Ab

FIGURE 11.15. Case 2. MR arthrogram in sagittal orientation of the acetabular fossa (A) and medial third of the proximal femur (B) showing chondromas within the acetabular fossa and peripheral compartment (arrows). zo, zona orbicularis.

FIGURE 11.16. Case 2. Placement of the posterolateral portal to the central compartment of the hip with traction. Identification of a chondroma (ch). Lunate cartilage (fl), posterior labrum (pl), posterior capsule (pc), femoral head (fh).
FIGURE 11.18. Case 2. Peripheral compartment with medial neck and head area. Chondroma (ch) between the medial synovial fold (psm) and zona orbicularis (zo).

mas, an additional portal was placed within the antero-lateral area in line with the femoral neck. Ten mostly soft chondromas with a small osseous core were removed using a forceps (Figure 11.20) and shaver (Figure 11.21). Arthroscopic scanning of the peripheral compartment revealed a complete removal (Figures 11.22, 11.23).

Result

At 3 months and 1 year postoperatively, the referring physician reported a complete relief of the catching and locking symptoms. The patient continued to be painfree.

FIGURE 11.17. Case 2. Removal of a chondroma (ch) with a FIGURE 11.19. Case 2. Peripheral compartment with inferior an-shaver introduced via the posterolateral portal. Pulvinar (p), terior neck area. Chondromas (ch) at the inferior capsular reflection femoral head (fh). at the intertrochanteric crest (ic).

FIGURE 11.17. Case 2. Removal of a chondroma (ch) with a FIGURE 11.19. Case 2. Peripheral compartment with inferior an-shaver introduced via the posterolateral portal. Pulvinar (p), terior neck area. Chondromas (ch) at the inferior capsular reflection femoral head (fh). at the intertrochanteric crest (ic).

FIGURE 11.20. Case 2. Removal of a chondroma (ch) with a forceps. Medial synovial fold (psm), zona orbicularis (zo).

FIGURE 11.22. Case 2. Status post removal. Medial neck area with medial synovial fold (psm), femoral neck (fn), and medial capsule (mc).

Discussion

Contrary to case 1, synovial chondromatosis was present in both compartments. Chondromas were found in the characteristic locations, the acetabular fossa, and the recesses of the anterior neck and medial neck and head areas. The use of the posterolateral portal is ideal for removal of loose bodies within the peripheral compartment, at least in the supine position. Follow-

ing gravity, chondromas and loose bodies tend to accumulate in the posterior space between femoral head and lunate cartilage and acetabular fossa, respectively. Here, the posterolateral portal offers an ideal access for instruments and a drainpipe for small chondromas. Because chondromas tend to accumulate in the anterior and medial areas of the peripheral compartment, an anterolateral portal in line with the femoral neck

FIGURE 11.21. Case 2. Removal of a chondroma (ch) with a shaver. area with femoral neck (fn), capsular reflection at the inMedial synovial fold (psm), medial capsule (mc). tertrochanteric crest (ic), and anterior capsule (ac).
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