Capsular Preservation Using Suture Suspension Technique in Hip Arthroscopy for Femoroacetabular Impingement

Abstract

This article describes the use of sutures to enhance visualization while protecting the capsule in both the central and peripheral compartments during hip arthroscopy. We describe first a technique to preserve the proximal capsule cuff while working in the central compartment and then an alternative to the T-capsulotomy while maintaining excellent visualization of the peripheral compartment during femoroplasty of cam-type femoroacetabular impingement. By use of suture suspension of the capsule, multiple goals are achieved: The integrity of the proximal capsule cuff is maintained while aiding in visualization of the central compartment; the iliofemoral ligament is spared, which plays a critical role in preventing microinstability; the necessary space is created to obtain adequate visualization of the peripheral compartment for complete femoroplasty; and operative time is reduced because creation and subsequent repair of the T-capsulotomy can be avoided.

Hip arthroscopy for femoroacetabular impingement

“…Capsule management is one of the most debated topics in hip arthroscopy. Some authors recommend making large T-shaped capsulotomies, 37 while others opt for very small incisions in the capsule with special sutures or devices to help elevate it, 38 and others use a minimally invasive iliofemoral ligament-sparing capsulotomy. 39 Closure of the capsulotomy is also a matter of debate although most surgeons tend to repair large capsulotomies for fear of post-operative instability.…”