A Less-Invasive Technique for Capsular Management During Hip Arthroscopy for Femoroacetabular Impingement

Abstract

The aim of this work is to describe a new arthroscopic technique for the treatment of femoroacetabular impingement that allows a complete articular joint view with maximum protection of the capsuloligamentous complex. This arthroscopic technique avoids injury to the capsuloligamentous complex, preventing the risk of postoperative instability. The diagnosis of femoroacetabular impingement was based on clinical and radiographic grounds. An alpha angle greater than 50 was considered pathologic. In this technique, the use of intra-articular devices (retractors) allows us to separate the capsular tissue from the femoral head-neck junction and mobilize the capsule, achieving an adequate joint view without performing a capsulotomy and, consequently, avoiding the complications of capsular damage.

Biomechanical Evaluation of Capsulotomy, Capsulectomy, and Capsular Repair on Hip Rotation

“…In addition to contributing to the resistance of internal and external rotation in extension, the lateral arm of the iliofemoral ligament has been shown to limit external rotation in flexion. 15 The T-capsulotomy is a distal perpendicular extension toward the intertrochanteric line from the midportion of the interportal capsulotomy. This distal extension takes advantage of the plane separating the medial and lateral limbs of the iliofemoral ligament and represents the separation between the iliocapsularis tendon medially and gluteus minimus tendon laterally.…”

“…[11][12][13][14] Treatment of the capsule during hip arthroscopy can come in different forms and is not standardized between surgeons. 3,14-18 Capsular management techniques can range from capsulectomy to limited capsulotomy, 15,18 interportal capsulotomy with or without repair, or T-capsulotomy with 3,16 or without repair. 3 The Tcapsulotomy is popular among some surgeons because it allows complete visualization of the femoral neck and any cam deformity, 3 but it requires a larger capsular incision.…”

Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy

“…[9,21,22] Moreover, we believe that the pathology in DDH originates from structures that prevent intra-articular reduction, whereas the treatment of CP can be performed by extra-articular methods without the need for open reduction, since the pathology originates from extra-articular structures. [8,9,[23][24][25][26][27][28][29][30][31][32] Cast immobilization after recent hip joint reconstruction has become an important debate issue due to various complications. Some authors suggest routine use of spica cast after surgical hip reconstruction procedure in CP to achieve stability and prevent early dislocation.…”

Anatomic Hip Capsular Reconstruction With Separate Suture Anchors

“…Although several capsular closure techniques have been described, 4,5,13,[19][20][21][22][23][24][25] there are still very few clinical studies that show the advisability to close the capsule in all cases. 20,21 The instances of capsular failure reported in the literature arise, in their majority, from a dehiscence of the transverse arm of the capsulotomy (the vertical arm tends to heal more easily as it is incised in the direction of the IFL fibers) 32 ; hence the importance of avoiding a horizontal section.…”

“…20,21 Several capsular closure techniques, with or without suture anchors, have been reported. 4,5,13,[19][20][21][22][23][24][25] The current trend seems to favor less aggressive capsulotomy techniques that use limited incisions. This article describes a technique based on an anatomic opening of the capsule in the direction of the IFL fibers and subsequent capsular closure by means of 1 or 2 suture anchors, independent of the ones used for labral reattachment.…”