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Surgically Relevant Bony and Soft Tissue Anatomy of the Proximal Femur.

Philippon MJ, Michalski MP, Campbell KJ, Goldsmith MT, Devitt BM, Wijdicks CA, LaPrade RF - Orthop J Sports Med (2014)

Bottom Line: The insertions of the piriformis, conjoint tendon of the hip (superior gemellus, obturator internus, and inferior gemellus), and obturator externus were identified relative to the superomedial border of the greater trochanter.The vastus tubercle, superomedial border of the greater trochanter, and the femoral head-neck junction were reliable osseous landmarks for the identification of the tendinous and hip capsular insertions on the proximal femur.The qualitative and quantitative clinically relevant anatomic data presented here will aid in the diagnosis of proximal femur pathology and will provide a template for anatomic repair or reconstruction.

View Article: PubMed Central - PubMed

Affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA. ; The Steadman Clinic, Vail, Colorado, USA.

ABSTRACT

Background: Hip endoscopy facilitates the treatment of extra-articular disorders of the proximal femur. Unfortunately, current knowledge of proximal femur anatomy is limited to qualitative descriptions and lacks surgically relevant landmarks.

Purpose: To provide a quantitative and qualitative analysis of proximal femur anatomy in reference to surgically relevant bony landmarks.

Study design: Descriptive laboratory study.

Methods: Fourteen cadaveric hemipelvises were dissected. A coordinate measuring device measured dimensions and interrelationships of the gluteal muscles, hip external rotators, pectineus, iliopsoas, and joint capsule in reference to osseous landmarks.

Results: The vastus tubercle, superomedial border of the greater trochanter, and femoral head-neck junction were distinct and reliable osseous landmarks. The anteroinferior tip of the vastus tubercle was 17.1 mm (95% CI: 14.5, 19.8 mm) anteroinferior to the center of the gluteus medius lateral insertional footprint and was 22.9 mm (95% CI: 20.1, 25.7 mm) inferolateral to the center of the gluteus minimus insertional footprint. The insertions of the piriformis, conjoint tendon of the hip (superior gemellus, obturator internus, and inferior gemellus), and obturator externus were identified relative to the superomedial border of the greater trochanter. The relationship of the aforementioned footprints were 49% (95% CI: 43%, 54%), 42% (95% CI: 33%, 50%), and 64% (95% CI: 59%, 69%) from the anterior (0%) to posterior (100%) margins of the superomedial border of the greater trochanter, respectively. The hip joint capsule attached distally on the proximal femur 18.2 mm (95% CI: 14.2, 22.2 mm) from the head-neck junction medially on average.

Conclusion: The vastus tubercle, superomedial border of the greater trochanter, and the femoral head-neck junction were reliable osseous landmarks for the identification of the tendinous and hip capsular insertions on the proximal femur. Knowledge of the interrelationships between these structures is essential for endoscopic navigation and anatomic surgical repair and reconstruction.

Clinical relevance: The qualitative and quantitative clinically relevant anatomic data presented here will aid in the diagnosis of proximal femur pathology and will provide a template for anatomic repair or reconstruction.

No MeSH data available.


Related in: MedlinePlus

Photograph of a right hip demonstrating footprints of the muscular origins and insertions after fine dissection from the underlying osseous attachment while simultaneously outlining the locations using a fine-tipped calligraphy pen and India ink. This photograph demonstrates the India ink outlines of the gluteus medius and minimus insertions as well as the vastus lateralis insertion.
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fig2-2325967114535188: Photograph of a right hip demonstrating footprints of the muscular origins and insertions after fine dissection from the underlying osseous attachment while simultaneously outlining the locations using a fine-tipped calligraphy pen and India ink. This photograph demonstrates the India ink outlines of the gluteus medius and minimus insertions as well as the vastus lateralis insertion.

Mentions: Fourteen fresh-frozen, nonpaired, human cadaveric proximal femurs (mean age, 58 years; range, 47-65 years; mean body mass index, 24.6 kg/m2; range, 19.2-32.1 kg/m2; 12 male and 2 female, 8 right and 6 left) without evidence of prior injury, abnormality, or surgery were used for this study. Dissection commenced with removal of the skin, tensor fascia lata, and the sartorius muscle. All muscles attached to the proximal femur were isolated and excised through their midsubstance, which left the tendinous or muscular insertions intact. A qualitative assessment of the individual muscles was made in a systematic fashion from anterior to posterior. The short external rotator muscles, the superior gemellus, obturator internus, and inferior gemellus, had a common conjoint tendon. The additional tendinous structures not relevant to this study, including the adductor brevis, adductor longus, adductor magnus, vastus medialis, and vastus intermedius, were removed (Figure 1). A circumferential incision was made through the hip capsule at its midsubstance for disarticulation. The individual tendons of the proximal femoral musculature were carefully separated from each other and the capsule. Once isolated, each tendon was sharply dissected from its insertion while outlining the footprints with India ink using a fine-tipped calligraphy pen (Figure 2).


Surgically Relevant Bony and Soft Tissue Anatomy of the Proximal Femur.

Philippon MJ, Michalski MP, Campbell KJ, Goldsmith MT, Devitt BM, Wijdicks CA, LaPrade RF - Orthop J Sports Med (2014)

Photograph of a right hip demonstrating footprints of the muscular origins and insertions after fine dissection from the underlying osseous attachment while simultaneously outlining the locations using a fine-tipped calligraphy pen and India ink. This photograph demonstrates the India ink outlines of the gluteus medius and minimus insertions as well as the vastus lateralis insertion.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4555602&req=5

fig2-2325967114535188: Photograph of a right hip demonstrating footprints of the muscular origins and insertions after fine dissection from the underlying osseous attachment while simultaneously outlining the locations using a fine-tipped calligraphy pen and India ink. This photograph demonstrates the India ink outlines of the gluteus medius and minimus insertions as well as the vastus lateralis insertion.
Mentions: Fourteen fresh-frozen, nonpaired, human cadaveric proximal femurs (mean age, 58 years; range, 47-65 years; mean body mass index, 24.6 kg/m2; range, 19.2-32.1 kg/m2; 12 male and 2 female, 8 right and 6 left) without evidence of prior injury, abnormality, or surgery were used for this study. Dissection commenced with removal of the skin, tensor fascia lata, and the sartorius muscle. All muscles attached to the proximal femur were isolated and excised through their midsubstance, which left the tendinous or muscular insertions intact. A qualitative assessment of the individual muscles was made in a systematic fashion from anterior to posterior. The short external rotator muscles, the superior gemellus, obturator internus, and inferior gemellus, had a common conjoint tendon. The additional tendinous structures not relevant to this study, including the adductor brevis, adductor longus, adductor magnus, vastus medialis, and vastus intermedius, were removed (Figure 1). A circumferential incision was made through the hip capsule at its midsubstance for disarticulation. The individual tendons of the proximal femoral musculature were carefully separated from each other and the capsule. Once isolated, each tendon was sharply dissected from its insertion while outlining the footprints with India ink using a fine-tipped calligraphy pen (Figure 2).

Bottom Line: The insertions of the piriformis, conjoint tendon of the hip (superior gemellus, obturator internus, and inferior gemellus), and obturator externus were identified relative to the superomedial border of the greater trochanter.The vastus tubercle, superomedial border of the greater trochanter, and the femoral head-neck junction were reliable osseous landmarks for the identification of the tendinous and hip capsular insertions on the proximal femur.The qualitative and quantitative clinically relevant anatomic data presented here will aid in the diagnosis of proximal femur pathology and will provide a template for anatomic repair or reconstruction.

View Article: PubMed Central - PubMed

Affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA. ; The Steadman Clinic, Vail, Colorado, USA.

ABSTRACT

Background: Hip endoscopy facilitates the treatment of extra-articular disorders of the proximal femur. Unfortunately, current knowledge of proximal femur anatomy is limited to qualitative descriptions and lacks surgically relevant landmarks.

Purpose: To provide a quantitative and qualitative analysis of proximal femur anatomy in reference to surgically relevant bony landmarks.

Study design: Descriptive laboratory study.

Methods: Fourteen cadaveric hemipelvises were dissected. A coordinate measuring device measured dimensions and interrelationships of the gluteal muscles, hip external rotators, pectineus, iliopsoas, and joint capsule in reference to osseous landmarks.

Results: The vastus tubercle, superomedial border of the greater trochanter, and femoral head-neck junction were distinct and reliable osseous landmarks. The anteroinferior tip of the vastus tubercle was 17.1 mm (95% CI: 14.5, 19.8 mm) anteroinferior to the center of the gluteus medius lateral insertional footprint and was 22.9 mm (95% CI: 20.1, 25.7 mm) inferolateral to the center of the gluteus minimus insertional footprint. The insertions of the piriformis, conjoint tendon of the hip (superior gemellus, obturator internus, and inferior gemellus), and obturator externus were identified relative to the superomedial border of the greater trochanter. The relationship of the aforementioned footprints were 49% (95% CI: 43%, 54%), 42% (95% CI: 33%, 50%), and 64% (95% CI: 59%, 69%) from the anterior (0%) to posterior (100%) margins of the superomedial border of the greater trochanter, respectively. The hip joint capsule attached distally on the proximal femur 18.2 mm (95% CI: 14.2, 22.2 mm) from the head-neck junction medially on average.

Conclusion: The vastus tubercle, superomedial border of the greater trochanter, and the femoral head-neck junction were reliable osseous landmarks for the identification of the tendinous and hip capsular insertions on the proximal femur. Knowledge of the interrelationships between these structures is essential for endoscopic navigation and anatomic surgical repair and reconstruction.

Clinical relevance: The qualitative and quantitative clinically relevant anatomic data presented here will aid in the diagnosis of proximal femur pathology and will provide a template for anatomic repair or reconstruction.

No MeSH data available.


Related in: MedlinePlus