Hip Arthroscopy Capsular Closure: The Figure of Eight Technique

Aoki, Stephen K.; Karns, Michael R.; Hananouchi, Takehito; Todd, Dane C.

doi:10.1016/j.eats.2016.10.021

Cited by 18 publications

(8 citation statements)

References 21 publications

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“…The third measurement of the hip capsule (right scheme and picture in Fig. 3, closured capsule) was done after the joint capsule was sutured twice using the figure of eight technique [6]. The probe was inserted through a tiny gap of the sutured capsule to measure the capsule resistance.…”

Section: Methodsmentioning

confidence: 99%

Quantitative evaluation of capsular and labral resistances in the hip joint using a probing device

Hananouchi

Aoki

2019

BME

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BACKGROUND: Probing to assess conditions of hip capsule and acetabular labrum is performed by “surgeons’ feeling”. OBJECTIVE: We investigated the resistance of the labrum and the hip capsule quantitatively while they were pulled with a probing device. METHODS: With the probing device in which a strain gauge was embedded, ten fresh frozen specimens of the pelvis and proximal femur were measured in each three surgical steps, (1) closed, (2) open, (3) closured for the capsule, and (1) intact, (2) cut, (3) repaired for the labrum. RESULTS: The mean highest resistance levels for the capsule were 9.8 N at the closed capsule, 4.1 N at the open capsule, and 8.5 N at the closured capsule. The values at the three phases were statistically significant. The mean highest resistance levels for the hip labrum were 8.2 N at the labrum intact, 4.0 N at the labrum cut, and 7.9 N at the labrum repair. The values at the three phases were also statistically significant. CONCLUSIONS: Since the quantitatively measured values in each three steps were significantly different, the values with the probing device might be useful to evaluate whether the lesion of the soft tissue exists and whether some surgical intervention works well.

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Section: Methodsmentioning

confidence: 99%

Quantitative evaluation of capsular and labral resistances in the hip joint using a probing device

Hananouchi

Aoki

2019

BME

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“…In select patients such as those with borderline hip dysplasia or ligamentous laxity, we will additionally plicate the capsule. We have also evolved into utilizing a figure of eight technique for all of our capsular stitches [61]. For those patients who have failed capsular repair or have thin anteromedial capsule, we will place an anchor in the anterior subspine region to reinforce the capsular repair.…”

Section: Authors Preferred Techniquementioning

confidence: 99%

Surgical Treatment of Labral Tears: Debridement, Repair, Reconstruction

Woyski

Mather

2019

Curr Rev Musculoskelet Med

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Purpose of Review With the rapid growth of hip arthroscopy over the past decade, new treatment paradigms as well as recognition of new disease states have sprung forth. The ability to perform complex arthroscopic procedures of the hip such as labral augmentation and reconstruction is essential for hip arthroscopists in the revision setting, with patient selection and indications for various labral treatments the key driver for improved short-and mid-term clinical outcomes. Recent Findings Current techniques have been developed to address disease states where the labrum is either unstable, torn, deficient, or otherwise incompetent. Many early reports focused on the description of these techniques with new literature reporting short-and mid-term outcomes. A few of these have demonstrated improved outcomes with a contemporary arthroscopy with emphasis on capsule preservation and repair. Summary Studies have demonstrated that labral repair has improved outcomes over labral debridement, with results of labral reconstruction in a revision approaching those of labral repair. In addition, newer reports have shown significantly improved outcomes and survivorship with capsule repair and therefore should be included in every hip arthroscopy.

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“…Capsular closure was performed by implementing previously described techniques using either simple sutures or figure-of-8 sutures for capsular closure. 3,37 The senior author switched from simple sutures to figure-of-8 sutures in April 2016; as such, patients who underwent surgery after this date had capsular closure using figure-of-8 sutures. Regardless of the suture method used, complete closure of the capsulotomy and full repair of capsular tissue were attempted during each revision procedure.…”

Section: Methodsmentioning

confidence: 99%

Clinical and Radiographic Presentation of Capsular Iatrogenic Hip Instability After Previous Hip Arthroscopy

et al. 2020

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Background: The clinical and radiographic features of iatrogenic hip instability following hip arthroscopy have been described. However, the prevalence of presenting symptoms and associated imaging findings in patients with hip instability has not been reported. Purpose: To detail the prevalence of clinical and magnetic resonance arthrogram (MRA) findings in a cohort of patients with isolated hip instability and to determine midterm patient-reported outcomes in this patient population. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed patients from 2014 to 2016 who underwent an isolated capsular repair in the revision hip arthroscopy setting. Patients were excluded if they underwent any concomitant procedures, such as labral repair, reconstruction, femoral osteoplasty, or any other related procedure. Several clinical data points were reviewed, including painful activities, mechanical symptoms, subjective instability, Beighton scores, axial distraction testing (pain, toggle, and apprehension), and distractibility under anesthesia. Patient-reported outcomes—including modified Harris Hip Score, Hip Outcome Score–Sports Subscale, Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function Computer Adaptive Test, and a return patient hip questionnaire—were collected pre- and postoperatively. Pre-revision radiographs were obtained, and lateral center-edge angle and alpha angle were measured on anteroposterior and frog-leg lateral views, respectively. Pre-revision MRAs were reviewed and evaluated for capsular changes. Capsular changes were defined as follows: 0, normal; 1, capsular redundancy; 2, focal capsular rent; and 3, gross extravasation of fluid from the capsule. Results: A total of 31 patients met inclusion criteria (5 male, 26 female; 14 right and 17 left hips). The mean age of patients was 36 years (range, 20-58 years). Overall, 27 (87%) reported hip pain with activities of daily living, and 31 (100%) experienced pain with sports or exercise. In addition, 24 (77%) had at least 1 positive finding on axial distraction testing. All patients had evidence of capsular changes on review of pre-revision MRAs. Out of 31 patients, 23 (74%) were available for follow-up at a minimum of 3.3 years and a mean ± SD of 4.6 ± 0.8 years. On average, modified Harris Hip Score improved by 20.3, Hip Outcome Score–Sports Subscale by 25.1, and PROMIS Physical Function Computer Adaptive Test by 6.4. Additionally, 20 (87%) patients reported improved or much improved physical ability, and 18 (78%) reported improved or much improved pain. Conclusion: The current study suggests that patients with hip instability demonstrate high rates of pain with activities of daily living and exercise, positive findings on axial distraction testing, and evidence of capsular changes on magnetic resonance imaging. Furthermore, these patients improve with revision surgery for capsular repair at midterm follow-up.

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Hip Arthroscopy Capsular Closure: The Figure of Eight Technique

Cited by 18 publications

References 21 publications

Quantitative evaluation of capsular and labral resistances in the hip joint using a probing device

Quantitative evaluation of capsular and labral resistances in the hip joint using a probing device

Surgical Treatment of Labral Tears: Debridement, Repair, Reconstruction

Clinical and Radiographic Presentation of Capsular Iatrogenic Hip Instability After Previous Hip Arthroscopy

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