Periportal Capsulotomy: A Technique for Limited Violation of the Hip Capsule During Arthroscopy for Femoroacetabular Impingement

Monroe, Emily; Chambers, Caitlin C.; Zhang, Alan L.

doi:10.1016/j.eats.2018.10.015

Cited by 27 publications

(32 citation statements)

References 10 publications

(17 reference statements)

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“…Two arthroscopic portals (anterolateral and midanterior) and a periportal capsulotomy was used. 6 , 24 Based on the classification by Beck et al, 1 the acetabular cartilage, femoral cartilage, and labral condition were recorded. Procedure time from incision to closure, and traction time were recorded.…”

Section: Methodsmentioning

confidence: 99%

Is There a Gender Gap in Outcomes After Hip Arthroscopy for Femoroacetabular Impingement? Assessment of Clinically Meaningful Improvements in a Prospective Cohort

Flores

Chambers

Borak

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Although patients have experienced significant improvements after hip arthroscopy for femoroacetabular impingement (FAI), prior studies suggest that women have worse outcomes than men. These previous studies lack comparisons of patient-reported outcome (PRO) scores based on gender with respect to clinical significance measurements, including the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). Purpose: To evaluate outcomes after hip arthroscopy for FAI based on patient gender by prospectively assessing changes in PRO scores, MCID, and PASS. Study Design: Cohort study; Level of evidence, 2. Methods: Women and men undergoing hip arthroscopy for FAI were prospectively enrolled, and preoperative radiographic and intraoperative findings were collected. Patients completed the following PRO surveys before surgery and 2 years postoperatively: modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and 12-Item Short Form Health Survey. Mean scores and percentage of patients reaching MCID and PASS were analyzed. Results: A total of 131 hips were included (72 women, 59 men). Women had smaller preoperative alpha angles (59.1° vs 63.7°, respectively; P < .001) and lower acetabular cartilage injury grade (6.9% vs 22.0% with grade 4 injury, respectively; P = .013). Both women and men achieved equivalent significant improvements in PRO scores after surgery (scores increased 18.4 to 45.1 points for mHHS and HOOS). Women and men reached PASS for mHHS at similar rates (76.4% and 77.2%, respectively; P = .915). MCID was also achieved at similar rates between women and men for all scores (range, 61.4%-88.9%) except the activities of daily living subscale of the HOOS, in which a greater percentage of women reached MCID compared with men (79.2% vs 62.7%, respectively; P = .037). Additional stratification by age group using the median cohort age of 34 years showed no significant differences in PRO improvement based on age group for each gender. Conclusion: Women can achieve clinically meaningful improvements in PRO scores after hip arthroscopy for FAI. Compared with men, women demonstrated equivalent high rates of achieving MCID and PASS at 2 years after surgery.

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Section: Methodsmentioning

confidence: 99%

Is There a Gender Gap in Outcomes After Hip Arthroscopy for Femoroacetabular Impingement? Assessment of Clinically Meaningful Improvements in a Prospective Cohort

Flores

Chambers

Borak

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…This senior surgeon maintains a high-volume hip arthroscopy practice and uses standard arthroscopic portals (anterolateral and midanterior) with periportal capsulotomies. 5,26 Surgical treatment for this cohort of patients included arthroscopic labral repair with osteoplasty (femoroplasty/acetabuloplasty) as indicated by type of FAI pathology. Capsular closure was performed on patients who were potentially at risk for postoperative instability or had greater joint laxity.…”

Section: Methodsmentioning

confidence: 99%

Fast Starters and Slow Starters After Hip Arthroscopy for Femoroacetabular Impingement: Correlation of Early Postoperative Pain and 2-Year Outcomes

et al. 2020

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Background: Patients experience varying degrees of pain and symptoms during the early recovery period after hip arthroscopy for femoroacetabular impingement (FAI). Some “fast starters” report minimal discomfort and are eager to advance activities, while “slow starters” describe severe pain and limitations. The relationship between these early postoperative symptoms and 2-year outcomes after hip arthroscopy is unknown. Purpose: To analyze the relationship between early postoperative pain and 2-year patient-reported outcomes (PROs) after hip arthroscopy for FAI. Study Design: Cohort study; Level of evidence, 2. Methods: Patients without arthritis or dysplasia who were undergoing primary hip arthroscopy for FAI were prospectively enrolled and completed validated PROs. Scores for visual analog scale (VAS) for pain were collected preoperatively and at 1 week, 6 weeks, and 2 years postoperatively. Scores for the modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and 12-Item Short Form Health Survey (SF-12) were collected preoperatively and 2 years postoperatively. Paired t tests were used to evaluate PRO score changes, and correlation analyses were used to assess relationships between early postoperative pain and 2-year postoperative outcomes. Results: A total of 166 patients were included (55% female; mean ± SD age, 35.29 ± 9.6 years; mean body mass index, 25.07 ± 3.98 kg/m2). Patients demonstrated significant improvements in PRO scores (VAS, SF-12 Physical Component Score, mHHS, and all HOOS subscales) at 2 years after hip arthroscopy for FAI ( P < .001). There was a significant correlation between lower 1-week VAS pain level (fast starters) and lower 2-year VAS pain level ( R = 0.31; P < .001) as well as higher 2-year PRO scores (SF-12 Physical Component Score, mHHS, and all HOOS subscales: R = −0.21 to −0.3; P < .001). There was no correlation between 1-week VAS pain and 2-year SF-12 Mental Component Score ( P = .17). Preoperative VAS pain levels showed positive correlations with 1-week postoperative pain scores ( R = 0.39; P < .001) and negative correlations with 2-year patient outcomes ( R = −0.15 to −0.33, P < .01). There was no correlation between 6-week postoperative pain scores and 2-year PRO scores. Conclusion: Fast starters after hip arthroscopy for FAI experience sustained improvements in outcomes at 2 years after surgery. Patient pain levels before surgery may delineate potential fast starters and slow starters.

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“…It is still unclear what leads to inherent or iatrogenic instability; thus, if the native head size is not substantially reduced or altered, capsular repair in the setting of a small arthroscopic capsulotomy may not be necessary in the otherwise congruent and stable hip 4,54,56 . Recently, a periportal capsulotomy technique (i.e., midanterior and anterolateral portal dilations) showed that it can preserve the iliofemoral ligament, without necessitating capsular closure 57,58 ; however, it is unclear if this applies to dysplastic hips 59 .…”

Section: Surgical Management Hip Preservation Capsulotomy and Repairmentioning

confidence: 99%

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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Periportal Capsulotomy: A Technique for Limited Violation of the Hip Capsule During Arthroscopy for Femoroacetabular Impingement

Cited by 27 publications

References 10 publications

Is There a Gender Gap in Outcomes After Hip Arthroscopy for Femoroacetabular Impingement? Assessment of Clinically Meaningful Improvements in a Prospective Cohort

Is There a Gender Gap in Outcomes After Hip Arthroscopy for Femoroacetabular Impingement? Assessment of Clinically Meaningful Improvements in a Prospective Cohort

Fast Starters and Slow Starters After Hip Arthroscopy for Femoroacetabular Impingement: Correlation of Early Postoperative Pain and 2-Year Outcomes

Hip Joint Capsular Anatomy, Mechanics, and Surgical Management

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