MRI Evaluation of Repaired Versus Unrepaired Interportal Capsulotomy in Simultaneous Bilateral Hip Arthroscopy

Abstract

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Two-Year Patient-Reported Outcomes for Patients Undergoing Revision Hip Arthroscopy with Capsular Incompetency

“…Previous studies have demonstrated that evidence of capsular closure is observed in both patients with capsular repair and leaving the capsule intact after interportal capsulotomy. Using MRI, Strickland et al 45 compared 15 hips with capsular closure of interportal capsulotomies with 15 with the capsule intact and demonstrated that both demonstrated healing with a contiguous appearance at 24 weeks after surgery. The limitations of radiographic studies such as this include the underpowered analysis caused by a small number of patients in the study group, and based their findings on radiographic evidence that is unable to capture capsular adhesions and small capsular incompetency that can cause refractory pain.…”

Arthroscopic partial capsulotomy for exposure and treatment of hip disease

“…Domb et al (23) performed a systematic review of ~4,000 cases of hip arthroscopic surgeries that used various degrees of capsule resection treatment of femoroacetabular impingement without patching or overlapping and identified no case of iatrogenic instability. Strickland et al (24) reported that repaired and unrepaired capsulotomy sites progressed to healing with a continuous appearance on MRI by 24 weeks post-operatively. Dippmann et al (25) performed a multicenter study to compare capsular closure with non-capsular closure during hip arthroscopy in Danish patients with femoroacetabular impingement, and concluded that whether the hip capsule should be closed during hip arthroscopy or not should be decided based on the biomechanical pre-conditions of the patients.…”

Hip Joint Capsular Anatomy, Mechanics, and Surgical Management

“…It is essential to understand that capsular characteristics and mechanical properties of the hip with pathological conditions are different (i.e., a thicker, stiffer capsule) than a healthy joint 38,50,52 ; thus, the need for full capsular closure may depend on several other confounding factors (e.g., age, sex, osseous anatomy, and muscle function) [53][54][55] . More importantly, since unrepaired capsulotomies have been shown to heal within 24 weeks postoperatively 56 , and completely resecting the iliofemoral ligament does not destabilize the native hip 43 , there is evidence that not all capsulotomies need to be repaired after The findings of in vitro cadaveric studies on the effects of capsular conditions and surgical stages, outlining the contributions of the interportal capsulotomy 5,7,8,10,11,14,46 and T-capsulotomy 6,11,14,15,46 and the effects of instability 7,[11][12][13]16,47 , effusion arthroscopy, especially when capsular contracture may be part of the pathological process. It is still unclear what leads to inherent or iatrogenic instability; thus, if the native head size is not substantially reduced or altered, capsular repair in the setting of a small arthroscopic capsulotomy may not be necessary in the otherwise congruent and stable hip 4,54,56 .…”

“…More importantly, since unrepaired capsulotomies have been shown to heal within 24 weeks postoperatively 56 , and completely resecting the iliofemoral ligament does not destabilize the native hip 43 , there is evidence that not all capsulotomies need to be repaired after The findings of in vitro cadaveric studies on the effects of capsular conditions and surgical stages, outlining the contributions of the interportal capsulotomy 5,7,8,10,11,14,46 and T-capsulotomy 6,11,14,15,46 and the effects of instability 7,[11][12][13]16,47 , effusion arthroscopy, especially when capsular contracture may be part of the pathological process. It is still unclear what leads to inherent or iatrogenic instability; thus, if the native head size is not substantially reduced or altered, capsular repair in the setting of a small arthroscopic capsulotomy may not be necessary in the otherwise congruent and stable hip 4,54,56 . Recently, a periportal capsulotomy technique (i.e., midanterior and anterolateral portal dilations) showed that it can preserve the iliofemoral ligament, without necessitating capsular closure 57,58 ; however, it is unclear if this applies to dysplastic hips 59 .…”