Peripheral Compartment

After completing arthroscopy of the intraarticular compartment, the instruments are removed, the traction released, and the hip flexed approximately 45° (Fig. 7). This relaxes the capsule, providing access to the peripheral compartment.

Fig. 5. The arthroscope cannula is passed over a guide wire that was inserted through a prepositioned spinal needle. Fluoroscopy aids in avoiding contact with the femoral head or perforating the acetabular labrum. (From Smith & Nephew Endoscopy, Andover, MA. Copyright Smith & Nephew, Inc. 2003-2004; with permission.)

Fig. 5. The arthroscope cannula is passed over a guide wire that was inserted through a prepositioned spinal needle. Fluoroscopy aids in avoiding contact with the femoral head or perforating the acetabular labrum. (From Smith & Nephew Endoscopy, Andover, MA. Copyright Smith & Nephew, Inc. 2003-2004; with permission.)

Two portals are routinely used to access the peripheral compartment. These include the anterolateral portal and an ancillary portal established approximately 5 cm distally. The anterolateral portal is redirected onto the anterior neck of the femur (Fig. 8). The ancillary portal is then established distally under direct arthroscopic and fluoroscopic guidance (Fig. 9). The arthroscope and

Anterolateral Portal (Camera)

Fig. 6. (A) Arthroscopic view of a right hip from the anterolateral portal demonstrates the anterior acetabular wall (AW), anterior labrum (AL), and femoral head (FH). The anterior cannula is seen entering underneath the labrum. (B) Arthroscopic view from the anterior portal demonstrates the lateral aspect of the labrum (L) and its relationship to the lateral two portals. (C) Arthroscopic view from the posterolateral portal demonstrates the posterior acetabular wall (PW), posterior labrum (PL), and the femoral head (FH). (D) The acetabular fossa can be inspected from all three portals to view the ligamentum teres (LT) with its accompanying vessels traversing in a serpentine fashion from its more posteriorly placed acetabular attachment. (Line art from Smith & Nephew Endoscopy, Andover, MA. Copyright Smith & Nephew, Inc. 20032004; with permission. Arthroscopic images courtesy of J.W. Thomas Byrd, MD.)

(Camera)

Fig. 6. (A) Arthroscopic view of a right hip from the anterolateral portal demonstrates the anterior acetabular wall (AW), anterior labrum (AL), and femoral head (FH). The anterior cannula is seen entering underneath the labrum. (B) Arthroscopic view from the anterior portal demonstrates the lateral aspect of the labrum (L) and its relationship to the lateral two portals. (C) Arthroscopic view from the posterolateral portal demonstrates the posterior acetabular wall (PW), posterior labrum (PL), and the femoral head (FH). (D) The acetabular fossa can be inspected from all three portals to view the ligamentum teres (LT) with its accompanying vessels traversing in a serpentine fashion from its more posteriorly placed acetabular attachment. (Line art from Smith & Nephew Endoscopy, Andover, MA. Copyright Smith & Nephew, Inc. 20032004; with permission. Arthroscopic images courtesy of J.W. Thomas Byrd, MD.)

Posterolateral Portal (Camera)

Posterolateral -

Portal Femoral

(Camera) Head

instruments are interchanged, and both the 30° and 70° scopes are used for inspection (Fig. 10).

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