The second portal was located 2 cm distal to the first portal along the anterior adductor longus muscle border. The intersection created was the first portal location. This line was then crossed perpendicularly by the anterior border of the adductor longus muscle. The first point was found by drawing a parallel line to the ilioinguinal ligament that was 3 cm distal to the ligament. ![]() Injury to the obturator nerve was avoided when the portals were placed in two medial locations. The obturator nerve, medial femoral circumflex artery, and other femoral neurovascular structures are at risk of injury when medial hip portals are used. Specifically, medial hip portals are useful when medial hip lesions are present. Major neurovascular vessels are at risk of injury, and care must be taken to preserve these structures. ĭespite the hip joint proving to be a challenge to treat arthroscopically, the interest in arthroscopic surgery of the hip joint has increased. It is proposed that the primary indication for this approach is psoas tendon tenotomy. The trans-abductor approach involves a risk to the obturator nerve, which can be avoided in the medial hip approach. This surgical approach contrasts with the traditional trans-abductor approach to the hip, which passes anterior to the adductor longus and adductor brevis muscles but is posterior to the pectinate muscle. This medial hip approach is anterior to the adductor longus, adductor brevis, pectinate, and adductor magnus muscles. describe a minimally invasive medial hip approach that allows for visualization and access to the iliopsoas tendon and the intraarticular region without risking injury to the nerve and vascular supply. Total analgesic consumption was 14.5% less in the adductor canal block, and postoperative pain control was comparable to the femoral canal block. Adductor canal blocks preserve the ability of patients to ambulate better than a femoral block. While FNB has been shown to reduce quadriceps strength by 49%, adductor canal blocks result in significantly less (i.e., 8%) quadriceps weakness postoperatively. Thus, FNB theoretically delays mobilization in this subset of patients. However, FNB has fallen out of favor due to its associated quadriceps weakness in patients postoperatively. Both techniques provide similar analgesic benefits while mitigating the risks of general anesthesia. Ī femoral nerve block (FNB) and adductor canal block have been used for pain control during and after total knee arthroplasty (TKA). The posterior branch of the obturator nerve supplies motor innervation to the deep adductor muscles as well as sensation to the posterior knee. The anterior branch of the obturator nerve provides motor innervation to the superficial medial thigh muscles as well as sensation to the hip joint and the medial thigh. The obturator nerve comes from the lumbar plexus (second, third, and fourth lumbar levels). Of the muscles in the medial thigh, the femoral nerve innervates the sartorius and pectineus muscles via its anterior motor branch. The femoral nerve mostly innervates the hip flexor and knee extensor muscles. Unlike the femoral artery, which then enters the adductor hiatus, the saphenous nerve pierces between the gracilis and sartorius and travels superficially, eventually providing sensory innervation to the medial distal leg. ![]() ![]() Once in the adductor canal, the saphenous nerve courses distally towards the knee joint. At this location, it is found adjacent to the femoral artery. The muscles at the front of the thigh, the quadriceps, straighten the knee, and those at the back, the hamstrings, bend the knee.Īll of these factors provide smooth, stable and pain free movement of the knee joint.The saphenous nerve enters the adductor canal at the distal apex of the femoral triangle. Muscles around the knee provide movement. There are two cruciate ligaments (anterior cruciate ligament and posterior cruciate ligament) and two collateral ligaments (medial collateral ligament and lateral collateral ligament). The knee bones are connected by strong ligaments which stabilise the knee and allow it to function properly. The knee joint is also lined by synovium, which produces a lubricating fluid. Between the femur and tibia the medial meniscus and the lateral meniscus (a specialised form of cartilage) help to distribute load, absorb shock, stabilise the knee and aid in lubrication. The surfaces of these bones within the knee are coated with cartilage (articular cartilage) which is very smooth. The bones of the knee are the femur (thigh bone), tibia (shin bone) and patella (kneecap).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |