Outside-In Capsulotomy of the Hip for Arthroscopic Pincer Resection

Abstract

Hip surgical techniques have evolved significantly, transitioning from open techniques to arthroscopic techniques. Hip arthroscopy has many advantages over open techniques, including reduced trauma to surrounding tissues, reduced risk of infection, and improved patient-reported outcome measures. Hip arthroscopic techniques are now commonly used for pathologies such as femoroacetabular impingement (FAI). FAI can include cam, pincer, or mixed impingement. Through hip arthroscopy, FAI may be treated with a femoroplasty and acetabuloplasty along with addressing any labral pathology that may exist. Owing to the capsule playing an integral role in hip stability, surgeons are now mindful of the initial approach and closure on completion of the intra-articular procedure. The most common approach for capsulotomy is the inside-out approach. However, this approach can be difficult in patients with a large pincer deformity. The authors describe an outside-in approach to arthroscopic hip capsulotomy. This capsular approach helps protect the labrum and articular cartilage while preserving capsular tissue.

Indirect Head of the Rectus Femoris Tendon as a Graft for Segmental Hip Labral Reconstruction: An Anatomic, Radiographical, and Biomechanical Study in Comparison With Iliotibial Labral Reconstruction

“…In the setting of a large pincer deformity where it is difficult to gain proper traction, it is preferred to access the joint in an outside-in fashion to avoid damaging the labrum or femoral head cartilage. 28 The measurements provided in the current study on the IHRF can be used to guide an outside-in approach during anatomic localization of the intraportal capsulotomy 1 cm distal to the labrum with no additional portal created. Ultimately, these findings corroborate previous anatomic descriptions found in the literature regarding the IHRF tendon 2,13,30 and are reinforced by radiological evidence presented in this study.…”

The Modified Longitudinal Capsulotomy by Outside-In Approach in Hip Arthroscopy for Femoroplasty and Acetabular Labrum Repair—A Cohort Study

“…This approach took the place of puncture approach by seldinger technique in traditional hip arthroscopy. In recent years, studies of hip arthroscopy using the outside-in approach has increased gradually [ 4 , 7 , 8 , 9 , 10 , 11 ]. This approach can make the operation process quite easy for surgeons performing hip arthroscopy, and all surgical procedures can be achieved without special surgical instruments for hip arthroscopy, or the intraoperative fluoroscopy.…”

“…Recently, some surgeons proposed a new approach for hip arthroscopy, the so-called outside-in approach [ 4 , 7 , 8 , 9 , 10 , 11 ]. By this approach, an extracapsular space anterior to the hip joint is established first.…”

Treatment of Coxa Profunda With Open Surgical Hip Dislocation, Rim Resection, Cam Resection, and Labral Reconstruction

“…4,5 An outside-in technique and potentially acetabuloplasty-first approach may additionally be required to enter the central compartment. 6,7 Because of these challenges, an open technique via a surgical hip dislocation approach has been suggested. 5 Although the use of arthroscopic hip surgery has continued to rise over the past decades, with ever-expanding indications, surgical hip dislocation was initially used as the gold standard treatment for FAIS.…”