PMC10234386_01
CT scan demonstrating the OO lesion of the medial femoral neck at the head-neck junction.
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F1
More specifically, the lesion was located on the posterior aspect of the medial femoral head and neck junction (Fig. 1).
(2a) The patient positioning in flexion, abduction and external rotation, with (b) being a more close-up view. The adductor tendon marked out with the two longitudinal lines, in line with the femur. Additionally, the three portals, AMP, PMP and DPMP, are indicated by the 'x' markings. The dots denote the superior pubis, and the line perpendicular to the adductor tendon denotes the inferior pubis bone.
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F2
The patient's right lower extremity was positioned in flexion, abduction and external rotation (Fig. 2).
The spinal needle introduced into the patient at the PMP portal, as the initial portal for medial hip arthroscopy.
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A spinal needle was utilized to identify the initial (PMP) portal, 1 cm distal to the origin of the adductor longus tendon on its posterior edge aiming for the medial femoral head-neck junction using fluoroscopy (Fig. 3).
Arthroscopy cannula and camera in the patient at the PMP and spinal needle introduced for the proposed AMP.
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F4
AMP was identified:this portal is on the anterior border of the adductor longus tendon, but again 1 cm distal to its origin. After placement of the spinal needle at the proposed AMP (Fig. 4), a guidewire was placed through the spinal needle, incision was made about the guidewire and a blunt trocar and sheath were placed onto the capsule of the joint.
Photographs of a closer (a) and more distant perspective (b) of the cannulas utilized for medial hip arthroscopy in this patient.
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F5
Using a shaver under arthroscopic and fluoroscopic visualization, a partial medial capsulotomy was performed, allowing visualization and access to the medial femoral head-neck junction (Fig. 5).
Photograph of the arthroscopy monitor demonstrating the vascularized soft tissue mass evident upon entering the joint capsule.
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F6
An opaque colored soft tissue mass with induration and small blood vessels was observed (Fig. 6).
Arthroscopic images of the posteromedial femoral head-neck junction (a) including the depths of the bony cyst, after excision of the OO (b).
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F7
Once the lesion was completely excised down to the sclerotic base, all the instruments were removed from the hip (Fig. 7).