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Level III-case-control study.

The role of capsular repair in the arthroscopic treatment of femoroacetabular impingement remains poorly defined. Some surgeons rarely repair the capsule, whereas others perform repairs routinely. There is little direct clinical evidence to guide surgeon decision making. When capsular repairs are performed, the procedure requires adequate visualization and careful suture placement either to re-establish the patient's normal capsular volume or to plicate a redundant capsule in a hip with hyperlaxity preoperatively. We present our preferred technique for arthroscopic capsular repair.

Posterolateral corner injuries of the knee are relatively rare; however, they can result in significant long-term disability without appropriate treatment. They often occur in the setting of multiligament knee injuries, and as a result, diagnosis and management can be challenging. Severe injuries often require reconstruction, and both anatomic and nonanatomic techniques exist. We describe our preferred operative technique to reconstruct the fibular collateral ligament and posterolateral corner using a single Achilles tendon allograft. Injuries to the posterolateral corner (PLC) of the knee commonly occur as a result of high-energy trauma involving hyperextension and either a varus or externalrotation force about the knee. Frequently, other ligaments are also injured; this makes accurate diagnosis and subsequent management challenging.The anatomy of the PLC is complex. The major structures include the fibular collateral ligament (FCL), the popliteofibular ligament (PFL), and the posterolateral capsule, which are the primary static stabilizers, and the popliteus tendon, which is an important dynamic and static stabilizer. Combined, these structures provide restraint to both posterolateral rotation of the tibia and varus opening forces.Reconstruction of PLC injuries is an evolving concept, and numerous techniques have been developed with slight variations. [1][2][3][4][5][6][7][8][9][10][11] In this article we describe our preferred technique, which uses a single Achilles tendon allograft, with anatomic fibular and femoral tunnels and a posterolateral capsular shift (Fig 1). This technique was developed by the senior author (B.A.L.) and is less complex than some anatomic reconstruction techniques because of elimination of the transtibial tunnel, but it still takes into account the posterolateral stabilizers of the knee and their respective anatomic relations. 12 Illustrative CaseA 16-year-old boy presented with left knee instability after a hyperextension injury during football that occurred approximately 4 weeks before presentation. At the time of the injury, he felt a pop and tearing sensation in the back and lateral aspects of the knee. He had immediate posterolateral knee pain, numbness to the dorsum of the foot, and instability with any attempt at weight bearing. In the 4 weeks that ensued, his numbness spontaneously resolved. Physical examination at presentation showed 1þ effusion, a negative Lachman test, positive posterior drawer and posterior sag tests, positive dial tests at both 30 and 90 , a positive external rotation drawer test, and a positive Marx spin test. In addition, the patient had 2þ opening to varus stress at full extension and at 30. He was found to be neurovascularly intact on presentation. The examination findings were consistent with a complete disruption of the posterior cruciate ligament (PCL) and the PLC. For the purposes of this illustrative case and technique, we will focus only on treatment of the PLC. Magnetic resonance imaging showed a complete PCL tear and PLC injury, wi...