Luca Pierannunzii, M.D. Arthroscopy Techniques

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Presentation transcript:

Endoscopic and Arthroscopic Assistance in Femoral Head Core Decompression Luca Pierannunzii, M.D. Arthroscopy Techniques Volume 1, Issue 2, Pages e225-e230 (December 2012) DOI: 10.1016/j.eats.2012.08.004 Copyright © 2012 Arthroscopy Association of North America Terms and Conditions

Figure 1 A Steinberg stage II idiopathic AVN is affecting the right femoral head of a 54-year-old man. (A) The anteroposterior radiograph shows mild cystic changes together with slight sclerosis in the central part of the head, without significant signs of osteoarthritis or flattening of the cephalic profile. (B) The axial magnetic resonance imaging scan in the equatorial plane shows the anterior location of the lesion, with preservation of the round shape. (C) The arthroscopic view of the femoral head (obtained from the anterolateral portal with a 70° arthroscope) shows intact cartilage lining the anterolateral part of the head, where the necrotic lesion is supposed to be. Arthroscopy Techniques 2012 1, e225-e230DOI: (10.1016/j.eats.2012.08.004) Copyright © 2012 Arthroscopy Association of North America Terms and Conditions

Figure 2 Drilling through the AVN lesion under fluoroscopic guidance (anteroposterior view). Arthroscopy Techniques 2012 1, e225-e230DOI: (10.1016/j.eats.2012.08.004) Copyright © 2012 Arthroscopy Association of North America Terms and Conditions

Figure 3 First tunnel endoscopy: the aim is verified, because the core track walls progress clearly from the reddish vital bone (VB) of the neck (A) through a transitional zone (B) toward the white-gray avascular tissue of the lesion (C). Arthroscopy Techniques 2012 1, e225-e230DOI: (10.1016/j.eats.2012.08.004) Copyright © 2012 Arthroscopy Association of North America Terms and Conditions

Figure 4 Debridement of the AVN lesion with the expandable reamer under fluoroscopic guidance. (A) Anteroposterior view. (B) Axial view. Arthroscopy Techniques 2012 1, e225-e230DOI: (10.1016/j.eats.2012.08.004) Copyright © 2012 Arthroscopy Association of North America Terms and Conditions

Figure 5 Second tunnel endoscopy: the walls of the chamber created by the expandable reamer appear to be vital and bleeding, thus confirming the adequate debridement. Some residual debris (D) is still visible in the distal part of the chamber and will be removed with a curette. (W, chamber wall.) Arthroscopy Techniques 2012 1, e225-e230DOI: (10.1016/j.eats.2012.08.004) Copyright © 2012 Arthroscopy Association of North America Terms and Conditions

Figure 6 Retrograde injection of the ceramic putty into the tunnel, after bone grafting of the cephalic cavity (anteroposterior view). Arthroscopy Techniques 2012 1, e225-e230DOI: (10.1016/j.eats.2012.08.004) Copyright © 2012 Arthroscopy Association of North America Terms and Conditions