Elsevier

Clinics in Sports Medicine

Volume 20, Issue 4, 1 October 2001, Pages 697-702
Clinics in Sports Medicine

ARTHROSCOPY OF THE HIP: Anatomy and Portals

https://doi.org/10.1016/S0278-5919(05)70279-9Get rights and content

Section snippets

Sequence of Portal Establishment

Portals for hip arthroscopy should be established in the following sequence:

  • 1

    Anterolateral portal

  • 2

    Anterior portal

  • 3

    Posterolateral portal

Use cannulas for all portals that will allow you to switch from one portal to the other with your scope and operating instruments.

Anterolateral Portal

The anterolateral portal starts at the anterior superior tip of the greater trochanter Figure 1, Figure 2, Figure 3Palpation alone can place you 1 to 2 inches superior to the trochanter, depending on the patient's weight. Using the image intensifier to locate the superior surface of the greater trochanter is a good idea. Both anterolateral and posterolateral portals pass through the gluteus medius and minimus muscles. Once again, it is best to use the image intensifier to establish these

Anterior Portal

The anterior portal is established by drawing a vertical line from the anterior superior iliac spine distally. A second line is drawn anteriorly from the superior surface of the femoral greater trochanter. The anterior portal is established at the point where these lines intersect. The needle is angled 45° cephalad and 30° medially for insertion into the joint. The angles may need to be changed 10° to establish the correct entry. The needle will pass through the rectus femoris and iliofemoral

Posterolateral Portal

The posterolateral portal is established by placing a spinal needle close to the superolateral corner of the greater trochanter and passing along the neck of the femur up into the joint. The two lateral portal needles should be passed fairly parallel to each other. This portal is at least 2.9 cm away from the sciatic nerve, according to published reports.3 Establishing this portal is safe if done carefully. The superior gluteal nerve is 4.4 cm superior to the lateral portals.

ARTHROSCOPIC ANATOMY OF THE HIP JOINT5

The hip joint is basically a large ball-and-socket joint located about 0.5 inch below the middle third of the inguinal ligament (Figs. 4 and 5). The socket is deepened by a labrum, which extends the acetabular cup. The capsule of the joint is attached to the margin of the acetabulum and transverse ligament of the socket, and extends almost to the base of the neck of the femur. The transverse acetabular ligament extends across the acetabular notch and is located antero-inferiorly. The acetabulum

SUMMARY

Establishing the three portals for hip arthroscopy in the correct sequence is crucial, as is use of the image intensifier for location and passage of needles. Patient position for hip arthroscopy can be either lateral decubitus or supine. Gentle techniques are essential to avoid scuffing of the articular surface. The 70° scope is the “workhorse” in this procedure. Location of portals is essential to successful hip arthroscopy.

First page preview

First page preview
Click to open first page preview

References (5)

  • J.W. Byrd et al.

    Arthroscopy

    (1997)
  • J.W. Byrd et al.

    Arthroscopy

    (1995)
There are more references available in the full text version of this article.

Cited by (15)

  • Hip Arthroscopy: A Brief History

    2016, Clinics in Sports Medicine
    Citation Excerpt :

    Lanny Johnson15 described the anatomic landmarks and proposed portal locations for hip arthroscopy. Byrd and Sweeney8,16 also published on the anatomic landmarks for hip arthroscopy as well as relative relationships of the portals to the muscles they penetrated and neighboring neurovascular structures. If bony landmarks are accurately marked, portal placement is relatively safe in hip arthroscopy.

  • Hip Arthroscopy Portals

    2011, Operative Techniques in Sports Medicine
    Citation Excerpt :

    From this point, the portal is aimed approximately 45° cephalad and 30° toward the midline. On average, the anterior portal is 6.3 cm distal to the ASIS, and it pierces the muscle belly of the Sartorius and the rectus femoris before entering the hip through the anterior capsule.10,15 This portal is established under direct visualization using a 70° arthroscope in the anterolateral portal (Fig 4).

  • An anatomic arthroscopic description of the hip capsular ligaments for the hip arthroscopist

    2011, Arthroscopy - Journal of Arthroscopic and Related Surgery
  • MR imaging of sports-related hip disorders

    2003, Magnetic Resonance Imaging Clinics of North America
  • A quantitative analysis of hip capsular thickness

    2015, Knee Surgery, Sports Traumatology, Arthroscopy
View all citing articles on Scopus

Address reprint requests to Howard J. Sweeney, MD, Northwestern University Medical School, 1144 Wilmette Avenue, Wilmette, Illinois 60091

View full text