Capsular Management Techniques and Hip Arthroscopy

Abstract

There has been an increased emphasis on capsular management during hip arthroscopy in the literature in recent years. The capsule plays a significant role in the hip joint stability and studies have demonstrated that capsular closure can restore the biomechanics of the hip back to the native state. Capsular management also affects functional outcomes with capsular repair resulting in better clinical outcomes in some studies. Management of the capsule has evolved in recent years with more surgeons performing routine capsular closure. Management techniques and degree of capsular closure, however, can be quite variable between surgeons. This review will discuss hip capsular anatomy, the importance of the capsule in hip biomechanics, management of the capsule during arthroscopy, and functional outcomes as it relates to the various capsular closure techniques versus leaving the capsulotomy unrepaired.

Extended Interportal Capsulotomy for Hip Arthroscopy, a Single-Center Clinical Experience

“…The overall number of hip arthroscopies performed worldwide has surged in the last decade [4,15]. The surge is due not only to the increased familiarity with the technique and the equipment but also to the awareness that pathologies around the hip joint have gained [16,17]. A painful hip is most commonly a result of femoroacetabular impingement syndrome (FAS), labral tears, snapping hip syndrome, osteoarthritis, synovitis, a loose body, or septic arthritis [17,18].…”

“…The surge is due not only to the increased familiarity with the technique and the equipment but also to the awareness that pathologies around the hip joint have gained [16,17]. A painful hip is most commonly a result of femoroacetabular impingement syndrome (FAS), labral tears, snapping hip syndrome, osteoarthritis, synovitis, a loose body, or septic arthritis [17,18]. Open procedures have been replaced by less invasive arthroscopic interventions and a recent systematic review by Kyin et al [18] reported considerable improvement in patient-reported outcomes in the mid-to long term.…”

Noninvasive shape‐fitting method quantifies cam morphology in femoroacetabular impingement syndrome: Implications for diagnosis and surgical planning

“…All patients were recruited from a single surgeon's high‐volume hip preservation clinical practice (Shane J. Nho). To be selected for this particular study, all participants had to meet the following criteria: be diagnosed with cam‐type FAIS based on clinical examination, have radiographic evidence of alpha angle $$\gt 5{0}^{\circ }$$, be scheduled to undergo hip arthroscopic surgery with a planned surgical resection of the proximal femur to remove the cam morphology, and be scheduled to undergo both preoperative and postoperative 1.5T MRI (Figure 1[1]) 49–52 . Exclusion criteria for the study included: radiographic evidence of Tönnis Grade $$\gt 1$$ hip osteoarthritis (OA), history of prior surgery to the index or contralateral hip, and history of a developmental hip disorder such as Legg‐Calvé‐Perthes disease, slipped capital femoral epiphysis, or developmental hip dysplasia (lateral center edge angle [LCEA] $$\lt 2{0}^{\circ }$$).…”

Arthroscopic Treatment of Mild/Borderline Hip Dysplasia with Concomitant Femoroacetabular Impingement—Literature Review

“…The joint capsule acts as a non-dynamic stabilizer restricting the femoral head’s excessive translation and rotational movement [ 73 ••, 74 , 75 ]. Most commonly performed hip arthroscopy involves capsulotomy to gain access to the hip joint, with the most common techniques being interportal and T-shaped capsulotomies [ 74 , 76 , 77 ]. Further, in hip dysplasia, the capsule is generally lax and redundant due to the bony undercoverage and ongoing instability [ 3 •, 9 , 73 ••, 74 , 78 ].…”