Hip Capsular Reconstruction Using Dermal Allograft

Chahla, Jorge; Dean, Chase S.; Soares, Eduardo; Mook, William R.; Philippon, Marc J.

doi:10.1016/j.eats.2016.01.015

Cited by 19 publications

(23 citation statements)

References 12 publications

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“…ITB allo- or autograft has been one of the most commonly used graft choices; however, some studies have reported the use of Achilles allograft or dermal allograft for capsular reconstructions. 6,25,28,46 Surgical techniques described in these studies include both arthroscopic and open approaches. 6,28,33,46 Neither approach has demonstrated superiority over the other, and regardless of the approach used, surgeons must balance the competing interests of preserving native tissues and ensuring adequate visualization.…”

Section: Discussionmentioning

confidence: 99%

A Biomechanical Comparison of 2 Hip Capsular Reconstruction Techniques: Iliotibial Band Autograft Versus Achilles Tendon Allograft

et al. 2020

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Background: Several techniques for hip capsular reconstruction have been described to address gross instability or microinstability due to capsular deficiency. However, objective biomechanical data to support their use are lacking. Purpose: To compare the kinematic effect of 2 capsular reconstruction techniques (iliotibial band [ITB] graft and Achilles tendon graft). Kinematic effect encompassed rotational range of motion (ROM) as well as joint translation in the coronal, sagittal, and axial planes. Study Design: Controlled laboratory study. Methods: 8 paired, fresh-frozen hemi-pelvises (16 hips) were tested on a custom-designed joint motion simulator in the intact state and after capsulectomy. Pairs were randomly allocated to either ITB or Achilles reconstruction and retested. Testing was performed at 0°, 45°, and 90° of flexion. Internal-external rotation (IR-ER) torques and abduction-adduction torques of 3 N·m were applied to the femur via a load cell at each position, and rotational ROM and joint translation in the coronal, sagittal, and axial planes were recorded. Results: At 45° and 90°, there was a significant effect of the condition of the hip on the total IR-ER ( P = .004, effect size [ES] = 0.305; and P < .001, ES = 0.497; respectively). At 45°, mean ± SD total rotation was significantly greater for the capsulectomy (59.7°± 15.9°) state compared with intact (53.3°± 13.2°; P = .007). At 90°, reconstruction significantly decreased total rotation to 49.0°± 18.9° compared with a mean total rotation of 52.8°± 18.7° after capsulectomy ( P = .02). No difference was seen in the total abduction-adduction of the hip between conditions. Comparisons of the 2 different reconstruction techniques showed no significant differences in total IR-ER or abduction-adduction ROM or joint translation in the coronal, sagittal, or axial planes. For translation, at both 0° and 45° there was a statistically significant effect of the condition on the medial-lateral translation ( P = .033; ES = 0.204). Reconstruction, independent of technique, was successful in significantly decreasing ( P = .030; P = .014) the mean medial-lateral translation at 0° and 45° of hip flexion from 5.2 ± 3.8 mm and 5.6 ± 4.0 mm to 2.8 ± 1.9 mm and 3.9 ± 3.2 mm, respectively. Conclusion: The integrity of the native hip capsule played a significant role in rotational stability, where capsulectomy significantly increased rotational ROM. Both ITB and Achilles reconstruction techniques restored normal rotational ROM of the hip at 90° of flexion as well as coronal plane stability at 0° and 45° of hip flexion. No differences were seen between ITB and Achilles reconstruction techniques. Clinical Relevance: Both capsular reconstruction techniques provide comparable joint kinematics, restoring rotation and translation to normal values with the exception of rotational ROM at 45°, which remained significantly greater than the intact state. The most significant results were the rotational stability at 90° of hip flexion and coronal plane stability at 0° and 45° of hip flexion, which were significantly improved compared with the capsulectomy state.

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Section: Discussionmentioning

confidence: 99%

A Biomechanical Comparison of 2 Hip Capsular Reconstruction Techniques: Iliotibial Band Autograft Versus Achilles Tendon Allograft

et al. 2020

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“…Many capsuloligamentous reconstruction techniques have been previously described to address symptomatic instability in both native and non-native hip joints. [6][7][8][9] However, the technique in this paper is unique in that using a direct anterior approach to a native hip, the anatomic configuration of the iliofemoral ligament is replicated with an Achilles tendon bone block allograft to turn the original insufficient capsule into a now enhanced reconstructed iliofemoral ligament. Table 1.…”

Section: Discussionmentioning

confidence: 99%

Anterior Capsule Reconstruction of the Native Hip: A Technique Guide

Kurz

Memon

Williams

et al. 2019

Arthroscopy Techniques

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This is a technique guide for open anterior capsule reconstruction in unstable native hips due to EhlerseDanlos syndrome. EhlerseDanlos syndrome is a connective tissue disease that predisposes an individual to hypermobility of their soft tissues and recurrent subluxations and dislocations of their joints. This may lead to constant instability, guarding of the hip, and subsequent arthritic changes and poor quality of life. We demonstrate anterior capsule reconstruction of the hip using an Achilles tendon allograft performed through a direct anterior approach to the hip (Heuter's approach). This technique guide outlines in detail the surgical steps required to accomplish this reconstructive procedure. Furthermore, a narrated surgical video is provided that clearly depicts the anticipated result of the increased constrained provided to the hip from the anterior capsule reconstruction using an Achilles tendon allograft.

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“…Intraoperative findings demonstrated continued capsular incompetency requiring capsular reconstruction with a dermal allograft (ArthroFlex; Arthrex, Napes, FL) augmentation as previously described. 33 This represents the only patient in this series who underwent capsular reconstruction.…”

Section: Complications and Reoperationsmentioning

confidence: 93%