The Modified Mid-Anterior Portal for Hip Arthroscopy

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The Modified Mid-Anterior Portal for Hip Arthroscopy Dean K. Matsuda, M.D., Angel Villamor, M.D. Arthroscopy Techniques Volume 3, Issue 4, Pages e469-e474 (August 2014) DOI: 10.1016/j.eats.2014.05.005 Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 1 MMAP in relation to other common portals in a right hip. One should note their relation to the anterior superior iliac spine and greater trochanter skeletal landmarks. (ALP, anterolateral portal; W, posterolateral portal; X, anterior portal; Y, mid-anterior portal; Z, distal anterolateral accessory portal.) Arthroscopy Techniques 2014 3, e469-e474DOI: (10.1016/j.eats.2014.05.005) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 2 Favorable angle of approach for acetabular rim preparation (drilling) and suture anchor placement for labral reparative and reconstructive procedures, shown in a right hip. Arthroscopy Techniques 2014 3, e469-e474DOI: (10.1016/j.eats.2014.05.005) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 3 External view of a supine right hip showing the 70° arthroscope in the ALP and the plastic cannula in the MMAP during arthroscopic osteosynthesis of a femoral head fracture. One should note the use of 2 guide pins for percutaneous insertion of headless screws. Arthroscopy Techniques 2014 3, e469-e474DOI: (10.1016/j.eats.2014.05.005) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 4 Supine arthroscopic view of right hip from ALP during global acetabuloplasty for severe global pincer FAI. One should note the posterior acetabular rim (AR) and the burr (Flat-top; Smith & Nephew, Andover, MA) resecting a remnant of posterior rim (asterisk) inferior to the direct posterior 9-o'clock location (9). Circumferential labral reconstruction was then performed. All procedures were performed through the MMAP. Arthroscopy Techniques 2014 3, e469-e474DOI: (10.1016/j.eats.2014.05.005) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 5 Supine arthroscopic view of right hip from ALP after arthroscopic posterior cam decompression. One should note the region of anterolateral (AL) and posterolateral (PL) femoroplasty. The latter is proximal to the retinacular vessels (asterisk) supplying the femoral head (FH). Arthroscopy Techniques 2014 3, e469-e474DOI: (10.1016/j.eats.2014.05.005) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 6 Supine arthroscopic view of right hip from ALP during arthroscopic internal fixation of anterior column acetabular fracture. The 2 large-fragment cannulated screws (arrow) were inserted through the MMAP. Concurrent arthroscopic femoroplasty, acetabuloplasty, and labral refixation were performed. (AR, acetabular rim; FH, femoral head; L, labrum.) Arthroscopy Techniques 2014 3, e469-e474DOI: (10.1016/j.eats.2014.05.005) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions