Prevention of motor ascending branch of the rectus femoris injuries in Bernese periacetabular osteotomy: a cadaveric study

Author:

Lara Joaquín1,Garín Alan23ORCID,Abara Selim4,del Río Javier15,Besomi Javier67,Herrera Cristhián67,Cancino Jaime5,Villegas Diego8,Tobar Carlos8

Affiliation:

1. Clínica MEDS, Hip Unit, Avenida José Alcalde Délano 10581 , Santiago 7691236, Chile

2. Intituto Traumatológico, Hip Unit, San Martín 771 , Santiago 8340220, Chile

3. Clínica RedSalud Santiago, Hip Unit, Avenida Libertador Bernardo O’Higgins 4850 , Santiago 9190015, Chile

4. Hospital DIPRECA, Hip Unit, Avenida Vital Apoquindo 1200 , Santiago 7601003, Chile

5. Hospital Clínico Mutual de Seguridad, Hip Unit, Avenida Libertador Bernardo O’Higgins 4848 , Santiago 9190015, Chile

6. Clínica Alemana de Santiago, Hip Unit, Avenida Vitacura 5951 , Santiago 7650568, Chile

7. Hospital Clínico San Borja Arriarán, Hip Unit, Avenida Santa Rosa 1234 , Santiago 8360160, Chile

8. Clínica RedSalud Providencia, Hip Unit, Avenida Salvador 100 , Santiago 7500995, Chile

Abstract

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.

Publisher

Oxford University Press (OUP)

Subject

General Medicine

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