IFL.

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  Fig. 6 Plotting distribution of the measurements in the modified anterior portal (MAP) versus standard anterior portal (SAP) groups: (A) Capsulotomy length. (B) Capsulotomy width. (C) Length of capsulotomy as a percentage of iliofemoral ligament (IFL) width. (D) Cross-sectional area of the anterolateral portal (ALP)-SAP and ALP-MAP capsulotomy.

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