Capsular Management of the Hip During Arthroscopic Acetabular Chondral Resurfacing: Pearls, Pitfalls, and Optimal Surgical Technique

Abstract

Treatment of hip joint chondral damage is a well-recognized aspect of the arthroscopic management of femoroacetabular impingement syndrome. Hip chondral resurfacing has evolved from microfracture to different forms of cartilage grafting, all with variable long-term outcomes. Recent literature has focused on techniques using different cartilage sources (native and synthetic products) that are available for clinicians to choose from during hip arthroscopy. None of the published reports on cartilage grafts have commented on hip joint capsular management as part of the procedure. This is likely because of the increased difficulty of capsular closure in the dry arthroscopic environment required for graft stabilization. However, potential iatrogenic hip instability induced by an unrepaired interportal capsulotomy can be detrimental to the existing joint architecture and possibly to the cartilage graft. This article presents a stepby-step approach, including tips and pearls, for capsular closure during arthroscopic acetabular chondral resurfacing with BioCartilage (Arthrex, Naples, FL). This method is a safe and reproducible way to close the joint capsule during chondral resurfacing in patients undergoing hip preservation that can potentially enhance the chances of a successful outcome.

Dual Cannula Combined With Modified Shoelace Continuous Capsular Closure Technique in Hip Arthroscopic Surgery

“…In recent studies, the prevailing approach for Joint capsular closure in most cases is choosing standard capsular closure, that is interrupted suture, sewing 2 to 4 needles intermittently on the left and right sides of the Joint capsule incision. 7 However, the risk of injuring blood vessels and nerves during operation also increases due to repeated suture operations in the portals. On the basis of this, we modified the shoelace suture technique and combined it with the dual cannula technique (Clear Cannula System; DePuy Mitek).…”

“… 11 Recent studies usually choose standard capsular closure, that is interrupted suture, sewing 2 to 4 needles intermittently on the left and right sides of the joint capsule incision to close the joint capsule. 7 However, the article also points out that the risk of standard capsular closure lies in the following; (1) There exists a risk of suture strand entanglement, incomplete knotting, air knot, and even breakage. (2) An excessively wide needle pitch can easily prevent the capsule from closing completely.…”