The safe zones for endoscopic proximal hamstring repair: a cadaveric assessment of standard portal placement and their relationship to major neurovascular structures

2021 ◽  
pp. 112070002110341
Author(s):  
Charles A Su ◽  
Mark W LaBelle ◽  
Jason G Ina ◽  
Lakshmanan Sivasundaram ◽  
Shane Nho ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Secondary Outcome ◽  
Horizontal Orientation ◽  
Risk Of Injury ◽  
Direct Injury ◽  
Anatomical Relationship ◽  
Relationship Of ◽  
Safe Zones ◽  
Proximal Hamstring ◽  
Neurovascular Structures

Purpose: To define the anatomical relationship of the major neurovascular structures to the standard endoscopic portals used in endoscopic hamstring repair. A secondary outcome was to determine the safest angle of insertion from each standard portal. Methods: Endoscopic portals were established in the 3 standard locations (lateral, medial, and inferior) and Steinmann pins inserted at various angles. Each hip was dissected and the distance between the pins and the pertinent anatomy measured. Results: The lateral portal placed the sciatic and posterior femoral cutaneous (PFC) nerves at greatest risk: direct injury to the sciatic nerve was seen in 11/30 (37%) of the lateral portals sited. A lateral portal with an approach at 60° was the most dangerous orientation with a mean distance of 0.36 ± 0.49 mm and 4.30 ± 2.69 mm from the sciatic and PFC nerves, respectively ( p < 0.001). The 60° medial portal was the safest of all portals measured, at a mean distance of 67.37 ± 11.06mm (range, 47–78 mm) from the sciatic nerve and 58.90 ± 10.57 mm (range 40–70 mm) from the PFC nerve. Conclusions: While currently described techniques recommend establishing the standard lateral portal first, this study shows that it carries the highest risk of injury if used blind. We recommend that the standard medial endoscopic portal is established first to identify the neurovascular structures and minimise iatrogenic neurovascular injury. The inferior and lateral portals can then be established created under direct vision. The lateral portal should be inserted in a more horizontal orientation to decrease the risk of nerve injury.

Imaging Characteristics Predict Operative Difficulty Mobilizing the Sciatic Nerve for Proximal Hamstring Repair

Neurosurgery ◽  
2017 ◽  
Vol 83 (5) ◽  
pp. 931-939 ◽  
Author(s):  
Thomas J Wilson ◽  
B Matthew Howe ◽  
Robert J Spinner ◽  
Aaron J Krych
Keyword(s):  
Sciatic Nerve ◽  
Decision Tree ◽  
Predictive Values ◽  
Imaging Characteristics ◽  
Operative Difficulty ◽  
Preoperative Magnetic Resonance ◽  
Relationship Of ◽  
Proximal Hamstring ◽  
Tendon Avulsion ◽  
Tendon Retraction

Abstract BACKGROUND Repair of proximal hamstring avulsions requires mobilization of the sciatic nerve away from the tendon stump, which can be achieved with varying difficulty depending on the degree of scar formation and adherence. Predicting when a scarred, adherent, difficult-to-mobilize nerve will be encountered has been difficult. OBJECTIVE To identify clinical and/or radiological factors predictive of a difficult intraoperative dissection of the sciatic nerve during proximal hamstring repair. METHODS We retrospectively reviewed the medical records and preoperative magnetic resonance imaging of consecutive patients undergoing proximal hamstring repair. We compared the groups with and without a difficult sciatic nerve dissection. RESULTS The total cohort consisted of 67 patients. Factors found to increase the likelihood of a difficult sciatic nerve dissection included complete conjoint tendon avulsion, higher maximal amount of tendon retraction, higher degree of imaging abnormality in the sciatic nerve, and higher degree of circumferential relationship of hematoma to the sciatic nerve. At a threshold of 23 for the Sciatic Nerve Dissection Score, the positive and negative predictive values were 53% and 88%, respectively. For the decision tree, the positive and negative predictive values were 75% and 87%, respectively. CONCLUSION We have identified imaging factors associated with a scarred, adherent sciatic nerve that predict a difficult dissection during proximal hamstring repair. We have developed 2 novel methods—the Sciatic Nerve Dissection Score and a decision tree—that can be applied to predict the probability of a difficult sciatic nerve dissection at the time of surgical repair.

The X-pointer: A forgotten anatomical relationship of spinal accessory nerve and great auricular nerve

2021 ◽  
Vol 37 ◽  
pp. 101522
Author(s):  
Vishal Rao ◽  
Anand Subash ◽  
Piyush Sinha ◽  
Sataksi Chatterjee ◽  
Ravi C. Nayar
Keyword(s):  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Spinal Accessory ◽  
Great Auricular Nerve ◽  
Anatomical Relationship ◽  
Relationship Of

scholarly journals How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury

2016 ◽  
Vol 50 (17) ◽  
pp. 1030-1041 ◽  
Author(s):  
Torbjørn Soligard ◽  
Martin Schwellnus ◽  
Juan-Manuel Alonso ◽  
Roald Bahr ◽  
Ben Clarsen ◽  
...  
Keyword(s):  
Consensus Statement ◽  
Scientific Evidence ◽  
Research Priorities ◽  
Well Being ◽  
International Olympic Committee ◽  
Load Management ◽  
Risk Of Injury ◽  
Practical Guidelines ◽  
Relationship Of ◽  
The Relationship

Athletes participating in elite sports are exposed to high training loads and increasingly saturated competition calendars. Emerging evidence indicates that poor load management is a major risk factor for injury. The International Olympic Committee convened an expert group to review the scientific evidence for the relationship of load (defined broadly to include rapid changes in training and competition load, competition calendar congestion, psychological load and travel) and health outcomes in sport. We summarise the results linking load to risk of injury in athletes, and provide athletes, coaches and support staff with practical guidelines to manage load in sport. This consensus statement includes guidelines for (1) prescription of training and competition load, as well as for (2) monitoring of training, competition and psychological load, athlete well-being and injury. In the process, we identified research priorities.

scholarly journals Relationship of Sternal Foramina to Vital Structures of the Chest: A Computed Tomographic Study

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
J. Gossner
Keyword(s):  
Image Guidance ◽  
Subcutaneous Fat ◽  
Computed Tomographic ◽  
Adjacent Structure ◽  
Topographical Anatomy ◽  
Anatomical Relationship ◽  
Life Threatening ◽  
Relationship Of ◽  
Variant Anatomy ◽  
Sternal Foramen

Sternal foramina are a well-known variant anatomy of the sternum and carry the risk of life-threatening complications like pneumothorax or even pericardial/cardial punction during sternal biopsy or acupuncture. There have been numerous studies numerous studies examinimg prevalence of sternal foramina, but the study of the exact anatomical relationship to intrathoracic structures has received little attention. In a retrospective study of 15 patients with sternal foramina, the topographical anatomy in respect to vital chest organs was examined. In most patients, the directly adjacent structure was the lung (53.3%) or mediastinal fat (33.3%). Only in three patients, the heart was located directly adjacent to a sternal foramen (20%). Theoretically, if the needle is inserted deep enough it will at some point perforate the pericardium in all examined patients. There was no correlation between the patient habitus (i.e., thickness of the subcutaneous fat) and the distance to a vital organ. In this sample, pericardial punction would have not occured if the needle is not inserted deeper than 2.5 cm. Given the preliminary nature of the data, general conclusions of a safe threshold for needle depth should be made with caution. To minimize the risk of hazardous complications, especially with sternal biopsy, preprocedural screening or image guidance is advocated.

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