Biomechanical Assessment of Hip Capsular Repair and Reconstruction Procedures Using a 6 Degrees of Freedom Robotic System

Philippon, Marc J.; Trindade, Christiano A.C.; Goldsmith, Mary T.; Rasmussen, Matthew T.; Saroki, Adriana J.; Løken, Sverre; LaPrade, Robert F.

doi:10.1177/0363546517697956

Cited by 72 publications

(90 citation statements)

References 31 publications

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“…This ligament primarily restricts excessive hip extension and external rotation; thus, previous conventional hip arthroscopy and open surgical dislocation involve releasing the iliofemoral ligament to gain greater access to the femoral head and neck. In general, it was suggested that there were marginal differences in stability between common capsulotomy approaches (i.e., interportal and T-capsulotomy) 10,15,18 , and capsular closure restored motion to more similar intact conditions 9,10,12,14,15,18 . In studies involving similar stepwise capsular management, Philippon et al and Baha et al measured the differences in range of motion after each surgical stage during capsular management 15,48 .…”

Section: Surgical Management Hip Preservation Capsulotomy and Repairmentioning

confidence: 99%

“…In general, it was suggested that there were marginal differences in stability between common capsulotomy approaches (i.e., interportal and T-capsulotomy) 10,15,18 , and capsular closure restored motion to more similar intact conditions 9,10,12,14,15,18 . In studies involving similar stepwise capsular management, Philippon et al and Baha et al measured the differences in range of motion after each surgical stage during capsular management 15,48 . Although both studies demonstrated that common arthroscopic capsulotomy procedures (i.e., portal placement, interportal capsulotomy, and T-capsulotomy) increased the envelope of hip motion (internal-external rotation, abduction-adduction, and flexion-extension), their capsular repair and reconstruction helped to partially restore normative range of motion of the joint.…”

Section: Surgical Management Hip Preservation Capsulotomy and Repairmentioning

confidence: 99%

“…They noted that the anterior capsule predominantly controlled rotation and displacement, suggesting that the iliofemoral ligaments should be carefully preserved using more conservative capsulotomies. For capsular defect cases, allograft can be a viable option to restore distraction stability 15,16 . On the other hand, Hebert et al compared the effects of hip effusion (simulated with an injection of 10 mL of saline solution) and capsular tears 13 .…”

Section: Surgical Management Hip Preservation Capsulotomy and Repairmentioning

confidence: 99%

“…More importantly, how the hip capsule is managed during surgical interventions (preservation and arthroplasty) and its effects on joint function are increasingly recognized [5][6][7][8] . Several recent laboratory studies have provided new insights into functional mobility and stability of the hip joint that should be carefully considered during surgery [9][10][11][12][13][14][15][16][17][18][19][20] . The purpose of this review was to provide a comprehensive summary of the functional anatomy and material characteristics of the hip capsule and the effects of different capsular management techniques during arthroscopic and arthroplasty procedures on joint function.…”

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confidence: 99%

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Hip Joint Capsular Anatomy, Mechanics, and Surgical Management

Jeffers

Beaulé

2019

The Journal of Bone and Joint Surgery

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ä Hip joint capsular ligaments (iliofemoral, ischiofemoral, and pubofemoral) play a predominant role in functional mobility and joint stability. ä The zona orbicularis resists joint distraction (during neutral positions), and its aperture mechanism stabilizes the hip from adverse edge-loading (during extreme hip flexion-extension). ä To preserve joint function and stability, it is important to minimize capsulotomy size and avoid disrupting the zona orbicularis, preserve the femoral head size and neck length, and only repair when or as necessary without altering capsular tensions. ä It is not fully understood what the role of capsular tightness is in patients who have cam femoroacetabular impingement and if partial capsular release could be beneficial and/or therapeutic. ä During arthroplasty surgery, a femoral head implant that is nearly equivalent to the native head size with an optimal neck-length offset can optimize capsular tension and decrease dislocation risk where an intact posterior hip capsule plays a critical role in maintaining hip stability. Characteristics Anatomy Human ligaments consist of predominantly type-I collagen (85%) and combinations of type III, V, VI, XI, and XIV (15%) 21,22. Within the hip joint, higher ratios of type-III collagen in the ligamentous capsule are associated with hip instability 23,24 , whereas elevated levels in the cartilage are associated with Disclosure: The authors indicated grant support from the Engineering and Physical Sciences Research Council (EPSRC) (EP/K027549/1 and EP/ N006267/1) and the Wellcome Trust (088844/Z/09/Z), during the conduct of the study. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJS/F511).

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Section: Surgical Management Hip Preservation Capsulotomy and Repairmentioning

confidence: 99%

Section: Surgical Management Hip Preservation Capsulotomy and Repairmentioning

confidence: 99%

Section: Surgical Management Hip Preservation Capsulotomy and Repairmentioning

confidence: 99%

mentioning

confidence: 99%

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Hip Joint Capsular Anatomy, Mechanics, and Surgical Management

Jeffers

Beaulé

2019

The Journal of Bone and Joint Surgery

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“…Earlier studies explored the biomechanical contributions of local hip anatomy to stability, 4,5 and this evolved into a greater understanding of how the capsule itself taken together with pericapsular structures contributes to hip stability. 3,[6][7][8] More recently, the debate over the importance of capsular repair 9,10 and various repair strategies [11][12][13] has culminated with several outcome studies that leave no question as to the evidence in support of superior surgical outcomes with capsular repair. 14,15 Yes, folks, it is quite clear that the capsule must be addressed during routine arthroscopy.…”

Section: See Related Article On Page 116mentioning

confidence: 99%

Editorial Commentary: #Capsule-ophilesRejoice! The Evidence in Support of Diligent Capsular Management During Hip Arthroscopy Can No Longer Be Ignored

Walters

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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From its infancy until now, the enthusiasm and growth of the field of hip arthroscopy have been exciting to watch. Perhaps, it could be argued that there has not been a more hotly debated topic in recent years than what to do with the hip capsule. Once merely an afterthought in the context of hip arthroscopy, the oft overlooked and underappreciated intricacies of hip capsular anatomy and its role in hip stability have now taken center stage. As surgical indications continue to expand, our surgical techniques have rapidly evolved. Despite the rapid growth and advent of industry, the leaders in this field have remained steadfast in their relentless quest to improve their scientific knowledge and understanding of the native hip joint. If we have learned nothing else from watching the capsular debate evolve, it is that without an advanced understanding of the critical and complex marriage of anatomy and function that exists in a healthy hip joint, we cannot begin to master the surgical treatment of its pathologic states.

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The continuum of hip range of motion: From soft‐tissue restriction to bony impingement

Han

Owens

Patel

et al. 2020

Journal Orthopaedic Research

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Traditional studies of hip kinematics have not identified which anatomic structures limit the range of motion (ROM) when the hip is placed in different maneuvers. In this study, we attempted to answer two questions: (a) During which maneuvers is the motion of the hip limited by bony impingement between the femur and pelvis? (b) When is hip ROM determined by the constraint of soft tissues and to what extent? ROM of eight cadaveric hips was measured in 17 maneuvers using a motion capture system. The maneuvers were recreated in silico using 3D CT models of each specimen to detect the occurrence of bony impingement. If bony impingement was not detected, the variable component of 3D hip motion was increased until a collision was detected. The difference between the virtual ROM at the point of bony impingement and the initial ROM measured experimentally was termed as the soft‐tissue restriction. The results showed that bony impingement was present in normal hips during maneuvers consisting of high abduction with flexion, and high flexion combined with adduction and internal rotation. At impingement‐free maneuvers, the degree of soft tissue restriction varies remarkably, ranging from 4.9° ± 3.8° (internal rotation) at 90° of flexion to 80.0° ± 12.5° (internal rotation) at maximum extension. The findings shed light on the relative contributions of osseous and soft tissues to the motion of the hip in different maneuvers and allow for a better understanding of physical exams of different purposes in diagnosing bone‐ or soft tissue‐related diseases.

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Biomechanical Assessment of Hip Capsular Repair and Reconstruction Procedures Using a 6 Degrees of Freedom Robotic System

Cited by 72 publications

References 31 publications

Hip Joint Capsular Anatomy, Mechanics, and Surgical Management

Hip Joint Capsular Anatomy, Mechanics, and Surgical Management

Editorial Commentary: #Capsule-ophilesRejoice! The Evidence in Support of Diligent Capsular Management During Hip Arthroscopy Can No Longer Be Ignored

The continuum of hip range of motion: From soft‐tissue restriction to bony impingement

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