Arthroscopic Capsular Reconstruction of the Hip With Acellular Dermal Extracellular Matrix: Surgical Technique

Abstract

Atraumatic instability of the hip has become an increasingly studied occurrence in recent years. There are several established surgical techniques that help restore stability of the native hip joint. In some cases, these procedures are not an option. As the phenomenon has become recognized more frequently, a greater number of revision surgeries are warranted in patients with ligamentous laxity. A durable solution for irreparable microinstability needs to be formulated to address this vulnerable patient demographic. We describe the surgical technique for capsular reconstruction with acellular dermal extracellular matrix.

Fig 1

The Suture Tak anchor (Arthrex) is implanted into the femoral neck using the distal lateral accessory portal while being visualized with the camera in the anterolateral portal. This anchor will be used for the attachment of the Arthroflex (Arthrex) graft to the capsular defect zone. (A, Knotless Suture Tak Anchor [Arthrex]; DC, distal capsule; FN, femoral neck.)

Fig 2

Distance between the anchors is measured by the use of an arthroscopic measuring tool (Arthex) to plan for appropriate allograft dimensions. (AC, acetabulum; FH, femoral head; S, suture.)

Fig 3

The Arthroflex graft (Arthrex) is prepared according to the measurements taken arthroscopically. The graft is cut to be 1 cm beyond the distances between the anchors.

Fig 4

The Arthroflex (Arthex) graft is shuttled through the DLAP into the left hip joint while pulling the posts of the proximal sliding knots. (AL, anterolateral portal into which the camera is inserted to visualize the procedure; DLAP, distal lateral accessory portal; LH, left hip.)

Fig 5

The graft is sutured to the anchors placed in each of the 4 corners of the capsular defect. (AG, Arthroflex graft [Arthrex]; CR, capsular remnant.)

Fig 6

The reconstructed capsule is then assessed on all facets. (AG, Arthroflex graft [Arthrex].)