Quadril

Liberação do iliopsoas

A exposição do tendão do iliopsoas necessita de capsulotomia na altura do encaixe do psoas. Uma pequena parte do tendão do iliopsoas é, então, liberada para corrigir o ressalto interno do tendão.

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

Gregor Möckel, MD, (Berlin, Germany) discusses the threedifferent types of snapping hip syndrome and how to address them surgically inthis informative presentation. Dr. Mockel describes the symptoms and treatments associated with intra-articular, internaland external snapping hip and provides an overview of the etiology of eachsyndrome.

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Snapping Hip Release

I'm speaking now about the first three compartments. Philip talked about the fourth, and I'm speaking about the first three compartments. So the snapping hip can be classified into an intra-articular intra-articular snapping hip, where the source of the snapping is inside the hip joint, first second in the so-called internal snapping hip. That means a snapping of the psoas tendon and the so-called external snapping hip. This is a snapping of the IT band or a hypertrophic bursitis. So first of all, the intra articular snapping the source of the snapping is inside the hip joint. And quite often it's a cartilage flap like this. You see it typically in cam impingement patients where the Cam lesion peels off the cartilage, the labrum stays intact for a long time and the cartilage is peeled off. Or we can have as a source for the intra articular snapping, a torn labrum room, or a torn ligament, or loose bodies in the central or in the peripheral compartment. The so-called internal snapping hip is a clinical diagnosis. Patients come and complain about a loud snapping and clicking in the groin, and if you do your investigation, you take the hip from a 90 degrees of flexion into an extension, and then you feel and can hear in the groin, in the groin, a snapping of the iliopsoas tendon. You can quite often see it in the MRI as you can see it here. And first of all, you should try a conservative treatment. And for instance ultrasound. Ultrasound guided injections to the tendon. The internal snapping hip occurs as well in patients after total hip replacement. And you can typically have it in two positions either at the femoral and at the femoral neck, especially in patients with prosthesis with a large collar like this with an overhanging collar. There you can have a snapping. You see the arthroscopic view here or in a tabular cup which is too large or which is retroverted, and then you have a snapping over the cup. So I come back to the non replaced hip. And there you can do the release of the tendon on different levels. The first level you can do is at the level of the lesser trochanter. This is more or less a complete tenotomy and you have even quite a lot retraction of the tendon. And there are some concerns in the literature about deficits in function. So to leave more of the tendon muscle complex intact is more suitable to release the tendon more proximal, for instance, at the level of the medial synovial fold in the peripheral Compartment or at the level of the acetabular notch in the central compartment. In patients with dysplastic hips or borderline dysplasia, let's say with a lateral center of edge wrinkle of below 25 degrees, you should be careful in releasing this tendon, because in this patient, the tendon plays an important role in stability of the hip. So there is recommended to make a bony decompression of the medial aspect of the inferior iliac spine, or a decompression of the eminence, the iliopectineal. So this is a view into a left hip, into the peripheral compartment of a left hip. You see here the femoral head. You see the capsule above. You see the zona orbicularis right here. You see the medial synovial fold in the middle. And there you can open up the capsule just in front of the medial synovial fold. Make a little hole into the capsule. So. And if you do not see immediately the psoas tendon, then you can stretch and extend the leg, rotate the leg until the psoas tendon comes across the window. And then you can do a release with your radiofrequency probe. It is not recommended to cut it with hand instruments because ossifications can occur if you don't use radiofrequency. So the external snapping hip is a clinical diagnosis. Again, mostly young females come to your office and say, okay, my hip is dislocating and then you watch them and you see the hip is not dislocating, but the IT band is snapping over the greater trochanter. And of course, this is the first line treatment in these patients is conservative as well. But if this fails as surgical release can be done and there are different options. I like to perform it from a subcutaneous way to remove the subcutaneous soft tissue, with the fat and then goes straight to the IT band and then make a little cut into the IT band. And then in a lateral position, you can very easily try to to, to feel this effect to, to produce the snapping or not. And, and then you can continue release or not. So for conclusion, ladies and gentlemen, for the intra-articular snapping, it is essential that you look for the source of the pain, for the source of the snapping inside the hip joint, in the central and in the peripheral compartment. For the internal snapping hip hip you can do a psoas tendon release. It is recommended to do it more proximal, more between the muscle tendon junction and for the external snapping hip, it is recommended to do an IT band release. Thank you very much.

BenjaminDomb, MD, (Chicago, IL) discusses his technique for the surgical correction ofinternal snapping hip syndrome through the fractional lengthening of the iliopsoastendon. In this live surgery demonstration, Dr. Domb describes relevant anatomyand the technique used to partially release the symptomatic tendon.

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

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Iliopsoas Fractional Lengthening

The hip is in distraction at this point, and the arthroscope is in the central compartment using a beaver blade. We extend the capsulotomy a little bit anteriorly, staying distal away from the acetabular rim to allow for subsequent capsular closure or plication using sutures at the completion of the surgery. We'll use the shaver to debride the iliopsoas Bursa with care not to debride the capsule at all. This is a very important point. We'd like to repair the capsule at the conclusion of the surgery, so it is important not to debris the capsule with the shaver, but to debride only the iliopsoas Bursa and stay between the capsule and the iliopsoas in performing this exposure. The iliopsoas crosses the joint at about the 3:00 position when it is missed. It is frequently because the rectus femoris tendon or part of the capsule is mistaken for the iliopsoas, and the psoas is often more inferomedial than expected. So one must clearly identify the tendinous fibers as seen here by debriding the Bursa, and identify the medial and lateral borders of the iliopsoas. That's absolutely critical. At this point we introduce a beaver blade which will be used for the actual fractional lengthening. Now at the level of the joint the iliopsoas is approximately 50% tendon, 50% muscle. So when we cut through the tendinous portion we'll see it snap open. And boom, there it snaps open. You see behind it the red muscle fibers. Those stay intact. We don't cut through the red muscle fibers. So this allows a lengthening of the iliopsoas by about one centimeter. And it will subsequently heal but about a centimeter longer. This has been very predictably shown to alleviate internal snapping of the hip.

Excalibur, Curved, HL, 4.2 mm x 19 cm

Terminal de artroscopia Excalibur, curvado, longitud decadera, Ø 4.2 mm

Excalibur, HL, 4.2 mm x 19 cm, steril, SU

Terminal de artroscopia Excalibur, longitud de cadera, Ø 4.2mm x 19 cm

SabreTooth, Curved, HL, 4.2 mm x 19 cm

SabreTooth, Gebogen, HL, 4.2 mm x 19.0 cm, steril, SU

Terminal de artroscopia SabreTooth, curvado, longitud decadera, Ø 4.2 mm

Bone Cutter, HL, 4.20 mm x 19.0 cm, steril, SU

Bone Cutter, longitud de cadera, Ø 4.20 mm x 19 cm

Dissector, HL, 4.2 mm x 19.0 cm, steril, SU

Terminal de artroscopia Dissector, longitud de cadera, Ø 4.2mm x 19 cm

Lâmina de shaver, Dissetor, HL, 4.2 mm x

Dissector, Curved, HL, 4.2 mm x 19 cm

Dissector, Gebogen, HL, 4.2 mm x 19.0 cm, steril, SU

Terminal de artroscopia Dissector, curvado, longitud decadera, Ø 4.2 mm

Lâmina de shaver, Dissetor, curvo, HL, 4

Arthrex CoolCut 90, Aspirating Ablator, 3 mm, 90°

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Arthrex CoolCut, Aspirating Ablator, 3 mm, 90

CoolCut de Arthrex, dispositivo de vaporización conaspiración, 3 mm, 90

ARTHREX COOLCUT 90, ASPIRATING ABLATOR, 90

Arthrex CoolCut 50, Aspirating Ablator, 3 mm, 50°

Arthrex CoolCut 50, Ablator mit Absaugung

Arthrex CoolCut, Aspirating Ablator, 3 mm, 50

CoolCut de Arthrex, dispositivo de vaporización conaspiración, 3 mm, 50

ARTHREX COOLCUT 50, ASPIRATING ABLATOR, 50

Punch, Medium 45° Left Tip, ø3.4 mm, 220 mm Straight Shaft

Medium Punch, 220 mm, Ø 3.4 mm, Schaft gerade, Maul 45° links gebogen

Punch - Medium, Ø 3.4 mm, 220.0 mm, Straight Shaft, 45° Left Angled Tip

Pinza sacabocados, mediana, punta en ángulo de 45°izquierda, vástago rec

PUNSOR, PONTA MÉDIA 45° PARA ESQUERDA, EIXO DE Ø3.4 MM, 220 MM RETO (220MM X Ø3.4MM)

PUNSOR, PONTA MÉDIA 45° PARA ESQUERDA, E

Punch, Medium 45° Right Tip, ø3.4 mm, 220 mm Straight Shaft

Medium Punch, 220 mm, Ø 3.4 mm, Schaft gerade, Maul 45° rechts gebogen

Punch - Medium, Ø 3.4 mm, 220.0 mm, Straight Shaft, 45° Right Angled Tip

Pinza sacabocados, mediana, punta en ángulo de 45° derecha,vástago recto

PUNSOR, PONTA MÉDIA 45° PARA DIREITA, EIXO DE Ø3.4 MM, 220 MM RETO (220MM X Ø3.4MM)

PUNSOR, PONTA MÉDIA 45° PARA DIREITA, EI

Punch, Medium Straight Reverse Tip, ø3.4 mm, 220 mm Straight Shaft

Medium Punch, 220 mm, Ø 3.4 mm, Schaft gerade, Maul gerade, rückwärtsschneidend

Punch - Medium Reverse, Ø 3.4 mm, 220.0 mm, Straight Shaft, Straight Tip

Pinza sacabocados inversa mediana, punta recta, vástagorecto, 220 mm, Ø

PUNSOR, PONTA MÉDIA REVERSA, EIXO DE Ø3.4 MM, 220 MM RETO (220MM X Ø3.4MM)

PUNSOR, PONTA MÉDIA REVERSA, EIXO DE Ø3.

Punch, Medium Straight Tip, ø3.4 mm 15° Up Curved Shaft, 220 mm

Medium Punch, 220 mm, Ø 3.4 mm, Schaft 15° aufgebogen, Maul gerade

Punch - Medium, Ø 3.4 mm, 220.0 mm, 15° Up Curved Shaft, Straight Tip

Pinza sacabocados, mediana, punta recta, vástago curvadoarriba 15°, 220

PUNSOR, PONTA MÉDIA RETA, EIXO DE Ø3.4 MM CURVADO 15° PARA CIMA, 220 MM(220MM X Ø3.4MM)

PUNSOR, PONTA MÉDIA RETA, EIXO DE Ø3.4 M

Punch, Medium Straight Tip, ø3.4 mm Straight Shaft, 220 mm

Medium Punch, 220 mm, Ø 3.4 mm, Schaft gerade, Maul gerade

Punch - Medium, Ø 3.4 mm, 220.0 mm, Straight Shaft, Straight Tip

Pinza sacabocados, mediana, punta recta, vástago recto, Ø3.4 mm, 220 mm

PUNSOR, PONTA MÉDIA RETA, EIXO DE Ø3.4 MM RETO, 220 MM (220MM X Ø3.4MM)

Punch, Medium 45° Left Tip, ø3.4 mm, 220 mm Straight Shaft w/WishBone Handle

WishBone Medium Punch, 220 mm, Ø 3.4 mm, Schaft gerade, Maul 45° linksgebogen

WishBone Medium Punch, 45° Left Angled Tip, Straight Shaft, 220.0 mm, Ø3.4 mm

Pinza sacabocados mediana WishBone, punta en ángulo de 45°izquierda, vá

PUNSOR PONTA MEDIA 45 PARA ESQUERDA EIXO DE 3.4 MM 220 MM RETO COMCABO WISHBONE

Punch, Medium 45° Right Tip, ø3.4 mm, 220 mm Straight Shaft w/WishBone Handle

WishBone Medium Punch, 220 mm, Ø 3.4 mm, Schaft gerade, Maul 45° rechtsgebogen

WishBone Medium Punch, 45° Right Angled Tip, Straight Shaft, 220.0 mm,Ø 3.4 mm

Pinza sacabocados mediana WishBone, punta en ángulo de 45°derecha, vást

PUNSOR PONTA MEDIA 45 PARA DIREITA EIXO DE 3.4 MM 220 MM RETO COM CABO WISHBONE

Punch, Medium Straight Reverse Tip, ø3.4 mm, 220 mm Straight Shaft w/WishBone Handle

WishBone Medium Punch, 220 mm, Ø 3.4 mm, Schaft gerade, Maul gerade, rückwärtsschneidend

WishBone Medium Reverse Punch, Straight Shaft, Straight Tip 220.0 mm, Ø3.4 mm

Pinza sacabocados mediana inversa WishBone, punta recta,vástago recto,

PUNSOR PONTA MEDIA REVERSA EIXO DE 3.4 MM 220 MM RETO COM CABO WISHBONE

Punch, Medium Straight Tip, ø3.4 mm 15° Up Curved Shaft, 220 mm w/WishBone Handle

WishBone Medium Punch, 220 mm, Ø 3.4 mm, Schaft 15° aufgebogen, Maul gerade

WishBone Medium Punch, Straight Tip, 15° Up Curved Shaft, 220.0 mm, Ø 3.4 mm

Pinza sacabocados mediana WishBone, punta recta, vástagocurvado arriba

PUNSOR PONTA MEDIA RETA EIXO DE 3.4 MM CURVADO 15 PARA CIMA 220 MMCOM CABO WISHBONE

Liberação do iliopsoas

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Snapping Hip Release

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

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Iliopsoas Fractional Lengthening

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