Under both fluoroscopic and direct visualization, hip joint access can be facilitated using the spinal needles and guide wires included in the Hip Arthroscopy Disposable Kits as well as the instrumentation included in the Hip Arthroscope System Set.

Knee

Not Hidden

English  - en

application/pdf

Human

A comprehensive overview of a product team’s portfolio.

Ein umfassender Überblick über das Portfolio eines Produktteams.

Kataloge

Visão geral e abrangente do portfólio de produtos de cada segmento.

Catálogos

Descripción general y completa sobre la cartera de productos de cada segmento. 

Catalogs

Hip Next Generation in Soft-Tissue Repair and Reconstruction

Benjamin G. Domb, MD (Chicago, IL), demonstrates entry into the hip joint using a percutaneous intracapsular peripheral access (PIPA) technique with the FlushFit atraumatic cannula system. Dr. Domb outlines the surgical steps and explains when he chooses to perform this technique.

video

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

Operationstechnikvideos

Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

Vídeos de técnicas cirúrgicas

Grabación en vídeo de una técnica quirúrgica de un paciente en un quirófano o una demostración cadavérica.

Videos de técnicas quirúrgicas

Surgical Technique Videos

Percutaneous Intracapsular Peripheral Access (PIPA) Technique for Hip Joint Access

This is Doctor Benjamin Dohm. I am presenting the pipa technique for access to the hip joint. The Pipa technique is the percutaneous intracapsular peripheral access technique for hip access. We begin with the hip in extension and traction. Knowing that we are not going to access the hip intra-articular because it is a difficult to access Hip, will identify the locations of the portals in that position because that is the position we'll ultimately wind up working in. We simply mark the portals using Fluoroscopic guidance in a standard fashion, marking where we will place the anterolateral and anterior portals. We then take traction off and come into flexion, usually 30 to 40 degrees, and we will establish the portals and access the hip in flexion. So at this point we'll begin with the anterolateral portal. And we'll do this under Fluoroscopic guidance. The spinal needle at this point is aimed toward the peripheral compartment. And we aim to come inside the capsule. So we want to see that the guidewire passes into the joint and ends on the medial capsule, but our entry point with the spinal needle should be around the middle of the anterior capsule. Now that we've established our access into the capsule, we can establish our portal as well. We can also make our anterior portal. And now we will use the cannula over the guidewire entering into the peripheral compartment. So once we have our scope inside the joint, we can establish our second portal using a combination of fluoroscopy and direct visualization. Once we have the spinal needle inside the joint, we have an outflow. So at this point we can start to run the water and we'll see a better visualization within the joint. So notice that everything we have done up until this point has been in flexion, with no traction on at all. We have not attempted to access the intra-articular aspect of the hip joint, and therefore everything we have done so far has had complete protection of the labrum and Abraham and femoral head in a difficult to access hip. So we have now established both our anterior and our anterolateral portals. And through the spinal needle, we'll pass the guidewire into the anterior portal. At this point you can see on the x ray, the spinal needle is arriving at around the middle of the anterior capsule. And then through that we pass the guidewire. You'll see the guidewire goes quite medially and lands on the medial capsule. And now we can use the over the guidewire technique to pass a second cannulated cannula. And that enters the joint again under direct visualization. Notice how this protects the femoral head and protects the labrum using the Pipa technique. At this time we can switch portals and switch into the anterior portal, repositioning the anterolateral portal. Here we are viewing from the anterior portal and we are positioning into an intracapsular but extra articular position. And even if there is lacking distraction, we can still get into a very tight hip joint here. So we pass the guidewire into the joint and then pass the cannula over the guidewire into the hip joint. And again, we can do this safely under direct visualization, leading it into an intracapsular extra articular position. Now through this cannula we can introduce the beaver blade to begin the capsulotomy. And in this instance we're going to perform the capsulotomy in a longitudinal fashion connecting the anterior and anterolateral portals. Now that we have begun to establish the capsulotomy around the anterolateral portal, we can switch portals. We can introduce a half pipe over the beaver blade. Here. It's a switching stick. Even into a tight joint, we can fit a switching stick and then we can switch the portals over. Switching sticks. So we now introduce the beaver blade through the anterior portal while viewing from the anterolateral portal. And here we can complete an intra portal capsulotomy. Now that we have completed the capsulotomy, we can apply a little bit more distraction. And under X-ray, visualize how much distraction we have and if it's adequate distraction. At that point, we can enter into the hip joint, as you see here, in a very safe fashion. The Pippa technique, or percutaneous intracapsular peripheral access, is useful in hard to access hips. Those may be hips that are difficult to distract due to stiffness, or hips that are overcovered, either globally or focally. So the protrusio acetabuli or the coxa profunda hips with high center edge angles or with a calcified labrum are ones that may be difficult to access as described. And our hips, where the Pippa technique can be useful for safe access in a peripheral access first technique, avoiding any risk to the labrum or the femoral head.

John J. Christoforetti, MD (Bethesda, MD), demonstrates a cadaveric acetabular labral repair while highlighting the advantages of using the Pano™ scope and NanoScope™ system for visualization.

Acetabular Labral Repair Using the Pano™ Scope

Hi, I'm John Cristoforetti from Bethesda, Maryland, and I'm here to demonstrate a two anchor acetabular labrum repair utilizing the NanoScope we have set up here, a cadaver specimen demonstrating an anterior portal, a distal anterolateral accessory portal. And we're utilizing the NanoScope through the anterolateral portal. If you look to the posterolateral portal, we have a NanoScope in place for dual viewing. We're going to go ahead and start and highlight some of the features of the NanoScope very quickly. On your screen, you'll see a small circle demonstrating the 105 degree field of view of the typical 70 degree lens. As I move to the 30 degree lens with the NanoScope, you can see the same field of view. The true magnitude of the 140 degree field of view of the 45 degree at the NanoScope is incredible. What it allows us to do at this point is see what was previously never seen, which is both the articular side of a labor repair and the acetabular side of the labor repair, without having to make the dreaded move from looking at the rim to looking at the safe view while we drill. So again, we're just going to highlight that before we get to the steps of the operation, we can see a 70 degree lens. We can really only see, as we all know, the articular acetabular view. Or then by moving the oblique, we can then see at that bird's eye view as popularized by dome, the acetabular rim. But we just simply can't see both. We're going to change that. Nanoscope into that 140 degree view. And we can really see an amazing amount. So we're going to go ahead and start. This specimen has a prepared rim. We can see some very cool features with the 45 degree angle that previously took a significant amount of camera driving down to the. So as you or so is notch at 3:00 all the way down to the transverse acetabular ligament to the ligamentum teres femoral head. And as we look to the crease and that 12:00 position on the acetabulum, we know that we're looking at that anterior wall acetabulum. Our next step will be to instrument as typical utilizing the 45 degree angle. We're going to now use one of the new curved guides for the Nautilus FiberTak. I'm going to bring that drill guide into position. And we're going to start with that far anterior drilling angle. I'm going to go ahead and use that 45 degrees showing us both sides at the same time, both the acetabular surface and the articular surface. We're going to take that just off the rim view. And we're going to pre-drill our pilot hole for the knotless FiberTak into the far anterior position. The Moody Children's. This is a fluted drill bit that will reduce the need for cycling and clearance of bone debris. In and out. No friction at the bend. Next we're going to place the Knotless FiberTak Knotless FiberTak goes into position. We'll start it by hand, and then we'll use the mallet to mallet it into position. Once the FiberTak is placed, we'll draw the handle. We'll draw the sheath. We attempt to see in cadaver bone what kind of purchase that we have. We want to check and see that we have full movement for the central passing suture and our core sutures in position. We'll do. Next is use the SwiftStitch passing device to pass the round limb of the passing suture. We'll make a simple stitch for the purpose of this demonstration. Using the NanoScope we're able to do is simply grab the round limb. This will have the loop on it. Capture this with the swift stitch. We find the base tissue itself of the labrum and go right off the rim of the acetabulum, passing our first passing suture. Withdrawing the SwiftStitch, one can use the SwiftStitch again, if so elected. I tend to use a ring Grasper. I'm going to grab that loop pass by the SwiftStitch again. The 45 degree angle lends the NanoScope, requiring very little if any, movement of the assistant's hand. When we grab this, we're going to grab this concomitantly with the core suture. Once we have both the passing loop suture and the blue suture, withdraw them out the anterior portal. We're going to take a clear pathway of passage around and around our simple suture, bypassing our core loop suture, capturing all the way to the demarcated line as typical for knotless FiberTak and tensioning back in line with the way that we've drilled our anchor out the distal anterolateral portal, allowing a nice sequential repair. Tensioning through the way that we've passed this suture is particularly unique to this knotless tension device, because when we pull in the direction that we've passed in this technique. We're going to demonstrate is that this is going to actually curl and invert rather than inverting that labral tissue, beautifully approximating it down. So that's going to be the the trick of the day on the passage. And then we're going to go ahead and take and leave this for later final tensioning. So we're going to go ahead and take the 16 degree curved guide down. And we bring the curve against the half pipe cannula. Bring it into the hip joint itself. Once it's in the joint we've careful to tension the other suture. Yep. And we take this and we can use the markings, both the laser line and the curved guide and the flat surface of the handle to help us understand where that angle is going on the drill, we're going to go ahead and place this again with the 45 degree broad view of the NanoScope right against the acetabular rim. We're going to go for that closer to 1:00 position anchor. We'll have our assistant drill down the drill guide again passing that core rather than. Tensioning all at once. We now have two anchor repair with a 45 degree view with a single Angle view utilizing an expanded field of vision, and we can tension these and or accept the tension. In this particular case, they look just fine. We'll use the open cutter and just come co-linear with the placement of the anchors. And we can cut these flush. There's no suture interference. So now we have an anatomic two anchor repair. And again to highlight a 70 degree lens demonstrating the need for moving one's hand, moving the oblique to see both sides versus the NanoScope singular stadium view. So for the ultimate visual examination of an arthroscopic case, take a look at the expanded field of the NanoScope. And up in screen right, you can see the zero degree direction of the nano needle. So literally demonstrating an entire universe of examination. Notice how we can hold the NanoScope demonstrating the rim view, and we can go all around our labor repair with that zero degree nano needle.

Imaging and Resection

A document containing information about Arthrex products and product lines.

Ein Dokument mit Informationen über Arthrex Produkte und Produktlinien.

Broschüren

Documento contendo informações sobre produtos e linhas de produtos da Arthrex.

Brochuras

Documento que contiene información sobre los productos y líneas de productos de Arthrex.

Folletos

Brochures

CoolCut™ Specialty Series: Hip-Length Shaver Blades and Burrs

John J. Christoforetti, MD (Allen, TX), shares technical pearls for inserting anchors into the acetabulum using curved and straight guides. He also discusses safe joint access when beginning hip arthroscopy procedures. In this cadaveric and sawbones demonstration, Dr. Christoforetti reviews the appropriate use of the curved anchor delivery system during acetabular labral repair and details a unique method for entering the hip joint with minimal damage to surrounding anatomy during periportal capsulotomies.

Safe Hip Joint Access and Anchor Placement Considerations and Technical Pearls

So we've already made an anterior lateral portal in this cadaver specimen. You have a way here to try to minimize the trauma associated with your portal creation. We're making a second, more anterior portal. And as we create that portal, we can see on the external side of the capsule, deep in our arthroscopic field, the pressure of the needle tip against the capsule. I simply readjust and find the right way into the hip joint. Capsule. We pass the nitinol wire down. We'll hold the very posterior end of the nitinol wire, and our assistant will remove the needle. And we regrasp the wire. What we'll typically do is take the interior sheath down without its external cannula. We always want to visualize the tip of that nitinol wire, so it's not driven into the socket itself. And we're going to going to go see this straight down onto the capsule. And we can use two fingers to feel the trampoline style bounce back of the capsule. Then we just make a half moon arc of twist that helps us to dilate a pathway, gently making sure that there's no undue pressure to dilate our way in. We can see ourselves about to emerge into the joint back out of the joint. And at this point, we've dilated. Now we'll typically do that serially with a 4.0 and then or the 4.5mm, then the 5.0. Then we take the closed cannula, make sure that we're screwed in tightly. We then go down over seeing again on the arthroscopic view the tip of the wire. We go down with a twisting fashion. No excessive pressure, with a twisting fashion right down to the entrance of the capsule. Then, rather than take the metal sheath in, we remove the center and we remove the nitinol wire. At this step, we use the straight blade to come straight down the cannula and enters directly at the capsule or entry point that we've pre dilated. At this position, we're now able to very carefully open the capsule without trauma to the labrum or the femoral head by the outer sheath of the cannula. Now this is what we're terming a periportal not inter portal but periportal capsulotomy that goes full thickness from the capsule superficial surface into the joint itself opens mobility for the portal. And at this point, we're capable of recanting the closed cannula and safely and gently screwing the cannula in for an appropriate switch of the camera to view the blind portal created without the assistance of arthroscopic localization. And we can see that our blind portal had also been created without labral penetration. So at this point, you can visualize that the metal cannula itself has very limited mobility inside a blind portal, because we were not able to create this with a capsulotomy first. Now, as I draw back by gentle twisting motion, just to feel the exit of the metal cannula from the capsule, leaving the blade itself inside the joint, I can make an easy full thickness periportal capsulotomy surrounding my anterolateral portal as well. And this will allow easy passage of the cannula without excessive pressure of the cannula tip against the cartilage surfaces. So we're going to talk about now are some concepts and principles of safety for drilling into the acetabulum as we get into multi-angle drilling devices and procedures. What's important for surgeons to understand is the orientation of the acetabulum. And each individual patient looking at this side on view against the model of the cadaver hip, we can imagine the same type of view could be achieved by bringing a three dimensional model into the surgeons operating room. Using that model and trying to set using the anterior superior iliac spine on both the model as well as the cadaver to help orient the ideas in the brain of where are the ilium, ischium, and pubic bone stocks of the acetabulum as you're approaching. In addition, looking at the differences between straight and curved drill guides. There are consequences as to which main bone stock are being accessed for the depth of drilling beyond the tip of the guide that is required into that between one and a half and 2.5cm distant, or distal to the tip of the guide. When you look into the far posterior positions and posterior anchors, where safety bordering the sciatic nerve posteriorly is an issue. Angling the curved device or straight device away from the articular surface will result in penetrance posteriorly in these particular areas, utilizing a Utilizing a posterolateral drilling angle approach. Turning the curve of that device towards the posterior wall will help access the ischium bone stock anteriorly within the acetabulum at the psoas you or 3:00 position. Finding that low, flat angle to avoid penetration of the articular surface can result in very little bone on the inner table, and often depth of drilling will penetrate back on the inner canal of the psoas and lead to irritation and the need for explantation of those devices. So curving that guide away from the penetration danger points and towards the main body of the pubic bone will allow an angle of approach that creates a safer approach for these low anterior anchors. These have traditionally been the most difficult anchors. As a straight guide, coming even low and flat can have a difficult time with the soft tissues and the angle of approach with the with the trochanter achieving the appropriate angle to make a low anterior. Drill approach. Understanding the trajectory of the curve. Is critically important to allow access to drill an appropriate depth drill hole into the main body of the pubic bone. There are cues to mark that there is a laser line, as well as a flat area to the handle. That allow the surgeon to feel the direction of the concavity of the drill, such that from outside the skin you can feel, as. In this position, my thumb is resting on the flat area, and we know that that means the drill is curving towards this area in the 70 degree lens. Just like in this video lens, it can be difficult to perceive the actual angle as the camera here is focusing on what is a curved drill, but appears in two dimensions to be straight until we really bring it into profile. And now we can see that. So utilization of the laser line as well as the external ergonomic flat handle are critically important to avoid positioning and then needing to reposition or not understanding exactly where that's going. And a rule of thumb might be to visualize the psoas you arthroscopically with the camera and the anterolateral portal viewing up towards this area. We'll see this as a U-shaped construct, and we're just going to turn that model to show that you here we can see in the camera projection the U. Of the so is U. And that is more typical of what arthroscopically we're going to be seeing, which will just look like a dip away into the 3:00 position and down below utilization of the thumb against the flat portion of the handle, and recognizing that the thumb itself should be down towards the patient's leg in order to really access the appropriate drill angle if that flat portion is towards the ceiling in a typical supine position. One can see that that's going to result in a drill penetrance at a high likelihood. So you have different ways to use that ergonomics. Now if we place that angle and use our thumb towards the patient's foot, we're now at minimum we're going to be drilling into safer pubic bone stock. We'll use the straight guide to demonstrate that. Now that's quite different from the use of the straight handled guide, which in all dimensions on the camera is going to be straight because it is straight. And as we access that area, the traditional difficulty in this zone has been trying to angle one's hand enough at the same time as one is trying to image from the same direction to see what they're doing. And all of the soft tissue interference has made it a problem. So now you can see how you can best from outside and inside, use the curve to access far anterior areas of the pelvis.

Animations demonstrating the features and benefits of a specific product.

Animationen, die die Funktionen und Vorteile eines bestimmten Produkts demonstrieren.

Produktdemonstrationen

Animações demonstrando os recursos e benefícios de um produto específico.

Vídeos de demonstração de produtos

Animaciones que demuestran las características y beneficios de un producto específico.

Videos de demostración de productos

Product Demonstrations

Overview of Hip Joint Access Featuring the Synergy Extended Length Hip Arthroscope System

We'll begin today with a demonstration of the landmarks around the hip as we approach access to the hip. Here we've marked the anterior superior iliac spine, or ASIS. We've drawn a line inferiorly from the axis, and we'll avoid going medial to that line with any of our portals in order to protect the femoral neurovascular bundle. Here we've marked the greater trochanter. We'll take care during the procedure not to use the greater trochanter as a landmark, because the greater trochanter can move. So if we have more or less distraction, the greater trochanter may move inferiorly or superiorly. If we have more or less femoral anteversion or more or less internal or external rotation of the hip, the greater trochanter will move anteriorly or posteriorly. So we don't want to use the greater trochanter as a landmark. It's more something to avoid. We want to use the ASIS and the pelvis as our landmark, because ultimately what we're approaching is the acetabulum, and we want to maintain a consistent angle of approach toward the acetabulum. Posteriorly, the sciatic nerve is back in this range, so as long as we're anterior to the. Posterior edge of the greater trochanter, we should be well away from the sciatic nerve. So first we'll begin with an anterolateral portal. And the way that we locate our anterolateral portal. Is by first laying the spinal needle across the expected trajectory. We'll take an x ray here. And that gives us an idea of where we want to be from superior to inferior. Now, as far as anterior to posterior, we want to be somewhere along this line. We will not use the greater trochanter as our landmark. We'll imagine where would be in line with the 12:00 position on the acetabulum. That's where we want to be. We want to be approaching the 12:00 or perhaps 1230 o'clock position on the acetabulum. We're going to get a shot with the spinal needle meeting the most inferior part of the Gram. So that'll be here. We'll turn the bevel so that we pass the labrum. So the flat part of the bevel is toward the labrum. We'll pass through the capsule like this. And then we flip the bevel like this so that now we can use the bevel to pass the femoral head. And here you see it's passed the femoral head without digging into the femoral head. So we want to be as inferiorly as possible in the air ArthroFX gram while not hitting the actual femoral head. Here we insert the guidewire through the spinal needle. We'll take the spinal needle out, and then we'll use over the guidewire technique to insert our cannula. This is a 4 or 5 cannula. And this is generally the first cannula that we'll enter the joint with. So you can you want to avoid plunging with this cannula. And you can do that by using your finger your index finger on the skin. Or you can use a golf grip where you use two hands like so. And use this to avoid plunging, so you stop yourself from plunging. We'll see the cannula coming toward the joint. We'll lever like this away from the femoral head so that we avoid hitting the femoral head. And then we avoid our plunge using our golf grip or using our index finger. Now we're in the joint and we'll place our scope. Through the candle. So there's our scope. Now I generally start my approach dry. And what we want to visualize here is the triangle between the femoral head on the right and the labrum on the left. And this anterior triangle is going to be our insertion site for our second portal. My second portal is going to be an anterior portal. So we want to be a little bit lateral to this line, which we drop down from the ASIS. So we'll come to about here and we'll pick a spot essentially parallel with our anterolateral portal. And I want to pick a spot where my spinal needle and my scope are going to converge at about a 30 degree angle. That's about the the spot that I want to pick. So you shouldn't define a particular distance between these two portals, because the distance may vary depending on the size or shape of the patient. But what can remain consistent is this angle of convergence between the spinal needle and the scope. So we'll then insert the spinal needle into the joint. And we want to come in through this anterior triangle here. And we want to come in at a point where we leave a little bit of a cuff of capsule on the acetabular side, which we can then use later to repair the capsule. So we pass our guidewire again through our spinal needle. And then we'll now pass the blue or 5.0mm scope sheath over the guidewire. This comes into the joint. Again, I'm watching the cannula come in and I can use my index finger to prevent plunges. So my index finger is right up against the patient. I lever away from the femoral head. I make sure I don't scuff the femoral head on the way in. And now my cannula is in. And now we have an outflow. So we can now run the pump and we have an outflow. So we'll be able to flush out the joint. Scope sheaths have been smoothed on the end. So they're less likely to scuff the femoral head. And that's important. But of course we should still take care to avoid bumping them into the femoral head on the way in and out. So now we'll pass a banana blade or any type of blade you choose through this, Us through this scope sheath and into the joint. And I'm going to use this blade for my capsulotomy. Now, I like to do this through the anterior portal, not through a more distal portal, but through the anterior portal, because this gives me an angle where the blade is essentially perpendicular to the fibers of the capsule. And you can see this in the arthroscopic picture. If you come from a more distal portal, the blade will be cutting obliquely across the fibers of the capsule, which makes it harder to repair afterward. So we're going to use this beaver blade to to perform an inter portal capsulotomy. And we want to take care to see the tip of the blade at all times so that we don't cut the femoral head. Take a lot of care to see the tip of the blade so you don't cut the femoral head. Now notice I'm coming. I'm cutting from bottom right to top left because I'm going parallel to the labrum, so I'm not cutting directly toward myself. I'm cutting this way, using the blade as a rudder to cut parallel to the labrum. And that's important as well, because we want to leave a consistent cuff of tissue on the acetabular side. For later capsular repair. Here we go. We can now demonstrate that we'll switch the candles. So I'll turn off the flow. I'll switch portals using the bridging system and put the scope in the anterior portal and look posteriorly. And I'll take that blade. And now we'll pass the blade through. This. And now we can complete our capsulotomy here. And again we've checked that the portal did not go through the labrum and we did not scuff the femoral head, and we keep the beaver blade in view throughout. So we'll complete our capsulotomy now. Cutting anteriorly again parallel to the labrum, not necessarily directly toward us. Rather I'm going parallel to the labrum. That's that's important because that's how we preserve a good cuff. Of a uniform thickness along the acetabular side for the later capsular repair. So now I can switch back using the bridging system. We can use half pipes to pass instruments. One thing I would note is that when you use half pipes, it's important that the half pipe converge toward the switching stick or instrument that it's going along. So you want the half pipe to converge like this. You do not want them running in parallel like this, because if you run them in parallel and it catches a little soft tissue, then it will diverge. So you want it converging. You want the tip running along the switching stick or instrument. So it's converging at all times. So when you go in with the half pipe you come out with the switching stick. When you come in with the switching stick you come out with the half pipe always converging. And same with any other instrument. So we're here converging toward the switching stick as we come in and switching stick out. And then we'll put a probe in sharp part of any instrument, always toward the half pipe converging as we come down and half pipe out. And now we'll go through a diagnostic arthroscopy. So we'll begin with the ligamentum teres. This is obviously a cadaver. So we see the ligamentum teres is quite badly torn. We can evaluate the acetabular fossa. Look at the foveal cartilage here. You see. Femoral head defect in the superomedial. Posterior superior medial femoral head posterior to the fovea. We can look for notch osteophytes like this one around the acetabular fossa and for synovitis in the acetabular fossa. So we begin again at 6:00 at the ligamentum teres below the ligamentum teres you see the transverse acetabular ligament. Then we go anterior inferiorly. So this is 5:00, 4:00. At 3:00 you see the psoas. You. So this is the psoas notch. And this is a good marker directly anteriorly to this is where the iliopsoas runs. So if you do an iliopsoas fractional lengthening at the level of the joint line, it's right on the other side of that capsule. You don't necessarily need to cut through the capsule. You can go up and over the capsule. But this you gives you a good localizer of where it is. A note if you do ISO's lengthening at the level of the joint line, it's often bifid at the level of the joint line. So look for a second or third slip of the tendon. So 3:00 2:00. 1:00. 12:00. And then as you move more posteriorly. 11:00, 10:00, 9:00, 8:00, 7:00. And right back to 6:00. Right back to the ligamentum teres. A couple of interesting views to work with. This is an intra-articular view, of course, of the labrum. And from here you can probe the anterior labrum and the peripheral cartilage of the acetabulum, which are some of the most commonly worked on areas in hip arthroscopy. It's also useful to use a use a bird's eye view where you come from superior from the capsular side, and you can see the capsular side of the labrum from this view. So at this point, I'll point out a distal anterolateral accessory portal, which will be approximately in this region. So I want this to be converging now from distal to proximal at a 30 degree angle to my to my scope. And this will be quite a bit more lateral than the anterior portal was. So through this portal, I'll have a nice trajectory for placement of anchors most of the way around the acetabulum. I can use a I can use a switching stick to enter the joint here. Through the this anterolateral portal, we can see the capsule here. We see the the labrum here. This is the anterior labrum. Lateral labrum. 12:00 here. This is the rectus femoris up above the capsule. The indirect head of the rectus femoris here, traveling above the capsule. I'm now retracting it. These fibers with my probes. So that's indirect. Head of the rectus femoris. And this is capsule. So I'll preserve this cuff of capsule throughout for later repair. And you can see how laterally at 12:00 the capsule almost fuzes with what's left of the indirect head of the rectus femoris. So we'll preserve that as well for later repair. I'll also demonstrate the bird's eye view here, viewing from above the labrum. If you retract the capsule up, you can. You can view the capsular side of the labrum. So nice view of the capsular side. Very useful view. And we'll use this view often to develop the plane between the capsule and the labrum for an acetabular plasty before doing a labral repair. So now we're going to create a posterolateral portal. And this will be parallel with our anterolateral and our anterior portals. And this portal will allow us to access the more posterior parts of the acetabular rim working down here. Okay. So the the posterior portal is parallel to about the 10:00 position on the posterior lateral acetabulum. Usually this coincides with the posterior lateral corner of the trochanter. Approximately. But as before, I do not use the trochanter as my reference point for locating the landmark. I think of where is it going to arrive on the acetabulum. So I'm targeting the acetabulum with this portal, not targeting the greater trochanter.

CapsuleCut Blade, 4 mm, Detachable

CapsuleCut Blade, 4 mm, Detachable, Curved

CapsuleCut-Klinge, abnehmbar, gebogen, 4 mm

CapsuleCut Blade , Detachable, Curved 4 mm

CapsuleCut, cuchilla, extraíble, curvada, 4 mm

Hip Joint Access Disposable Kit with 2 Distension Needles with Styletand 2x 1.1mm x 45cm Nitinol Guide Wires

Kit de inst. Desech. Art. Cadera con agujas de distensioncon estilete

Hip Arthroscopy Disposable Kit w/ Banana Blade

Einmalset zur Hüftarthroskopie mit Banana Blade

Hip Arthroscope Disposable Kit with Banana Blade

Kit de instrumental desechable para artroscopia de caderacon hoja de bis

Kit de descartáveis para artroscopia de anca com lâmina Banana

Disposables Kit, Master, for Hip Arthroscopy

Einmalset zur Hüftarthroskopie mit Capsulatomie-Messer, steril, SU

Hip Arthroscopy Master Disposable Kit with Blades

Kit completo de instrumental desechable para artroscopia decadera, conbi

KIT INSTRUMENTAL PARA ARTRSOCOPIA DE QUADRIL

Inflow Cannula Adapter with Stopcock

Adaptador de cánula de flujo de entrada con grifo

C-Mount Hip Arthroscope, 30° 3.5 x 202 mm

Arthroskopieoptik, C-Mount, 30°, 3.5 mm x 202 mm, HL

C-Mount Hip Arthroscope, 30°, 3.5 mm x 202 mm

Óptica de artroscopia de cadera con conexión C-Mount, 30°,Ø 3.5 mm x 202

ARTROSCOPIO C-MOUNT, QUADRIL, 30, 3.5 X 202 MM

C-Mount Arthrosc 30°, Ø 3.5 mm x 202 mm

C-Mount Hip Arthroscope, 70° 3.5 x 204 mm

Arthroskopieoptik, C-Mount, 70°, 3.5 mm x 204 mm

C-Mount Hip Arthroscope, 70°, 3.5 mm x 204 mm

Óptica de artroscopia de cadera con conexión C-Mount, 70°,Ø 3.5 mm x 206

ARTROSCOPIO C-MOUNT, QUADRIL, 70, 3.5 X 204 MM

Sheath, Hip, Tap/Fen, 2 Stopcock for 3.5 mm Hip Scope

Schaft, HL, mit Verjüngung / mit Spüllöchern, 1 Hahn, für 3.5 mmHüft-Optik

Sheath, HIP, TAP/FEN, 2 Stopcock for 3.5 mm Hip Scope

Vaina, alto flujo, cónica/fenestrada, 2 grifos,para ópticas de cadera de

CAMISA QUADRIL AFUNILADO/FENESTRADO 2 VALVULAS DE 3.5 MM DE EXTENSAO 

Conical Obturator for Tap/Fen 3.5 mm Hip Scope Sheath w/Handle

Obturator, konisch, für 3.5 mm Hüft-Arthroskopschaft mit Verjüngung /mit Spüllöchern, mit Handgriff

Conical Obturator for TAP/FEN 3.5mm Hip Scope Sheath w/Hndle

Obturador cónico, para sistema de vaina de óptica de caderade alto flujo

OBTURADOR CONICO PARA SISTEMA DE CAMISA ENDOSCOPICA DE QUADRIL DE 3.5MMDE ALTO FLUXO

Cannulated Obturator for Tap/Fen, High-Flow, 3.5 mm, Hip Scope Sheath w/Handle

Obturator, kanüliert, für 3.5 mm High-Flow-Hüft-Arthroskopschaft mitVerjüngung / mit Spüllöchern, mit Handgriff

Cannulated Obturator for TAP/FEN HF 3.5 mm Hip Scope Sheath w/Handle

Obturador canulado para sistema de vaina de alto flujo paraóptica de cad

OBTURADOR CANULADO PARA SISTEMA DE CAMISA ENDOSCOPICA DE QUADRIL DE 3.5MM DE ALTO FLUXO

Bridge, XL,Qc, 2 Stpck F/3.5mm Hip Scope

Brückensystem, XL, Schnellverschluss, 2 Hähne, für 3.5 mm Hüftarthroskop

Bridge, XL, Quick Connect, 2 Stopcock, for 3.5 mm Hip Scope

Puente, para endoscopio de cadera de 3,5 mm,conexión rápida, 2 llaves de

PONTE, XL, CONEXAO RAPIDA, QUADRIL, 2 VALVULAS, DE 3.5 MM EXTENSAO

Metallkanüle, für die Hüfte, 5 mm XL

Metallkanüle, für die Hüfte, 5.5 mm XL

Metallkanüle, für die Hüfte, 6.5 mm XL

Cannulated Obturator, XL, Hip, 4.5mm

Obturator, für die Hüfte, kanüliert, 4.5 mm XL

Cannulated Obturator, XL, Hip, 5.0mm

Obturator, für die Hüfte, kanüliert, 5 mm XL

Cannulated Obturator, XL, Hip, 5.5mm

Obturator, für die Hüfte, kanüliert, 5.5 mm XL

Cannulated Obturator, XL, Hip, 6.5mm

Obturator, für die Hüfte, kanüliert, 6.5 mm XL

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

Switching Stick, Long, Cannulated, 4 mm x 15''

Varilla de intercambio, larga, canulada, 4 mm x 15''

Switching Stick, Long, Cannulated, 3.5 mm x 15"

Wechselstab, lang, kanüliert, 3.5 mm x 38 cm

Switching Stick, Long, Cannulated, 3.5 mm x 15''

Varilla de intercambio, larga, canulada, Ø 3.5 mm x 381 mm

PINO PARA COMUTACAO , LONGO, CANULADO, 3.5 X 15 POL.

Hip Arthroscope System Instrument Case

Hüftarthroskopieinstrumentencontainer, extralang

CAIXA PARA INSTRUMENTAL DE QUADRIL COMPRIMENTO EXTENDIDO

Hip Arthroscope System, XL, C-Mount

Hip Arthroscope HD, 30° 3.5 x 202 mm

Arthroskopieoptik, HD, 30°, 3.5 mm x 202 mm, HL

Hip Arthroscope, 30°, 3.5 mm x 202 mm, HD

Óptica de artroscopia, 30°, HD, Ø 3.5 mm x 202 mm, cadera

ARTROSCOPIO HD, QUADRIL, 30, 3.5 X 202 MM

Hip Arthroscope HD, 70°, 3.5 x 204 mm

Arthroskopieoptik, HD, 70°, 3.5 mm x 204 mm, HL

Hip Arthroscope 70°, 3.5 mm x 204 mm, HD

Óptica de artroscopia, 70°, HD, Ø 3.5 mm x 204 mm, cadera

ARTROSCOPIO HD, QUADRIL, 70, 3.5 X 204 MM

Hip Arthroscope System, XL, Eye Piece

Open Cannula, Blunt Tip, Low Profile

Open Cannula, Tapered 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

Hip Joint Access

Educational Resources and Products

Featured Resources

All Resources

All Products

Safe Hip Joint Access and Anchor Placement Considerations and Technical Pearls

Overview of Hip Joint Access Featuring the Synergy Extended Length Hip Arthroscope System

Videos

Documents

Languages

Surgical Technique Videos (3)

Percutaneous Intracapsular Peripheral Access (PIPA) Technique for Hip Joint Access

Acetabular Labral Repair Using the Pano™ Scope

Safe Hip Joint Access and Anchor Placement Considerations and Technical Pearls

Brochures (1)

CoolCut™ Specialty Series: Hip-Length Shaver Blades and Burrs

Catalogs (1)

Hip Next Generation in Soft-Tissue Repair and Reconstruction

Product Demonstrations (1)

Overview of Hip Joint Access Featuring the Synergy Extended Length Hip Arthroscope System

CapsuleCut Blade (4)

AR-6527-02

AR-6527-02C

AR-6527-03

AR-6527-03C

Hip Arthroscopy Disposable Kit (3)

AR-6526-01S

AR-6527S

AR-6526S

Hip Arthroscope System, XL, C-Mount (1)

AR-6576S-C

Hip Arthroscope System, XL, Eye Piece (1)

AR-6576S-E

Open Cannulas (3)

AR-6507LP

AR-6506LP

AR-6507LPR

Clear Open Cannulas (2)

AR-6507-01

AR-6507-02