Nml

FIGURE 10.21. (A) Arthroscopic view from the anterior portal. (Courtesy of Smith & Nephew Endoscopy, Andover, MA.) (B) Demonstrated are the lateral aspect of the labrum (L) and its relationship to the lateral two portals.

FIGURE 10.22. View inferomedially from the anterior portal demonstrates where the inferior aspect of the anterior labrum (L) becomes contiguous with the transverse acetabular ligament (TAL) below the ligamentum teres (LT).

OPERATIVE ARTHROSCOPY Loose Bodies

Loose bodies can be extracted, and arthroscopy offers an excellent alternative to arthrotomy, previously indicated for this condition.9-11 The three standard portals offer access to most parts of the joint where symptomatic loose bodies reside. Removal of free-floating pieces can be a challenge. If there is soft tissue at tachment, debridement should leave a small tag of tissue attached that tethers the loose body, making it easier to grasp. Manipulating the position of the inflow cannula often flushes pieces up toward the instrumentation. Many can be debrided with shavers or flushed through large-diameter cannulas. Larger ones can be morselized and removed piecemeal; however, some may be too large for removal through a cannula. Sturdy graspers with various angles are available. Once a portal tract has been developed with a cannula, then, with a little attention to detail, the cannula system can be removed and the larger grasper can be passed along the remaining tract to the joint in a freehand fashion. Make sure to enlarge the capsular incision with an arthroscopic knife and the skin incision so that, as the fragment is retrieved, it will not be lost in the tissues at either the capsule or subcutaneous level. Also note that many loose bodies can reside undetected in the peripheral compartment. Thus, inspecting this area is often important as part of a thorough assessment.

One issue regards timing of arthroscopy following acute trauma. Fluid extravasation can occur due to loss of the capsular integrity or through an acetabular fracture. Waiting several weeks may result in sufficient soft tissue healing to create a fluid seal; however, this must be weighed against the consequences of secondary damage incurred from the entrapped fragments. A high-flow fluid management system can allow adequate flow for visualization without requiring high pressure, which could accentuate extravasation. However, it is always imperative to be cognizant of the rate of fluid ingress. It is also important that the

FIGURE 10.23. (A) Arthroscopic view from the posterolateral labrum (PL), and the femoral head (FH). [JWT Byrd, Operative Techportal. (Courtesy of Smith & Nephew Endoscopy, Andover, MA.) niques in Sports Medicine 10:184, 2002, with permission.] (B) Demonstrated are the posterior acetabular wall (PW), posterior

FIGURE 10.23. (A) Arthroscopic view from the posterolateral labrum (PL), and the femoral head (FH). [JWT Byrd, Operative Techportal. (Courtesy of Smith & Nephew Endoscopy, Andover, MA.) niques in Sports Medicine 10:184, 2002, with permission.] (B) Demonstrated are the posterior acetabular wall (PW), posterior

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

Get My Free Ebook


Post a comment