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Lara J, Garín A, Abara S, del Río J, Besomi J, Herrera C, Cancino J, Villegas D, Tobar C. Prevention of motor ascending branch of the rectus femoris injuries in Bernese periacetabular osteotomy: a cadaveric study. J Hip Preserv Surg 2024; 11:51-58. [PMID: 38606330 PMCID: PMC11005754 DOI: 10.1093/jhps/hnad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/08/2023] [Accepted: 09/24/2023] [Indexed: 04/13/2024] Open
Abstract
The Bernese periacetabular osteotomy (PAO) is a surgical procedure used to treat hip dysplasia in young adults, but it carries the risk of neurological complications, including injury to the motor ascending branch of the rectus femoris (MABRF). This study aimed to describe anatomical considerations to prevent MABRF injuries during PAO. A cadaveric study was conducted on seven specimens. The original and modified PAO approaches were used, with and without disinsertion of the rectus femoris muscle origin. The femoral nerve was dissected in all specimens from the endopelvic position to the MABRF origin (T-point). The average distance from the anterosuperior iliac spine to the T-point was 10.2 ± 0.4 cm. To protect the MABRF, a safety zone was identified for the osteotome placement during the ischial cut. The osteotome was slid over the joint capsule, deflecting the iliocapsularis muscle medially and distally. This manoeuvre shields the MABRF with the iliocapsularis muscle, reducing the risk of neurological injury. Both the original and modified PAO approaches were considered safe techniques with low risk to the rectus femoris innervation. These findings offer valuable insights for surgeons performing PAO, emphasizing the significance of understanding anatomical relationships and implementing protective measures to enhance patient outcomes and minimize complications. In conclusion, implementing these anatomical considerations can help prevent MABRF injuries during PAO, contributing to safer and more successful surgical interventions for hip dysplasia in young adults.
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Affiliation(s)
- Joaquín Lara
- Clínica MEDS, Hip Unit, Avenida José Alcalde Délano 10581, Santiago 7691236, Chile
| | - Alan Garín
- Intituto Traumatológico, Hip Unit, San Martín 771, Santiago 8340220, Chile
- Clínica RedSalud Santiago, Hip Unit, Avenida Libertador Bernardo O’Higgins 4850, Santiago 9190015, Chile
| | - Selim Abara
- Hospital DIPRECA, Hip Unit, Avenida Vital Apoquindo 1200, Santiago 7601003, Chile
| | - Javier del Río
- Clínica MEDS, Hip Unit, Avenida José Alcalde Délano 10581, Santiago 7691236, Chile
- Hospital Clínico Mutual de Seguridad, Hip Unit, Avenida Libertador Bernardo O’Higgins 4848, Santiago 9190015, Chile
| | - Javier Besomi
- Clínica Alemana de Santiago, Hip Unit, Avenida Vitacura 5951, Santiago 7650568, Chile
- Hospital Clínico San Borja Arriarán, Hip Unit, Avenida Santa Rosa 1234, Santiago 8360160, Chile
| | - Cristhián Herrera
- Clínica Alemana de Santiago, Hip Unit, Avenida Vitacura 5951, Santiago 7650568, Chile
- Hospital Clínico San Borja Arriarán, Hip Unit, Avenida Santa Rosa 1234, Santiago 8360160, Chile
| | - Jaime Cancino
- Hospital Clínico Mutual de Seguridad, Hip Unit, Avenida Libertador Bernardo O’Higgins 4848, Santiago 9190015, Chile
| | - Diego Villegas
- Clínica RedSalud Providencia, Hip Unit, Avenida Salvador 100, Santiago 7500995, Chile
| | - Carlos Tobar
- Clínica RedSalud Providencia, Hip Unit, Avenida Salvador 100, Santiago 7500995, Chile
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Facciorusso S, Spina S, Gasperini G, Picelli A, Filippetti M, Molteni F, Santamato A. Anatomical landmarks for ultrasound-guided rectus femoris diagnostic nerve block in post-stroke spasticity. Australas J Ultrasound Med 2023; 26:236-242. [PMID: 38098618 PMCID: PMC10716569 DOI: 10.1002/ajum.12354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Introduction/Purpose To determine the location of the rectus femoris (RF) motor branch nerve, as well as its coordinates with reference to anatomical and ultrasound landmarks. Methods Thirty chronic stroke patients with stiff knee gait (SKG) and RF hyperactivity were included. The motor nerve branch to the RF muscle was identified medially to the vertical line from anterior superior iliac spine and the midpoint of the superior margin of the patella (line AP) and vertically to the horizontal line from the femoral pulse and its intersection point with the line AP (line F). The point of the motor branch (M) was located with ultrasound, and nerve depth and subcutaneous tissue thickness (ST) were calculated. Results The coordinates of the motor branch to the RF were 2.82 (0.47) cm medially to the line AP and 4.61 (0.83) cm vertically to the line F. Nerve depth and subcutaneous tissue thickness were 2.71 (0.62) cm and 1.12 (0.75) cm, respectively. Conclusion The use of specific coordinates may increase clinicians' confidence when performing RF motor nerve block. This could lead to better decision-making when assessing SKG in chronic stroke patients.
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Affiliation(s)
| | - Stefania Spina
- Spasticity and Movement Disorders ‘ReSTaRt’ Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti HospitalUniversity of FoggiaFoggiaItaly
| | - Giulio Gasperini
- Villa Beretta Rehabilitation CenterValduce HospitalCosta MasnagaLeccoItaly
| | - Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Mirko Filippetti
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Franco Molteni
- Villa Beretta Rehabilitation CenterValduce HospitalCosta MasnagaLeccoItaly
| | - Andrea Santamato
- Spasticity and Movement Disorders ‘ReSTaRt’ Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti HospitalUniversity of FoggiaFoggiaItaly
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