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Alright, so let's, uh, move on

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and we're gonna spend about, uh, 45 minutes

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or so talking about this important topic,

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which is femoral acetabular impingement

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and the acetabular labrum.

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And what I plan to do is to, uh,

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show you some basic concepts,

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introduce some controversies about this whole subject,

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and we'll look at some historical aspects

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that you may not know about.

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So let's start with a look at the anatomy

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of the hip joint here.

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I show you in a specimen the hip joint,

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it's often designated the lunate surface

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of the acetabulum.

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It's shaped like a horseshoe.

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You can see a deficient inferiorly in the area

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of the double-headed arrow.

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And that area is often called the acetabular notch.

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Now, surrounding the hip joint is a capsule,

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much like a sleeve.

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And I wanted to illustrate a little bit of the anatomy

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of this capsule, and I show it here on this

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transverse section.

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The proximal attachment

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of the capsule is along the periphery

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of the ace tabula adjacent to the labrum.

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And I've labeled that both anteriorly

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and posteriorly with the number two.

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The distal attachments vary according

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to whether you're looking at the anterior aspect

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of the femoral neck or the posterior anteriorly.

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The distal attachment is along the in truckin enteric line

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and many introduce the bump that may be seen there.

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I'll talk more about that a little bit, uh, uh, later.

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But that's the anterior capsular attachment.

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When you look at the posterior capsular attachment,

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it only partially covers the femoral neck.

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So there's a portion of the femoral neck posteriorly

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that is not covered by the capsule of the hip joint.

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There are three capsule ligaments

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and these pictures taken from an article one

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of our visiting scholars did years ago.

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It's a beautiful article, um,

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and, uh, you might wanna look for it, just Google Wagner,

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FV Wagner to find the article.

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He went through the anatomy in great detail of the capsule

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and structures in and about the hip.

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There are three particular ligaments,

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the one I'm emphasizing here with the orange uh, arrows.

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The ileal femoral ligament, which classically has two bands,

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is one of the strongest ligaments in the, uh,

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human body additionally.

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And we have a pubal femoral ligament labeled PFL

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and an ischial femoral ligament located posteriorly.

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It too can have two bands.

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So this is what the capsular

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and capsular ligaments look like.

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Quite thick. Okay. Particularly the ileal femoral ligament.

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It can look very, very thick.

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There's another area about the hip joint

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that you should know about.

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It's known as the zona orbicularis.

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It's a constricted region,

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often looks like a sling or a collar.

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I'm showing you, again, taken from that same article

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what the zona orbicularis looks like.

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And because it constricts the joint,

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often fluid collects both either above

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or below it in the form of recesses.

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And I've found through the years, that's one

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of the locations you wanna look for bodies,

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intraarticular bodies.

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In the, uh, in the hip,

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there is a blood supply to the femoral head, of course,

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and it is forms one of the synovial folds

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or pica that has been described in our literature.

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This is the medial synovial fold.

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This is what it looks like when fluid is present in the hip

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or you do an arthogram.

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You don't want to call that an abnormal pica

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because that particular synovial fold is the one

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that brings a lot of blood supply to the femoral head.