Original in Russian is available at the link: Нижний портал. Часть 2. below is a machine translation edited by a non-native speaker.
INFERIOR PORTAL FOR HIP ARTHROSCOPY: A PILOT STUDY
PART 2. Inferior Portal Prototypes
Arkhipov S.V., Independent Researcher, Joensuu, Finland
CONTENTS
PART 1. Background and Hypothesis
[1]. Introduction
[2]. Passage through the Inferior Portal
[3]. Main Advantages of the Proposed Technique
[4]. Specific Risks of the Proposed Technique
[5]. Main Limitations of the Proposed Technique
[6]. References (Part 1)
PART 2. Inferior Portal Prototypes
[7]. Open Reduction
[8]. Puncture and Arthrography
[9]. Arthroscopy and Debridement
[10]. References (Part 2)
[7]. Open Reduction
Our idea to reduce the trauma of hip joint surgery through an inferior approach has a rich history. In the spring of 1907, Professor Karl Rudolf Ludloff (1864-1945, photo) from the University Hospital of Breslau (career) was the first to reach the acetabulum using the "anteroinferior incision". This was reported in a paper entitled "On the bloody reduction of congenital dislocation of the hip," which he presented at the 7th Congress of the German Society of Orthopaedic Surgery on April 25, 1908 (Fig. 1). According to the author, the operation had been developed over many years and tested several times on a corpse. The surgical intervention was performed in the clinic on a child with an irreducible congenital hip dislocation after approval by Professor Hermann Küttner (1870-1932). The patient was in a supine position “…with abduction at a right angle, hyperextension and external rotation.” K.R. Ludloff describes his approach as follows: “…a deep incision is made along the lateral edge of the adductor magnus muscle. Then, through the muscle gap, we approach directly the acetabular notch. After the skin incision is made, the operation is virtually bloodless. You only need to ligate a few small veins. In the depths, you will be able to see the Obturatoria and Obturatorius muscles without damaging any of them. The large vessels are located far laterally. Then, having spread the muscles widely, the capsule is opened from the side of the acetabular notch and the entire empty acetabulum with all its details is visible in front of you.” (Fig. 2). Below it is emphasized: “…after the skin incision, only a few small vessels need to be ligated; the large vessels and nerves remain lateral to the incision and are not included in the manipulation area at all.” The conclusion notes: “I think that the greatest advantage is that this incision allows a very good examination of the socket and the head.” (1908LudloffK). K.R. Ludloff addresses this topic in subsequent publications, calling the proposed approach “the anterior incision for the exposure of the acetabulum” (1911,1913LudloffK).
 |
| Fig. 1. The first page of the article Ludloff K. Zur blutigen Einrenkung der angeborenen, in the journal Zeitschrift für orthopedic surgery (from 1908LudloffK). |
In essence, the described approach
was the first to allow the surgeon to reach and see the external opening of the
acetabular canal (Acetabular Canal. Part 1). But at the beginning of the 20th
century there was no need for this. The patient's position on the operating
table with the K.R. Ludloff approach was similar to the Lorenz-2 position in
the treatment of congenital hip dislocation. It creates maximum abduction of
90°, flexion of 70° and external rotation in the hip joints with flexion in the
knee joints (1980ВолковМВ_ДедоваВД). The position of the operated
lower limb is convenient for inserting the instrument into the peripheral part
of the acetabular canal (Acetabular Canal. Part 2). Moreover, the absence of
rigid fixation of the leg makes it possible to move the LCF during the
operation. In particular, to bring its distal end closer to the external
opening of the acetabular canal (Acetabular canal. Part 3) by abduction and
rotation of the femur. The indicated and reverse maneuver is necessary for LCF
reconstruction.
 |
| Fig. 2. Internal approach to the hip joint according to K.R. Ludloff (from 1958БойчевБ_ЧокановК, we have colored and indicated the head of the femur). |
The approach described by K.R.
Ludloff was modified by M. Zalzer & H. Zuckriegl (1967), who proposed to
shift part of the pectineus muscle inward together with the long adductor
muscle. A.B. Ferguson (1973), S.L. Weinstein & I.V. Ponseti (1979), and
S.L. Weinstein (1980, 1987) introduced a more medial approach
(2004ScapinelliR_IacobellisC). According to A.B. Ferguson (1973), the patient
also lies on his back with flexion, abduction and external rotation in the hip
joint. A longitudinal incision is made above the long adductor muscle,
retreating approximately 3 cm distal to the pubic tubercle. The surgeon passes
between the gracilis and longus adductor muscles, and deeper between the brevis
and magnus adductor muscles, dividing the psoas tendon (2004KielyN_MeadowsTM;
2014ChironP_ReinaN). The danger here is injury to:
- the medial circumflex femoral
artery, which runs along the medial side of the distal part of the psoas
tendon;
- the anterior branch of the
obturator nerve, which supplies the adductor longus, adductor brevis, and
gracilis muscles of the thigh;
- the posterior branch of the
obturator nerve, which runs inside the external obturator muscle and enters the
adductor magnus muscle;
- the deep external pudendal artery,
which runs proximally in front of the pectineus muscle, near the origin of the
adductor longus muscle (for a detailed description and illustrations by T.
Jones, see orthobullets.com).
The negative side of the
approach according to A.B. Ferguson is the risk of cutting the posterior branch
of the obturator nerve. In connection with this, a variation has been developed
– a “minimally invasive
medial hip approach” 6 cm long. It penetrates deep
between the bellies of the adductor muscles and in front of their aponeuroses
(2014ChironP_ReinaN; 2015CavaignacE_ChironP).
The structure of the medial part of the upper third of the thigh has been studied in detail by anatomists (Fig. 3). In this area of the lower limb, the localization of large veins, arteries and nerve trunks is clearly defined. This excludes unintentional damage to the listed morphological elements during surgery.
 |
| Fig. 3. Muscles of the thigh, anteromedial surface; on the left – the superficial layer of the adductor muscles, artist Б.П. Шкуратов; on the right – the deep layer of the adductor muscles, artist Ю.Р. Гржешкевич (from 1963КовановВВ_ТравинАА, images combined by us). |
The approach developed by K.R.
Ludloff provides a good view of the iliopsoas tendon, the anteromedial surface
of the hip joint capsule, the pubic part of the acetabulum, the head and neck
of the femur (2004ScapinelliR_IacobellisC). The modification of A.B. Ferguson
provides a safe approach for reduction of congenital hip dislocation and a
risk-free, direct approach to the femoral head during osteosynthesis
(1985DiepstratenFM; 2021AbdelazeemA_AbdelazeemH). The minimally invasive medial
approach helps to reach the anteroinferior, medial and posteroinferior parts of
the femoral head below the fossa of the head of the femur, but puts the medial,
circumflex femoral artery and its deep branch at risk
(2021BoonpermS_ApivatthakakulT). At the same time, this approach, like other
varieties of the K.R. Ludloff technique, helps not only to reduce congenital
hip dislocation and fix the femoral head in case of fracture, but also to treat
lesions of the iliopsoas muscle, resect and fill benign tumors of the femoral
neck, perform intra-articular operations, namely: arthrolysis, resection of
osteophytes, removal of foreign bodies, suturing of the articular labrum
(2014ChironP_ReinaN).
[8]. Puncture and Arthrography
The inferomedial approach is used for hip arthrography in children with congenital hip dislocation, Legg-Perthes disease, septic arthritis, proximal focal femoral deficiency, epiphyseal dysplasia, and spondyloepiphyseal dysplasia. In a position with hip abduction and flexion, the needle is placed on the vertical fold of the perineum approximately 1-2 cm below the tendon of the adductor muscle and inserted parallel to the operating table until contact with the bone (1984StrifeJL_TowbinR). This approach, otherwise called "subadductor", is considered safe due to the minimal risk of damage to surrounding structures and ensures accurate injection of contrast directly into the joint (Fig. 4). Some authors specify that the needle is placed at an angle of 45° to the joint under the tendon and fascial sheath of the long adductor with the hip abducted and flexed. As the needle advances through the tissue, the operator typically feels two clicks as it passes through the psoas tendon sheath and joint capsule (2014NowickiPD_DuhnR).
 |
| Fig. 4. Arthrography of the hip joint, legend: a Fluoroscopic image of the position of the 18-gauge spinal needle for a hip joint aspiration via a sub-adductor approach. b Fluoroscopic image of the hip arthrogram using a mixture of radio-opaque dye and saline. c Fluoroscopic image of needle position for aspiration of medullary blood from the proximal femur. d Fluoroscopic image of needle position for aspiration of medullary blood from the ilium (from 2015SchmaleGA_BompadreV, license CC BY 4.0, no changes). |
If a purulent process in the hip joint is suspected, synovial fluid is also aspirated for diagnostic purposes using the subadductor approach (2015SchmaleGA_BompadreV). The medial approach was used for puncture treatment of septic arthritis of the hip joint in children. The affected leg is placed in flexion and abduction, and the needle is inserted 1 cm below the adductor tendon and its sheath (2016KotlarskyP_EidelmanM). Aspiration-rinsing of the hip joint using the obturatur internus approach is considered the simplest, least invasive technique in the treatment of purulent arthritis in childhood (2011JourneauP_LascombesP). The medial approach is often used to drain the hip joint (2023BarikS_SinghV).
[9]. Arthroscopy and Debridement
In 1977, Professor Richard H. Gross of the University of Oklahoma first reported hip arthroscopy in children via a medial approach. A 2.2 mm Needlescope was inserted under the long adductor muscle into the lower medial compartment of the joint. This proved useful when the hip was subluxated and the joint space was widened. Sometimes this approach was controlled by palpation of the joint, and manual traction facilitated the introduction of the arthroscope (1977GrossR). From the description, it is clear that the optics entered the central compartment of the joint between the femoral head and the acetabular rim (Fig. 5). Despite the imperfect diagnostic tool, the author was able to differentiate the femoral head, acetabular labrum, and LCF with a clearly visible vascular network on the surface.
W.K. Chung et al. (1993) reported
positive arthroscopic lavage treatment of septic arthritis of the hip joint in
nine children from the anterolateral and medial approaches, but could not
visualize the central compartment. H.A.R. Hasan and A. Al-Sabat (1995) examined
six patients aged 1-2 years with hip dislocation by arthroscopy through the
subadductor portal and successfully identified all structures of the hip joint
(2016DennisRR).
 |
| Fig. 5. Arthroscopy for congenital hip dislocation; A: Using the sub-adductor portal as a viewing portal, B: Shaving the pulvinar, C: Cutting the transverse acetabular ligament (TAL) (from 2025RashwanAS_KhedrA, licensed under CC BY 4.0, unmodified). |
M.A. Teloken et al. (2002) reported
on the removal of a bullet from the femoral head using a medial arthroscopic
approach. The patient was positioned on an orthopedic table without traction of
the limb. The operated hip was extended and abducted by approximately 30°, with
the opposite leg abducted to position the surgeon. A 3-cm skin incision was
made in the projection of the femoral head, and blunt dissection was performed
behind the long adductor muscle, in front of the gracilis muscle. The iliopsoas
tendon was identified and retracted with a finger, and the joint capsule was
punctured more medially. Then, arthroscopic revision and removal of the foreign
body were performed with an instrument inserted through the same approach. No
complications from the operation were recorded, and at the 18-month follow-up,
no mechanical symptoms or radiographic evidence of avascular necrosis were
found (2002 TelokenMA_TomlinsonDP).
It should be noted that in the literature, the arthroscopic approach in front of the hip joint is sometimes called "medial". The entry point is 2 cm closer to the median sagittal plane relative to the line drawn through the anterior superior iliac spine. In the presence of traction, only part of the central compartment (Fig. 6) and a small area of the anteromedial surface of the femoral head can be examined from this approach (2013ThoreyF_BuddeS).
 |
| Fig. 6. Congenital hip dislocation, view through the subadductor portal before reduction (from 2013EberhardtO_WirthT, licensed under CC BY 4.0, unmodified). |
In our opinion, the term "medial" is also inapplicable when describing the approach to the hip joint in the projection of the adductor muscles. The true "medial approach" is penetration into the acetabulum from the pelvic cavity. Probably, the first to puncture the bottom of the acetabulum from the side of the lesser pelvis in an experiment on a corpse were W. Weber & E. Weber (1836). In a similar way, it is theoretically possible to perform hip arthroscopy, combining it with laparoscopic technology. The earliest trepanation of the acetabular bone plate from the pelvis was performed by British anatomists J. Struthers (1858) and G.M. Humphry (1858) when studying the LCF function on a corpse (Fig. 7, 8).
 |
| Fig. 7. Medial approach to the hip joint; The LCF is shown exposed by removing the acetabular floor, the femur in flexion and external rotation, view from the pelvic cavity (from 1858StruthersJ, unchanged). |
The intrapelvic approach (Fig. 9) to the floor and roof of the acetabulum according to В.Д. Чаклин (1964) is referred to by us as a medial or, more precisely, superomedial approach. It is technically not difficult to reach the superior and medial walls of the acetabulum by proceeding subperiosteally, elevating the iliacus muscle with a raspatory, and displacing it together with the femoral nerve. In this process, the muscle and abdominal organs are shifted medially using instruments such as a Hohmann elevator, as well as by tilting the operating table downward in the opposite direction.
We have repeatedly used this
technique to harvest large bone grafts from the iliac wing. In our opinion,
incisions and punctures made below the adductor longus muscle should be
referred to as subadductor or inferior approaches. The latter term is
preferable because the incision (or puncture) passes through the adductor
muscles rather than beneath them, meaning it is not truly "subadductor."
Specifically, in the inferior approach we proposed for arthroscopy, the
adductor magnus muscle is penetrated (see Part 1).
 |
| Fig. 8. Medial approach to the hip joint after extensive removal of the acetabular floor (from 1918GrayH, unchanged). |
O. Bulut et al. (2005) combined open
reduction of congenital hip dislocation with arthroscopic examination and
intervention on intra-articular structures. After approaching the hip joint
using a minimally invasive approach, colleagues created an arthroscopic portal
anteriorly lateral to the joint capsule and a portal anteriorly medially to the
capsule. Hypertrophic LCF was detected and removed in all four patients aged
11-14 months. In order to protect the femoral head from unintentional injury by
the arthroscope, 5-10 ml of saline solution was preliminarily injected into the
joint (2005BulutO_BulutS).
 |
| Fig. 9. Intrapelvic approach to the hip
joint according to В.Д. Чаклину; legend: 1 - place of cutting of
the spina iliaca anterior superior; 2 – m. gluteus medius; 3 – m. rectus
femoris; 4 - defect after removal of the cortical plate above the glenoid
cavity; 5 – head of the femur; 6 - pubic bone; 7 – m. iliacus (from 1964ЧаклинВД, unchanged). |
O. Eberhardt et al. (2012) reduced
hip dislocations in infants with developmental dysplasia of the hip using a
medial subadductor portal for a cannulated arthroscope system (2.7 mm) and an
anterolateral portal for instruments. During surgery, the hip joint was
maintained at 90° flexion with 40°-60° abduction. The subadductor approach
began at a point 1 cm lateral and 1 cm anterior to the ischial tuberosity and
passed through the space between the adductor muscle and the hamstring tendon,
which is similar to the approach for arthrography. In this case, the femoral
artery, vein, and nerve lie anteriorly, and the obturator artery and nerve are
posterior. First, an arthrogram was performed, then a guide wire was inserted
into the joint through the same needle, and along it - the cannulated obturator
system of the arthroscope. In the next step, under fluoroscopic control, the
needle was inserted into the lateral part of the joint (peripheral
compartment). After intra-articular revision, the hypertrophied LCF and the
acetabular fat pad were resected (2012aEberhardtO_WirthT). At the 31st annual
EPOS meeting, the above-cited authors stated that the technique they reported
“…is a safe approach for the arthroscopic treatment of dislocated hips”
(2012bEberhardtO_WirthT). In a subsequent publication, the innovators
recommended a subadductor portal for the endoscope and an anterolateral portal
for surgical instruments (2013EberhardtO_WirthT). Another team of surgeons
successfully tested the insertion of the instrument through the subadductor
portal and provided arthroscopic support using the anterolateral portal. To
more effectively detect and excise the LCF, the assistant operator internally
and externally rotated the femur and abducted the leg with distraction
(2025RashwanAS_KhedrA).
Arthroscopic intervention through the subadductor and lateral portals (Fig. 10) allows for visualization and removal of obstacles to reduction before repositioning a congenital hip dislocation. These obstacles include fatty tissue in the acetabular floor, capsular constriction, a hypertrophied LCF, and the transverse acetabular ligament (2014EberhardtO_WirthT; 2015EberhardtO_FernandezFF). A number of surgeons who used the medial subadductor portal, in addition to 90° hip flexion, abducted the leg by 50°-60°, reaching all the above structures and the acetabular labrum with the instrument (2019PreschC_FernandezFF).
 |
| Fig. 10. Arthroscopic technique demonstrating the portals (A), intra-articular pulvinar (B), hypertrophic ligamentum teres (C), intraoperative fluoroscopic image during incision of the transverse acetabular ligament (D), and intraoperative radiographic control for concentric reduction (E) (from 2019DumanS_YildirimT, licensed under CC BY 4.0, no modifications). |
G.C. Polesello et al. (2014)
distinguish up to three variants of medial arthroscopic approach to the hip
joint. In the description of the researchers, the anteromedial portal is located
on the upper edge of the long adductor muscle, directed toward the medial
articular surface of the femoral head, penetrates through the belly of the
pectineus muscle and the joint capsule. On its way, the nearest neurovascular
structure is the bundle of profunda femoris, which lies 6-14 mm lateral. The
posteromedial portal begins at the posterior edge of the long adductor muscle
and is also oriented toward the medial surface of the femoral head. It passes
between the long adductor muscle and the gracilis muscle, and in some cases
pierces the lateral edge of the long adductor muscle. Here, the nearest
neurovascular structure is the obturator nerve, passing 2-13 mm dorsally. The
distal posteromedial portal is located at the posterior edge of the adductor
longus muscle, 5 cm distal to the inguinal fold. The portal first penetrates
the medial posterior part of the adductor longus muscle and then the joint
capsule. Nearby, more superficially, 1-9 mm distally passes the obturator
nerve, and distally at a distance of 6-17 mm - the bundle of profunda femoris. The
medial circumflex femoral artery also follows distally. It is noted that during
flexion and abduction of the hip, the deep femoral artery branch, passing along
the lower edge of the iliopsoas muscle, moves distally. The listed medial
portals provide direct access to the medial surface of the femoral neck
(2014PoleselloGC_QueirozMC). Practice has shown that the posteromedial approach
is the most appropriate and safe for puncture and arthroscopic treatment of hip
joint pathology (2018Edmonds_UpasaniVV).
 |
| Fig. 11. Arthroscopy of congenital hip dislocation; A: Visualization of ligamentum teres, B: Cutting ligamentum teres from its femoral attachment (from 2025RashwanAS_KhedrA, licensed under CC BY 4.0, unmodified). |
In congenital hip dislocation, there is no true central or peripheral compartment because the femoral head is displaced. When viewing the joint cavity from the subadductor portal, the femoral head is sometimes identified only through a small capsular opening behind. As a rule, the LCF (Fig. 11) can be traced throughout its entire length, which is often so hypertrophied that it fills the entire acetabulum (2016EberhardtO_WirthT). By creating two medial portals above and below the long adductor muscle, all intra-articular obstacles for reduction of congenital hip dislocation can be eliminated. Such arthroscopic debridement and reduction is recognized as a safe procedure, an affordable means for the surgical treatment of irreducible dislocation in childhood (2024ZhangY_CaoY). According to the latest systematic review, in arthroscopically assisted reduction of congenital hip dislocation, most authors operated through the anterolateral and subadductor portal (2025ElzeinyA_ApratoA). Clinical and radiographic results in arthroscopic surgery through the subadductor and anterolateral portal are similar to those in medial open reduction (2019DumanS_YildirimT).
The
subadductor portal has been used for a long time with positive effect in
arthroscopic treatment of septic arthritis of the hip joint in children
(2016SanperaI_Sanpera-IglesiasJ). As a result of a retrospective review of
several series of observations, it was found that the subadductor approach in
case of purulent coxitis facilitates visualization of the medial region of the
joint, and has demonstrated its reliability (2020DumanS_SofuH).
Our brief literature review shows that the arsenal of traditional surgery includes a method for visualizing the external opening of the acetabular canal (Acetabular canal. Part 3). Using the approach developed by Karl Rudolf Ludloff, we can safely and, most importantly, minimally invasively operate in the area of the proximal LCF attachment, under the control of the eye: install intraosseous anchors, implants and introduce an optical system into the central compartment of the joint. Fluoroscopy and arthrography allow the endoscope to be purposefully inserted into the acetabular canal through a puncture. It seems that the lower portal we have proposed will expand the capabilities of orthopedists both in terms of arthroscopic diagnostics and reconstruction of elements of the central compartment of the hip joint. It is certain that extensive experimental and clinical studies are needed to implement the lower approach.
[10]. References
Abdelazeem A, Fahmy M, Abdelazeem H. Modified Ludloff’s medial approach for management of Pipkin’s type I femoral head fracture. International orthopaedics. 2021;45:1591-8. link.springer.com
Barik S, Raj V, Prasad SG, Garg V, Singh V. Comparison of Various Joint Decompression Techniques in Septic Arthritis of the Hip in Children: A Systematic Review and Meta-Analysis. Hip & Pelvis. 2023;35(2)73-87. pmc.ncbi.nlm.nih.gov
Boonperm S, Tangchitphisut P, Buranaphatthana T, Apivatthakakul V, Apivatthakakul T. Minimally invasive medial hip approach for femoral head fixation: How much can we see and what is the anatomical at risk? A cadaveric injection study. Injury. 2021;52(7)1679-87. injuryjournal.com
Bulut O, Öztürk H, Tezeren G, Bulut S. Arthroscopic-assisted surgical treatment for developmental dislocation of the hip. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2005;21(5)574-9. arthroscopyjournal.org , academia.edu
Cavaignac E, Laumond G, Régis P, Murgier J, Reina N, Chiron P. Fixation of a fractured femoral head through a medial hip approach: an original approach to the femoral head. Hip International. 2015;25(5)488-491. journals.sagepub.com
Chiron P, Murgier J, Cavaignac E, Pailhé R, Reina N. Minimally invasive medial hip approach. Orthopaedics & Traumatology: Surgery & Research. 2014;100(6)687-9. sciencedirect.com
Chung WK, Slater GL, Bates EH. Treatment of septic arthritis of the hip by arthroscopic lavage. Journal of Pediatric Orthopaedics. 1993;13(4)444-6. journals.lww.com
Dennis RR. The use of hip arthroscopy in the management of the pediatric hip. Journal of Hip Preservation Surgery. 2016;3(2)97-107. academic.oup.com
Diepstraten FM. Open reduction of congenital hip dislocation Acta Orthop Scand 1985;56:32-35. actaorthop.org
Duman S, Camurcu Y, Sofu H, Ucpunar H, Akbulut D, Yildirim T. Arthroscopic versus open, medial approach, surgical reduction for developmental dysplasia of the hip in patients under 18 months of age. Acta Orthopaedica. 2019;90(3)292-6. actaorthop.org
Duman S, Camurcu Y, Ucpunar H, Çöbden A, Karahan N, Sofu H. Arthroscopic treatment of acute septic arthritis of the hip joint in pediatric patients aged 10 years or younger. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020;36(2)464-72. academia.edu , arthroscopyjournal.org
Eberhardt O, Fernandez FF, Wirth T (a). Arthroscopic reduction of the dislocated hip in infants. J Bone Joint Surg (Br). 2012;94-B(6)842-7. boneandjoint.org.uk
Eberhardt O, Fernandez FF, Wirth T. Arthroskopische Hüftreposition zur Behandlung der Hüftluxation im Säuglings- und Kleinkindalter. OUP. 2016;5(7-8)420-5. online-oup.de
Eberhardt O, Fernandez, FF, Wirth T (b). Arthroscopic Anatomy of Dislocated Hips in Young Children and a Technique for Arthroscopic Reduction. EPOS 31st Annual Meeting. J Child Orthop. 2012;6(Suppl 1)S1-26. pmc.ncbi.nlm.nih.gov
Eberhardt O, Wirth T, Fernandez FF. Arthroscopic anatomy of the dislocated hip in infants and obstacles preventing reduction. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2015;31(6)1052-9. arthroscopyjournal.org
Eberhardt O, Wirth T, Fernandez FF. Arthroscopic reduction and acetabuloplasty for the treatment of dislocated hips in children of walking age: A preliminary report. Arch Orthop Trauma Surg. 2014;134:1587-94. link.springer.com
Eberhardt O, Wirth T, Fernandez FF. Hip arthroscopy in children under the age of ten. Open Journal of Orthopedics. 2013;3(1)41-8. scirp.org
Edmonds EW, Lin C, Farnsworth CL, Bomar JD, Upasani VV. A medial portal for hip arthroscopy in children with septic arthritis: A safety study. J Pediatr Orthop. 2018;38(10)527-31. journals.lww.com
Elzeiny A, Via RG, Cipolla A, Audisio A, Erdmenger S, Giachino M, Mass A, Aprato, A. Arthroscopic-Assisted Reduction for Developmental Dysplasia of the Hip in Children: A Systematic Review. Journal of Orthopaedics. 2025;67, 34-40. researchgate.net
Ferguson JrAB. Primary open reduction of congenital dislocation of the hip using a median adductor approach. J Bone Joint Surg. 1973;55(4)671-89. journals.lww.com
Gross R. Arthroscopy in hip disorders in children. Orthop Rev 1977;6(9)43-9. researchgate.net
Hasan HAR, Al-Sabat A. Arthroscopy of the hip in congenital dislocation. J Bone Joint Surg (Br). 1995;77-B(Suppl I)1-26. scholar.google.com
Humphry GM. A Treatise on the Human Skeleton including the Joints. Cambridge: MacMillan and Company, 1858.
Journeau P, Wein F, Popkov D, Philippe R, Haumont T, Lascombes P. Hip septic arthritis in children: Assessment of treatment using needle aspiration/irrigation. Orthopaedics and Traumatology: Surgery and Research. 2011;97(3)308-13. sciencedirect.com
Kiely N, Younis U, Day JB, Meadows TM. The Ferguson medial approach for open reduction of developmental dysplasia of the hip. A clinical and radiological review of 49 hips. J Bone Joint Surg Br. 2004;86:430-3. boneandjoint.org.uk , researchgate.net
Kotlarsky P, Shavit I, Kassis I, Eidelman M. Treatment of septic hip in a pediatric ED: A retrospective case series analysis. Am J Em Med. 2016;34(3)602-5. sciencedirect.com
Ludloff K. Die angeborene Hüftluxation mit besonderer Berücksichtigung der Luxationspfanne. In: Payr E, Küttner H (Eds). Ergebnisse der Chirurgie und Orthopädie. Berlin, Heidelberg: Springer, 1911:529-70. link.springer.com
Ludloff K. The open reduction of the congenital hip dislocation by an anterior incision. J Bone Joint Surg. 1913;2(3)438-54. journals.lww.com
Ludloff K. Zur blutigen Einrenkung der angeborenen Huftluxation. Zeitschrift für orthopädische Chirurgie.1908;22:272-6. archive.org
Nowicki PD, Duhn R. The use of arthrography in pediatric orthopaedic surgery. J Am Acad Orthop Surg. 2014;22(8)472-81. journals.lww.com
Polesello GC, Omine Fernandes AE, de Oliveira LP, Linhares JPT, Queiroz MC. Medial hip arthroscopy portals: an anatomic study. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2014;30(1)55-9. arthroscopyjournal.org , oquadril.com.br
Presch C, Eberhardt O, Wirth T, Fernandez FF. Comparison of arthroscopic and open reduction of conservatively irreducible dislocated hips of children. Journal of Children's Orthopaedics. 2019;13(4)377-84. journals.sagepub.com
Rashwan AS, El-Desouky M, Elbarbary H, Madbouly MAE, Khedr A. Arthroscopic-assisted reduction for Developmental Hip Dysplasia (DDH) through the sub-adductor and anterolateral portals; A 24-month follow-up prospective descriptive study. BMC Musculoskeletal Disorders. 2025;26(1)27. bmcmusculoskeletdisord.biomedcentral.com
Sanpera I, Raluy-Collado D, Sanpera-Iglesias J. Arthroscopy for hip septic arthritis in children. Orthop Traumatol Surg Res. 2016;102(1)87-89. sciencedirect.com
Scapinelli R, Iacobellis C. Ludloff’s anteromedial approach in disorders other than congenital hip dislocation. Journal of Orthopaedics and Traumatology. 2004;5:160-4. jorthoptraumatol.springeropen.com
Schmale GA, Bompadre V. Aspirations of the ilium and proximal femur increase the likelihood of culturing an organism in patients with presumed septic arthritis of the hip. Journal of Children's Orthopaedics. 2015;9(4)313-8. journals.sagepub.com
Strife JL, Towbin R, Crawford A. Hip arthrography in infants and children: the inferomedial approach. Radiology. 1984:152(2)536. pubmed.ncbi.nlm.nih.gov
Struthers J. Demonstration of the use of the round ligament of the hip joint. Edinburgh Med J. 1858;4(5)434-42.
Teloken MA, Schmietd I, Tomlinson DP. Hip arthroscopy: a unique inferomedial approach to bullet removal. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2002;18(4)1-3. arthroscopyjournal.org
Thorey F, Ezechieli M, Ettinger M, Albrecht UV, Budde S. Access to the hip joint from standard arthroscopic portals: a cadaveric study. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2013;29(8)1297-307. arthroscopyjournal.org
Weber W, Weber E. Mechanik der menschlichen Gehwerkzeuge: eine anatomisch-physiologische Untersuchung. Gottingen: Dietrichsche Buchhandlung, 1836.
Weinstein SL, Ponseti IV. Congenital dislocation of the hip: open reduction through a medial approach. J Bone Joint Surg Am. 1979;61:119-24.
Weinstein SL. Anteromedial approach to reduction for congenital hip dysplasia. Strategies Orthop Surg. 1987;6:2.
Weinstein SL. The medial approach in congenital dislocation of the hip. Isr J Med Sci. 1980;16:272-5.
Zalzer M, Zuckriegl H. Die Operationstechnik der offenen Hüftgelenks-reposition nach Ludloff. Zeitschr Orthop. 1967;103:409-17.
Zhang Y, Weng L, Zhang G, Zhou H, Liu X, Cao Y. Arthroscopic debridement and reduction is an effective procedure for failed closed reduction in young children with developmental dislocation of the hip. Int Orthop. 2024;48(6)1401-9. link.springer.com
Бойчев Б, Конфорти Б, Чоканов К. Оперативная ортопедия и травматология. София: Медицина и спорт, 1958.
Волков МВ, Дедова ВД. Детская ортопедия. Москва: Медицина, 1980.
Кованов ВВ, Травин АА. Хирургическая анатомия нижних конечностей. Москва: Государственное издательство медицинской литературы, 1963.
Address correspondence to Arkhipov Sergey, M.D., E-mail: archipovsv@gmail.com
Cite
Keywords
ligamentum capitis femoris, ligamentum teres, ligament of head of femur, acetabular canal, inferior portal, arthroscopy
Additions
25.02.2025. Replacement of drawing No. 8.
History of the article:
First publications in the online magazine:
Arkhipov SV. Inferior Portal for Hip Arthroscopy: A Pilot Experimental Study. Pt. 1. Background and Hypothesis. About Round Ligament of Femur. January 18, 2025. https://roundligament.blogspot.com/2025/01/lower-portal.html
Arkhipov SV. Inferior Portal for Hip Arthroscopy: A Pilot Experimental Study. Pt. 2. Inferior Portal Prototypes. About Round Ligament of Femur. February 8, 2025. https://roundligament.blogspot.com/2025/02/inferior-portal-part-2.html
Combined PDF version:
Arkhipov SV. Inferior Portal for Hip Arthroscopy: A Pilot Study. About Round Ligament of Femur. February 26, 2025. https://roundligament.blogspot.com/2025/02/inferior-portal-for-hip-arthroscopy.html; DOI: 10.13140/RG.2.2.27152.93449, www.researchgate.net, academia.edu, Google Drive
NB! Fair practice / use: copied for the purposes of criticism, review, comment, research and private study in accordance with Copyright Laws of the US: 17 U.S.C. §107; Copyright Law of the EU: Dir. 2001/29/EC, art.5/3a,d; Copyright Law of the RU: ГК РФ ст.1274/1.1-2,7
Comments
Post a Comment