Arthroscopic Capsule Reconstruction in the Hip Using Iliotibial Band Allograft

Abstract

The hip capsule has been identified as an important static stabilizer of the hip joint. Despite the intrinsic bony stability of the hip socket, the capsule plays a key role in hip stability, particularly at the extremes of motion, and the iliofemoral ligament is the most important stabilizer in extension and external rotation. Patients who do not undergo capsular closure or plication may continue to complain of hip pain and dysfunction postoperatively, likely because of microinstability or muscle invagination into the capsular defect, and high-resolution magnetic resonance imaging or magnetic resonance arthrography will identify the capsular defect. Seen primarily in the revision setting, capsular defects can cause recurrent stress at the chondrolabral junction. An attempt at secondary closure can be challenging because of capsular limb adherence to the surrounding soft tissues. Therefore reconstruction may be the only possible surgical solution for this problem. We describe our new surgical technique for arthroscopic hip capsular reconstruction using iliotibial band allograft.

Hip Capsular Reconstruction Using Dermal Allograft

“…11 However, only 1 report exists regarding capsular reconstruction in the native hip. 3 Recently, Trindade et al 3 described capsular reconstruction using the iliotibial band. Dermal allograft may more closely approximate the native hip capsule thickness and provide a stronger and more secure construct than the iliotibial band allograft.…”

“…1,2 The hip capsule is one of the most important static stabilizers of the hip joint, 3 and disruption or debridement of the capsule during arthroscopy is a potential contributor to postoperative iatrogenic hip instability. Therefore, hip arthroscopists must be mindful of hip capsule management because hip arthroscopic procedures are increasing exponentially.…”

Arthroscopic Capsular Reconstruction of the Hip With Acellular Dermal Extracellular Matrix: Surgical Technique

“…Anteroposterior translation and external rotation were restored to normal ranges after the authors repaired both the labrum and iliofemoral ligament. Recently, Trindade et al 21 published a surgical technique for arthroscopic capsular reconstruction of the hip that incorporates an iliotibial band allograft.…”

“…Capsular Reconstruction (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) 7. Preparing the capsular surface comprises 2 procedures: debridement of the scar tissue where the capsule once was and decortication of the acetabular and femoral beds for a better graft incorporation.…”

Microinstability of the hip: a previously unrecognized pathology

“…The hip capsule is one of the most important static stabilizers of the hip joint 3 and disruption or debridement of the capsule during hip arthroscopy is a potential contributor to postoperative iatrogenic hip instability. Therefore, hip surgeons must be thoughtful of hip capsule management as hip arthroscopic procedures are increasing exponentially 4 .…”