Prevention Of motor Ascending Branch Of the Rectus Femoris Injuries In Bernese Periacetabular Osteotomy: a Cadaveric Study

Overview

Journal J Hip Preserv Surg

Publisher Oxford University Press

Date 2024 Apr 12

PMID 38606330

Authors

Joaquin Lara

Alan Garin

Selim Abara

Javier Del Rio

Javier Besomi

Cristhian Herrera

Jaime Cancino

Diego Villegas

Carlos Tobar

Affiliations

Soon will be listed here.

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.

References

Kalhor M, Gharehdaghi J, Schoeniger R, Ganz R . Reducing the risk of nerve injury during Bernese periacetabular osteotomy: a cadaveric study. Bone Joint J. 2015; 97-B(5):636-41. DOI: 10.1302/0301-620X.97B5.35084. View

Kalhor M, Gharehdaghi J, Leunig M, Ahmadloo J, Collado Gastalver D, Ganz R . Surgical Anatomy of the Rectus-Sparing Approach for Periacetabular Osteotomy: A Cadaveric Study. JBJS Essent Surg Tech. 2021; 11(2). PMC: 8280039. DOI: 10.2106/JBJS.ST.20.00030. View

Ganz R, Klaue K, Vinh T, Mast J . A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res. 1988; (232):26-36. View

Lara J, Tobar C, Besomi J . Bernese periacetabular osteotomy for hip dysplasia. A modification to original technique and South American perspective. Curr Rev Musculoskelet Med. 2014; 7(4):337-41. PMC: 4596219. DOI: 10.1007/s12178-014-9241-z. View

Sierra R, Beaule P, Zaltz I, Millis M, Clohisy J, Trousdale R . Prevention of nerve injury after periacetabular osteotomy. Clin Orthop Relat Res. 2012; 470(8):2209-19. PMC: 3392380. DOI: 10.1007/s11999-012-2409-1. View

Tan J, Tan S, Rajoo M, Lim A, Hui J . Hip survivorship following the Bernese periacetabular osteotomy for the treatment of acetabular dysplasia: A systematic review and meta-analysis. Orthop Traumatol Surg Res. 2022; 108(4):103283. DOI: 10.1016/j.otsr.2022.103283. View

Podeszwa D, Tulchin-Francis K, De La Rocha A, Collins D, Sucato D . Rectus-sparing approach to the periacetabular osteotomy in adolescents preserves hip flexion strength. J Child Orthop. 2020; 14(3):208-212. PMC: 7302415. DOI: 10.1302/1863-2548.14.190168. View

Khan O, Malviya A, Subramanian P, Agolley D, Witt J . Minimally invasive periacetabular osteotomy using a modified Smith-Petersen approach: technique and early outcomes. Bone Joint J. 2017; 99-B(1):22-28. DOI: 10.1302/0301-620X.99B1.BJJ-2016-0439.R1. View

Lerch T, Steppacher S, Liechti E, Tannast M, Siebenrock K . One-third of Hips After Periacetabular Osteotomy Survive 30 Years With Good Clinical Results, No Progression of Arthritis, or Conversion to THA. Clin Orthop Relat Res. 2016; 475(4):1154-1168. PMC: 5339143. DOI: 10.1007/s11999-016-5169-5. View

10.

Peters C, Erickson J, Anderson M, Anderson L . Preservation of the rectus femoris origin during periacetabular osteotomy does not compromise acetabular reorientation. Clin Orthop Relat Res. 2014; 473(2):608-14. PMC: 4294922. DOI: 10.1007/s11999-014-3837-x. View

11.

Yang J, Zhang Z, Cheng H, Xiao K, Luo D, Zhang H . Sciatic and femoral nerve injury among patients who received Bernese peri-acetabular osteotomy. Int Orthop. 2018; 43(3):573-577. DOI: 10.1007/s00264-018-4035-3. View

12.

Samuel L, Munim M, Acuna A, Sultan A, Kamath A . Modified iliac spine wafer osteotomy for exposure during Bernese periacetabular osteotomy. J Hip Preserv Surg. 2020; 6(4):421-425. PMC: 6990385. DOI: 10.1093/jhps/hnz061. View

13.

Plante D, Janelle N, Angers-Goulet M, Corbeil P, Takech M, Belzile E . Anatomical variants of the rectus femoris motor innervation. J Hip Preserv Surg. 2019; 6(2):170-176. PMC: 6662958. DOI: 10.1093/jhps/hnz026. View

14.

Novais E, Kim Y, Carry P, Millis M . The Bernese periacetabular osteotomy: is transection of the rectus femoris tendon essential?. Clin Orthop Relat Res. 2014; 472(10):3142-9. PMC: 4160480. DOI: 10.1007/s11999-014-3720-9. View

15.

Maranho D, Williams K, Millis M, Kim Y, Novais E . Mid-Term Results of Periacetabular Osteotomy for the Treatment of Hip Dysplasia Associated with Down Syndrome: Minimum Follow-up of Five Years. J Bone Joint Surg Am. 2018; 100(5):428-434. DOI: 10.2106/JBJS.17.00957. View

16.

Lara J, Villegas D, Besomi J, Tobar C . Oblique Inguinal Incision in Bernese Periacetabular Osteotomy: Surgical Technique. J Am Acad Orthop Surg Glob Res Rev. 2018; 1(9):e061. PMC: 6132310. DOI: 10.5435/JAAOSGlobal-D-17-00061. View