title: Arthroscopy of the nondistractable hip: a novel extracapsular approach.
abstract: Adequate traction to achieve hip joint distraction is essential for avoiding iatrogenic injury to the joint during hip arthroscopy. An inability to distract the joint is a relative contraindication for hip arthroscopy. This report describes a novel technique involving an extracapsular approach to gain safe access to a hip joint that fails a trial of traction during positioning for hip arthroscopy. The anterolateral portal is established under fluoroscopic guidance. The arthroscope is positioned on the lateral rim of the acetabulum. A shaver, introduced through a modified anterior portal, is used to facilitate capsular exposure. An arthroscopic capsular incision is made proximal to the lateral acetabular rim and extended anteriorly with a radiofrequency probe. Osteoplasty of the anterolateral acetabular rim is carried out with a burr while protecting the labrum. Distraction of the hip is then possible, allowing safe central-compartment access and subsequent chondrolabral procedures.
authors: Department of Orthopedics, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Ran
authors: R
authors: Doron
authors: Department of Orthopedics, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Eyal
authors: E
authors: Amar
authors: Department of Orthopedics, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Ehud
authors: E
authors: Rath
authors: Hip Arthroscopy Department, Post Street Orthopaedics and Sports Medicine, San Francisco, California.
authors: Thomas
authors: T
authors: Sampson
authors: Nirschl Orthopaedic Center for Sportsmedicine & Joint Reconstruction, Virginia Hospital Center, Arlington, Virginia.
authors: Derek
authors: D
authors: Ochiai
authors: Department of Orthopedics, Southern California Permanente Group, Kaiser West Los Angeles Medical Center, Los Angeles, California, U.S.A.
authors: Dean K
authors: DK
authors: Matsuda