Capsular Management During Hip Arthroscopy: From Femoroacetabular Impingement to Instability

Bedi, Asheesh; Galano, Gregory J.; Walsh, Christopher P.; Kelly, Bryan T.

doi:10.1016/j.arthro.2011.08.288

Cited by 176 publications

(184 citation statements)

References 55 publications

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“…Capsulotomy techniques are also potentially important to maximize exposure and ability to correct impingement deformities during hip arthroscopy [34]. Minimal capsulotomies at the level of the portals, interportal capsulotomies, T capsulotomy, and capsulectomies have been proposed as techniques to improve arthroscopic exposure.…”

Section: The Hip Capsulementioning

confidence: 99%

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Current concepts and trends for operative treatment of FAI: hip arthroscopy

Larson

Stone

2013

Curr Rev Musculoskelet Med

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There has been an increasing body of literature regarding arthroscopic management of femoroacetabular impingement (FAI). Refinement of arthroscopic techniques has allowed for more complete management of FAI, and metaanalysis and systematic reviews have shown comparable outcomes to surgical hip dislocation with appropriate indications. There are still, however, pathomorphologies that are not accessible or much more challenging to address arthroscopically, and open corrective procedures should be considered in these situations. Extra-articular FAI is receiving increased attention and can be secondary to anterior inferior iliac spine/subspine impingement, trochanteric-pelvic impingement, and ischiofemoral impingement. Femoral and acetabular version and their impact on hip stability as well as the concept of impingement induced instability are being increasingly recognized. Acetabular labral and capsular management and repair techniques have also received increased attention. Finally, 3-dimensional imaging and dynamic software analysis are beginning to emerge as potential tools to better evaluate hip pathomorphology.

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Section: The Hip Capsulementioning

confidence: 99%

“…2) [34]. A recent systematic review reported on 47 published articles that met the inclusion criteria and concluded that the capsule was an important hip stabilizer and that surgeons should be competent in repair and plication techniques in certain situations when performing hip arthroscopy [35].…”

Section: The Hip Capsulementioning

confidence: 99%

Current concepts and trends for operative treatment of FAI: hip arthroscopy

Larson

Stone

2013

Curr Rev Musculoskelet Med

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“…5 Management of the capsule has become an important issue in recent years. 6 The role of the capsule is essential in hip stability and also significant regarding postoperative functional status and pain. [7][8][9] The initial capsulectomies and extensive capsulotomies have given way to more conservative trends with regard to capsular tissue.…”

mentioning

confidence: 99%

“…[7][8][9] The initial capsulectomies and extensive capsulotomies have given way to more conservative trends with regard to capsular tissue. 6 Currently, capsular management is carried out in 2 different ways: (1) T-capsulotomy, which allows a wide exposure of the femoral head and the head-neck junction, and (2) interportal capsulotomy, which is less aggressive. Both techniques provide an adequate view of the entire femoral head to assess and correct the bony deformity.…”

mentioning

confidence: 99%

“…In both cases, capsular suture at the end of the surgical procedure is preferred to restore the capsule back to the original anatomy. 6,[10][11][12][13] It is imperative to ascertain the correct balance between the maximum protection of the capsule and the broadest view of the joint. We describe a new arthroscopic technique that allows a complete view of the joint, with full protection of the capsuloligamentous complex.…”

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confidence: 99%

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

Fiz

Sánchez

Pérez

et al. 2014

Arthroscopy Techniques

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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.

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Retracted: Anatomy of the hip capsule and pericapsular structures: A cadaveric study

2015

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The anatomical literature contains relatively little qualitative or quantitative information regarding the anatomy of the hip joint capsule and its relationship to the surrounding pericapsular structures. We aimed to provide a detailed description of the anatomy of these relationships in a cadaveric study. Dissections of 11 nonpaired, fresh-frozen cadaveric hips were performed, documenting capsular dimensions and attachments to pericapsular structures including the rectus femoris, gluteus minimus, iliocapsularis, and piriformis and short external rotator muscles. Tendon footprints of these pericapsular muscles were measured, as well as their distance from reproducible bony landmarks. The thickest portion of the hip capsule is posterosuperiorly and superiorly near its acetabular origin, while the thinnest portion is posteriorly and posteroinferiorly near its femoral insertion. The piriformis has no capsular contribution; however, the reflected head of the rectus femoris, gluteus minimus, iliocapsularis, and external rotator tendons all demonstrate consistent capsular adhesions. There are complex associations among these structures, yet the surrounding layers of the capsule are confluent in predictable relationships. Knowledge of the intricate relationship between the hip capsule and pericapsular structures presented here will be useful for surgeons as they perform the precise and specific capsular releases required by various operative procedures. This study also provides information that can lead to further biomechanical, radiographic, and clinical studies on these structures.

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Capsular Management During Hip Arthroscopy: From Femoroacetabular Impingement to Instability

Cited by 176 publications

References 55 publications

Current concepts and trends for operative treatment of FAI: hip arthroscopy

Current concepts and trends for operative treatment of FAI: hip arthroscopy

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

Retracted: Anatomy of the hip capsule and pericapsular structures: A cadaveric study

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