The Effect of Capsulotomy and Capsular Repair on Hip Distraction: A Cadaveric Investigation

Hip Joint Capsular Anatomy, Mechanics, and Surgical Management

“…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 .…”

“…It is essential to understand that capsular characteristics and mechanical properties of the hip with pathological conditions are different (i.e., a thicker, stiffer capsule) than a healthy joint 38,50,52 ; thus, the need for full capsular closure may depend on several other confounding factors (e.g., age, sex, osseous anatomy, and muscle function) [53][54][55] . More importantly, since unrepaired capsulotomies have been shown to heal within 24 weeks postoperatively 56 , and completely resecting the iliofemoral ligament does not destabilize the native hip 43 , there is evidence that not all capsulotomies need to be repaired after The findings of in vitro cadaveric studies on the effects of capsular conditions and surgical stages, outlining the contributions of the interportal capsulotomy 5,7,8,10,11,14,46 and T-capsulotomy 6,11,14,15,46 and the effects of instability 7,[11][12][13]16,47 , effusion arthroscopy, especially when capsular contracture may be part of the pathological process. 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 .…”

“…4 ; see Appendix Table II ). Several in vitro studies examined conventional interportal-only 9 , 12 , 14 and T-shaped 10 , 15 , 18 capsulotomies, with all showing the substantial increases in motion immediately after release of the iliofemoral ligament. 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.…”

“…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.…”

Hip Capsular Management

“…When considering kinematic alterations to the hip joint, unrepaired interportal capsulotomy increases external rotation and decreases the force required for distraction as compared with the native hip. 15,[19][20][21] While interportal capsulotomy facilitates adequate visualization and access for diagnostic and interventional purposes, size of incision has been reported to correlate with the degree of iatrogenic instability. The length interportal capsulotomy may vary as small as 2 cm to greater than 6 cm depending on the pathology as well as surgeon preference.…”