No abstract

Background: Hip capsulotomy is routinely performed during arthroscopic surgery to achieve adequate exposure of the joint. Iatrogenic instability can result after hip arthroscopic surgery because of capsular insufficiency, which can be avoided with effective closure of the hip capsule. There is currently no consensus in the literature regarding the optimal quantity of sutures upon capsular closure to achieve maximal stability postoperatively. Purpose/Hypothesis: The purpose of this study was to determine the failure torques of 1-, 2-, and 3-suture constructs for hip capsular closure to resist external rotation and extension after standard anterosuperior interportal capsulotomy (12 to 3 o’clock). Additionally, the degree of external rotation at which the suture constructs failed was recorded. The null hypothesis of this study was that no significant differences with respect to the failure torque would be found between the 3 repair constructs. Study Design: Controlled laboratory study. Methods: Nine pairs (n = 18) of fresh-frozen human cadaveric hemipelvises underwent anterosuperior interportal capsulotomy, which were repaired with 1, 2, or 3 side-to-side sutures. Each hip was secured in a dynamic biaxial testing machine and underwent a cyclic external rotation preconditioning protocol, followed by external rotation to failure. Results: The failure torque of the 1-suture hip capsular closure construct was significantly less than that of the 3-suture construct. The median failure torque for the 1-suture construct was 67.4 N·m (range, 47.4-73.6 N·m). The median failure torque was 85.7 N·m (range, 56.9-99.1 N·m) for the 2-suture construct and 91.7 N·m (range, 74.7-99.0 N·m) for the 3-suture construct. All 3 repair constructs exhibited a median 36° (range, 22°-64°) of external rotation at the failure torque. Conclusion: The most important finding of this study was that the 2- and 3-suture constructs resulted in comparable biomechanical failure torques when external rotation forces were applied to conventional hip capsulotomy in a cadaveric model. The 3-suture construct was significantly stronger than the 1-suture construct; however, there was not a significant difference between the 2- and 3-suture constructs. Additionally, all constructs failed at approximately 36° of external rotation. Clinical Relevance: Re-establishing the native anatomy of the hip capsule after hip arthroscopic surgery has been reported to result in improved outcomes and reduce the risk of iatrogenic instability. Therefore, adequate capsular closure is important to restore proper hip biomechanics, and postoperative precautions limiting external rotation should be utilized to protect the repair.

No abstract

Because hip arthroscopic procedures are increasing in number, complications related to the operation itself are starting to emerge. Whereas the capsule has been recognized as an important static stabilizer for the hip, it has not been until recently that surgeons have realized the importance of its preservation and restoration. Disruption of the capsule during arthroscopic procedures is a potential contributor to postoperative iatrogenic hip instability. In cases of a symptomatic deficient capsule, a capsular reconstruction is mandatory because instability may lead to detrimental chondral and labral changes. The purpose of this report was to describe our technique for arthroscopic hip capsular reconstruction using dermal allograft.

The dynamic function of the acetabular labrum makes it an important structure for both hip stability and motion. Because of this, injuries to the labrum can cause significant dysfunction, leading to altered hip kinematics. Labral repair is the gold standard for symptomatic labral tears to keep as much labral tissue as possible; however, in cases where the labrum has been injured to such a degree that it is either deficient or repair is not possible, arthroscopic labral reconstruction is preferred. This article describes our preferred approach for reconstruction of the acetabular labrum using iliotibial band autograft.

Arthroscopic procedures for treatment of hip pathology are growing exponentially as a result of continued improvements in the understanding of intra-and extra-articular hip anatomy and technological advancements in instrumentation. Nevertheless, it has been reported that the main cause of revision hip arthroscopy is related to a suboptimal intrasurgical management of the abnormal morphology in femoroacetabular impingement (FAI). Underresection, over-resection, and in some cases combined under-resection and over-resection at different locations of the cam lesion at the femoral head-neck junction may lead to poor outcomes as a result of residual impingement or the iatrogenic creation of structural instability. Thus, an intraoperative assessment technique capable of revealing in real time the effect of the resection is vital for a successful procedure. Therefore, we present a technical note describing our preferred method to dynamically assess overall hip range of motion, motion at risk, and evaluation of the osteoplasty after surgical correction of FAI.

Femoroacetabular impingement (FAI) is an increasingly recognized cause of hip pain. This pathology often involves abnormal femoral neck shape (cam-type FAI), acetabular over coverage (pincer-type FAI), or mixed pathology. Surgical treatment of this entity includes labral repair and femoral head-neck osteochondroplasty. A mindful arthroscopic technique is of paramount importance, because maintaining the integrity of the labrum and a corresponding neck volume has been reported to be vital in maintaining the hip suction seal. Arthroscopic resection of the cam deformity must be performed with care to ensure appropriate femoral offset and maintenance of appropriate femoroacetabular contact. Although the most common cause of failure after hip arthroscopy is incomplete resection of a cam lesion, a previously unrecognized complication is excessive cam resection that can also lead to excessive femoral offset and loss of the suction seal. The purpose of this technical note is to describe the technique for arthroscopic recognition of excessive cam decompression leading to loss of the suction seal and a surgical treatment approach using the "remplissage" technique.

III Case-control, retrospective comparative study.