Vascular preservation during arthroscopic osteoplasty of the femoral head-neck junction: a cadaveric investigation.

Abstract

The goal of this study was to evaluate the risk of vascular injury with arthroscopic osteoplasty of the femoral head-neck junction in a cadaveric model. Eight fresh-frozen cadaveric pelvi were used for arthroscopic osteoplasty of a predetermined 150 degrees arc of resection along the anterior femoral head-neck junction. Postoperatively, injection studies of the deep femoral arteries were performed on all specimens to identify local extravasation of neoprene latex before polymerization as a reproducible indicator of vascular injury. Control specimens included 1 specimen without an osteoplasty and 1 specimen after an "aggressive" open osteoplasty with intention to violate the superior retinacular vessels. The first control specimen showed complete filling of the superior retinacula branches, whereas the second control specimen had evidence of intracapsular latex extravasation. In 7 of 8 experimental specimens, there was near-to-complete filling of the superior and inferior retinacula branches with no signs of latex extravasation. In 1 specimen, no superior retinacular branches were identified; however, no extravasation of the latex material was noted. No injury to the main extracapsular branches of the medial or lateral femoral circumflex vessels was noted. We noted on average 3 superior retinacular vessels penetrating the posterior-superior head-neck junction. There was no evidence of vascular injury to the main blood supply of the femoral head in any of the 8 experimental specimens as noted by latex extravasation. These findings show that arthroscopic osteoplasty can be performed without disrupting the vascular supply to the femoral head. This article has important information on the relation of vascular structures and the resection limit with arthroscopic osteoplasty of the femoral head-neck junction.