Capsular Management During Hip Arthroscopy

Hartwell, Matthew J.; Moulton, Samuel G.; Zhang, Alan L.

doi:10.1007/s12178-023-09855-x

Cited by 3 publications

(2 citation statements)

References 53 publications

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“…Moreover, capsulotomies have been a debated procedure to reduce traction forces [60, 61]. The size of the capsulotomy is known to reduce the traction force; however, capsule repair is essential to return the capsule to its native functionality [62, 63]. The combination of joint venting and capsulotomies further reduces the traction force safely, but the lower extremity joints remain exposed to excessive traction [8, 34].…”

Section: Discussionmentioning

confidence: 99%

Soft Tissue Mechanics in Hip Distraction after Total Knee Arthroplasty: A Finite Element Analysis

Soehnlen,

Sadeqi,

Kumaran

et al. 2024

Preprint

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INTRODUCTION: Improvement in diagnostic and surgical techniques in hip arthroscopy have led to a surge in hip distraction procedures over the recent years with the predicted annual frequency being four out of every 10,000 orthopedic procedures in 2017. Due to the large traction force required to achieve the appropriate joint spacing intra-operatively, an emergence of traction-related neurological and soft tissue injuries have surfaced. Pre-existing hip joint pathologies and surgical procedures disrupt the biomechanical stability of the joint and significantly increase the risk of iatrogenic damage. Furthermore, patients with total knee arthroplasties are often subject to intra-articular ligament releases, leading to reduced stability; however, it is not well understood how this may impact their outcomes of hip arthroscopic procedures. The current study aims to investigate the biomechanical behavior of various instrumented knee joints subjected to traction forces to aid clinical understanding and advancements of hip arthroscopy techniques. METHODS: A validated finite element (FE) model of the pelvis and lower extremity was developed from computed tomography (CT) scans of a healthy 45-year-old female. Three different models were assembled according to different TKA techniques performed: Bi-Cruciate Retaining (BCR) model, Posterior-Cruciate Retaining (PCR) model, and Posterior Stabilized (PS) model. The BCR model is noted by retaining all native ligaments of the knee joint (ACL, PCL, MCL, and LCL), whereas the PCR model was subject to ACL removal and the PS model required ACL and PCL removal (Figure 1). The pelvis was encastered to prevent translation under the traction forces as motion of the patients trunk is restrained, intraoperatively. To simulate the loading condition of hip distraction, an axial force was coupled to the distal fibula and tibia and incrementally increased from 100N to 500N. Joint spacing and ligament strain in the hip and knee joint were analyzed to assess the effects of traction forces. RESULTS: The medial and lateral compartment stiffness of the knee joint was analyzed under hip distraction for the three different TKA scenarios. The BCR model displayed the greatest average knee complex stiffness. Release of the ACL resulted in a larger decrease of stiffness compared to release of the PCL. There was no change in forces required for hip distraction as result of changes in the knee joint stiffness (Figure 3). The PCR and PS models were subject to excess knee joint distraction that exceeded 12 mm and ligament strain greater than 20% before adequate hip joint distraction of 10 mm was achieved. The BCR model remained below 10 mm of knee distraction and 15% ligament strain at 10 mm of hip joint distraction. DISCUSSION: Our study reveals patients undergoing hip distraction with a prior TKA may experience increased soft tissue damage or iatrogenic dislocation due to reduced knee joint stability. The PCR and PS models outline a trend suggesting patients who have undergone ligament sacrificing TKAs experience large reductions in knee joint stability, causing strain levels that are indicative of soft tissue injury. The BCR TKA was indicated to be the safest under the distraction conditions as joint spacing and strain levels were largely reduced comparatively; however, when surpassing 10 mm of knee joint distraction at forces greater than 350 N, the strain levels in the ACL suggest minor injury may occur.

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Section: Discussionmentioning

confidence: 99%

Soft Tissue Mechanics in Hip Distraction after Total Knee Arthroplasty: A Finite Element Analysis

Soehnlen,

Sadeqi,

Kumaran

et al. 2024

Preprint

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“…In recent years, there has been a growing recognition of the importance of managing the hip joint capsule appropriately during surgical interventions for hip joint diseases [ 22 – 24 ]. Increasing research efforts have been directed toward aspects of hip joint capsule management during hip surgeries, including the site of capsular incision, whether to close the capsule postoperatively, and other factors.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound had high accuracy in measuring hip joint capsule thickness

Gao,

Fang,

Zhou

et al. 2024

BMC Musculoskelet Disord

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Background The hip joint capsule is an essential component of hip joint function and stability, and its thickness is closely associated with certain medical conditions, surgical outcomes, and rehabilitation treatments. Currently, in clinical practice, hip joint capsule thickness is predominantly measured using magnetic resonance imaging (MRI), with limited utilization of ultrasound examinations for this purpose. Methods We retrospectively evaluated patients who visited our Sports Medicine Department between February 2017 and March 2023 and underwent both hip joint MRI and ultrasound imaging on the same side. All patients had undergone preoperative hip joint MRI and ultrasound examinations, with the time gap between the two examinations not exceeding three months. Measurements of hip joint capsule thickness were taken on both MRI and ultrasound images for the same patients to analyze their consistency. Additionally, we measured the alpha angle, lateral center-edge angle, acetabular anteversion angle, and femoral anteversion angle of the patients’ hip joints and analyzed their correlation with hip joint capsule thickness measure by ultrasound. Results A total of 307 patients were included in this study, with hip joint capsule thickness measured by MRI and ultrasound being 5.0 ± 1.2 mm and 5.0 ± 1.5 mm, respectively. The Bland-Altman analysis demonstrates good agreement or consistency. The paired t-test resulted in a p-value of 0.708, indicating no significant statistical difference between the two methods. The correlation analysis between acetabular anteversion angle and ultrasound-measured capsule thickness yielded a p-value of 0.043, indicating acetabular anteversion angle and capsular thickness may have negative correlation. Conclusions The measurements of joint capsule thickness obtained through ultrasound and MRI showed good consistency, suggesting that ultrasound can be used in clinical practice as a replacement for MRI in measuring hip joint capsule thickness. There was a significant correlation between acetabular anteversion angle and hip joint capsule thickness, indicating potential for further research in this area.

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Editorial Commentary: Capsular Management During Hip Arthroscopy Is Recommended, But a Limited Capsulotomy in Male Patients May Heal Without Closure

Zhang

2024

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Capsular Management During Hip Arthroscopy

Cited by 3 publications

References 53 publications

Soft Tissue Mechanics in Hip Distraction after Total Knee Arthroplasty: A Finite Element Analysis

Soft Tissue Mechanics in Hip Distraction after Total Knee Arthroplasty: A Finite Element Analysis

Ultrasound had high accuracy in measuring hip joint capsule thickness

Editorial Commentary: Capsular Management During Hip Arthroscopy Is Recommended, But a Limited Capsulotomy in Male Patients May Heal Without Closure

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