Ideal for passing curved instruments, open cannulas allow for quick portal exchange and easy introduction of working instruments into the joint. Use open cannulas to remove large loose bodies that will not fit through standard cannulas.

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Scope This Out Volume 25 Number 2

Asheesh Bedi, MD, (Ann Arbor, MI) describes a technique for retracting the capsule during arthroscopic cam resections using the new angled open half-pipe cannula.

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Capsular Management and Retraction for Cam Resection

So as you can see at this point in the case now, we've shifted our attention to the peripheral compartment just to orient you inside the joint. You can see I've switched the camera to the mid anterior portal. If you rotate your eyes there, you'll appreciate there's our prior labor repair sutures. We're in a cadaver so it doesn't maintain the perfect suction seal and doesn't. And the traction doesn't quite completely return to normal. But if you look now distally here, this is the orientation that you're looking at as you look laterally and posteriorly. Those are the inserting fibers of the gluteus minimus onto the capsule. As I rotate my eyes there anteriorly, you can see those are the inserting fibers of the capsule iris or branches of the iliopsoas muscle. And here you can see this nice intermuscular plane that I always look for, which is kind of the plane that's going to be covering our cam deformity. And if everything makes sense, you can see you can tip your hand up, you can see the labrum and your labor repair sutures there. That's going to be in the area of the greatest cam de-lamination. So it really helps to localize where we want to make our T capsulotomy, if at all, to visualize the Cam lesion. This is our single piece, as you can see CapsuleCut blade. You can bring this in. In my mind, this tends to come in best, as you can see here from your proximal anterolateral portal. And I can use it first to retract and see where is our cam delamination located, where is it beneath. And then once we've decided on the trajectory and the best angle to make our capsular flaps, we can commit right to that location and start to tee our capsule there, right in line with fiber. So as you can see there, we just lay it down. We cut right down along the head neck junction there like that. And I think as you're appreciating this makes two nice equal flaps there, one superior and one anterior flap there that's going to directly overlay our cam lesion. You can see we can start to spread those work a little bit inferiorly there along our capsule. You can also use the Dalla portal to make this cut as well. But it's been my preference to come from the proximal anterolateral portal as most of these Cam lesions, as you can see, tend to sit at this high anterolateral junction. Now do you appreciate there we have these nice flaps that we've preserved. We've cleaned. So these will be nicely there for later repair. And then as you appreciate we can retract this flap and drive up and see our perfusing retinacular vessels right here sitting at the head neck junction. Those are an area of of concern when you're burring and performing your surgery because we need to get up and high, but we also want to protect them. So there's a nice device here. This is a combination of a half pipe retractor I think as you can appreciate it, it's a slotted cannula that we can use to slide down. Can introduce our bur, but then leave it in place and it can actually function for us like a retractor of this capsule. So rather than having the capsule wrap up during our resection we can actually use it there. So here what we'll do is we'll slide it right along the handle of our beaver blade, which has now been lined up in line with our capsulotomy. So there you can see our half pipe cannula is in place. You can slide out the beaver blade. Perfect. So as you can see here, we now have our slotted cannula and retractor in place. There's our two capsular flaps. There's our anterior flap. Here's our supralateral flap. You can see how this nicely can tuck deep to the flap. And I can rotate around and even show you those superior retinacular vessels just peering around the corner there. This can now set here in this position and actually act as a retractor, not only to protect those vessels, but also to allow for introduction of your BR from that trajectory. And now we're in a position to go ahead and slide the BR. So you want to usually have a slightly increased angle. So the BR tip stays right up against. And if you notice that that brings in your your blade nicely and keeps the muscle out of the way. And I want you to see there I've actually taken the capsule retractor and tucked it deep to the flap. And I simply leave that in place. And now you can see that holds that lateral flap open. And I'm now in a good position to br making sure that I'm safe and protecting those retinacular vessels. Once we've introduced that with the half pipe in place, I can now retract the sheath of the BR back. And as you can see, this retractor, half pipe cannula and retractor is protecting me from those superior vessels. This now gives us a great trajectory to work and go ahead and start to perform our cam resection here, working from the anterolateral location. And as you can see here, nicely, proximally, right adjacent to our to our labrum, we can start to set the margin of our physeal scar here.

Open Cannula, Tapered Tip, Low Profile

Open Cannula, Blunt Tip, Low Profile

Open Cannula, Blunt, Curved, Low Profile

Open Cannula, Blunt Tip, Curved End, Low Profile

CÂNULA ABERTA, PONTA SEM CORTE, EXTREMIDADE CURVADA, PERFIL BAIXO

CÂNULA ABERTA, PONTA SEM CORTE, EXTREMID

Transparente Kanüle, halb offen, spitz mit Quick Connect

Clear Open Cannula, Tapered Tip, with Detachable Handle

Open Clear Cánula, punta cónica, con mango extraíble

Transparente Kanüle, halb offen, gerundet mit Quick Connect

Clear Open Cannula, Blunt Tip, with Detachable Handle

Open Clear Cánula, punta roma, con mango extraíble

Open Cannula, Tapered, Detachable, Low Profile

Kanüle, halb offen, konisch, Low Profile, mit abnehmbarem Handgriff

Open Cannula, Tapered Tip, Detachable Handle, Low Profile

CANULA ABERTA PONTA CONICA CABO DESTACAVEL BAIXO PERFIL

Open Cannula, Blunt, Detachable, Low Profile

Kanüle, halb offen, stumpf, Low Profile, mit abnehmbarem Handgriff

Open Cannula, Blunt Tip, Detachable Handle, Low Profile

CANULA ABERTA PONTA SEM CORTE CABO DESTACAVEL BAIXO PERFIL

Open Cannula, Blunt, Detachable, Curved

Open Cannula, Blunt Tip, Detachable Handle, Curved End, Low Profile

CÂNULA ABERTA, PONTA SEM CORTE, CABO DESTACÁVEL, CURVADA, BAIXO PERFIL

CÂNULA ABERTA, PONTA SEM CORTE, CABO DES

Open Cannulas

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Capsular Management and Retraction for Cam Resection

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Scope This Out Volume 25 Number 2

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