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Kalhor M, Gharehdaghi J, Leunig M, et al. Surgical Anatomy of the Rectus-Sparing Approach for Periacetabular Osteotomy: A Cadaveric Study. JBJS Essent Surg Tech. 2021;11(2)doi: 10.2106/JBJS.ST.20.00030.
Kalhor, M., Gharehdaghi, J., Leunig, M., Ahmadloo, J., Collado Gastalver, D., & Ganz, R. (2021). Surgical Anatomy of the Rectus-Sparing Approach for Periacetabular Osteotomy: A Cadaveric Study. JBJS essential surgical techniques, 11(2), . https://doi.org/10.2106/JBJS.ST.20.00030
Kalhor, Morteza, et al. "Surgical Anatomy of the Rectus-Sparing Approach for Periacetabular Osteotomy: A Cadaveric Study." JBJS essential surgical techniques vol. 11,2 (2021). doi: https://doi.org/10.2106/JBJS.ST.20.00030
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 Jun 03;11(2). doi: 10.2106/JBJS.ST.20.00030. eCollection 2021. PMID: 34277137; PMCID: PMC8280039.
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JBJS Essent Surg Tech. 2021 Jun 03;11(2). doi: 10.2106/JBJS.ST.20.00030. eCollection 2021.

Surgical Anatomy of the Rectus-Sparing Approach for Periacetabular Osteotomy: A Cadaveric Study.

JBJS essential surgical techniques

Morteza Kalhor, Jaber Gharehdaghi, Michael Leunig, Javad Ahmadloo, Diego Collado Gastalver, Reinhold Ganz

Affiliations

  1. Department of Orthopaedic Surgery, Iran University of Medical Sciences, Firoozgar Medical Center, Tehran, Iran.
  2. Iran Legal Medicine Organization, Legal Medicine Research Center, Tehran, Iran.
  3. Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland.
  4. Orthopedic Unit, Hospital Universitario del Valle de Hebron, Barcelona, Spain.
  5. Faculty of Medicine, University of Bern, Bern, Switzerland.

PMID: 34277137 PMCID: PMC8280039 DOI: 10.2106/JBJS.ST.20.00030

Abstract

BACKGROUND: The Bernese periacetabular osteotomy (PAO) is a widely used technique for the management of acetabular dysplasia and other hip deformities in adolescents and young adults. Originally, the approach was described with a release of both origins of the rectus femoris muscle

DESCRIPTION: Both the original and the rectus-sparing approach are modifications of the Smith-Petersen approach. The skin incision and further dissection remain identical in both approaches for the protection of the lateral femoral cutaneous nerve, the osteotomy of the anterior superior iliac spine (or takedown of the inguinal ligament), the exposure of the iliac fossa, and the medial retraction of the abdominal and iliopsoas muscles. In both variants, the further dissection traverses the iliopectineal bursa. In contrast to the original approach, in which the rectus muscle becomes part of the medial flap after releasing both heads, the rectus-sparing approach involves the undetached rectus muscle becoming part of the lateral flap while the medial flap includes the sartorius and iliacus-iliocapsularis muscles. The anterior capsule and deep structures can be accessed through the interval between the rectus femoris and iliopsoas muscles or lateral to the rectus muscle. The remaining surgical steps are again similar in both techniques. According to preference, the surgeon starts with the pubic osteotomy or with the ischial cut first, the latter avoiding additional bleeding from the pubic osteotomy. For the ischial osteotomy, the bone is accessed by making an anteroposterior tunnel between the medial capsule and the iliopsoas tendon anteriorly and between the medial capsule and the obturator externus muscle posteriorly. While the ischial osteotomy is an incomplete separation, the pubic osteotomy is a complete separation. It sections the superior pubic ramus medial to the iliopectineal eminence, in a somewhat oblique fashion. The third and fourth cuts are made in the iliac bone in such a way as to keep the posterior column intact. By connecting the posterior iliac and ischial cuts as the last osteotomy step, the acetabulum is freed and repositioned as needed. The aim of our cadaver dissection is primarily to describe part of the rectus-sparing approach and to test this modification for eventual disadvantages over the classic approach. The remaining steps of the procedure correspond to the approach as described earlier

ALTERNATIVES: Nonsurgical treatment may be an alternative in borderline dysplasia; however, it needs to be reconsidered and eventually changed to surgical treatment when symptoms persist or come back. Other current techniques for surgical treatment of adolescent and adult hip dysplasia include triple and rotational or spherical osteotomies

RATIONALE: The Bernese PAO is performed through a single incision. All cuts are performed from the inner side of the pelvis, avoiding interference with the vascularity of the acetabular and periacetabular bone, which mainly comes from the outside of the pelvis

Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.

Conflict of interest statement

Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online vers

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