Contemporary Management of the Hip Capsule During Arthroscopic Hip Preservation Surgery

Abstract

Purpose of review: The importance of the hip capsule and its effect on hip biomechanics, functional outcomes, and hip arthroscopy success rates has been demonstrated in recent studies. These results have led to a shift in management of the hip capsule, where an increasing number of surgeons routinely perform complete capsular closure. The purpose of this review is to highlight recent studies evaluating the hip capsule and describe contemporary capsular management and repair.

Recent findings: Biomechanical studies using cadaveric models have demonstrated that complete capsular closure restores hip distraction, rotation, and extension forces back to the native, intact state. Additionally, capsular closure by plication results in quantifiable intraarticular volume reduction, which increases hip stability, particularly in cases of patulous capsule and hypermobility. Clinical studies have demonstrated superior patient-reported functional outcomes and decreased failure rates when undergoing hip arthroscopy with comprehensive capsular management for femoroacetabular impingement surgery. Complete capsular management, including appropriate capsulotomy and subsequent closure, is critical for restoring biomechanical properties of the hip, ensuring high survivorship and improving functional outcomes. This review provides an update on the effects of contemporary capsular management as well as a detailed description of efficient T-capsulotomy and comprehensive capsule closure via plication.

Keywords: Capsular management; Capsular plication; Femoroacetabular impingement syndrome; Hip arthroscopy.

Fig. 1

Illustration demonstrating various types of capsular incisions for intraarticular access during hip arthroscopy. Capsular incision types include periportal incisions (left), interportal capsulotomy (center), and T-capsulotomy (right)

Fig. 2

Illustration demonstrating partial (left) vs complete (right) repair of a T-capsulotomy

Fig. 3

Illustration demonstrating the circle model of the hip joint. The top two illustrations depict a hip without a femoral cam lesion, which can go through full range of motion without impingement and subsequent subluxation. In the bottom illustration, an anterior cam lesion causes anterior hip impingement resulting in posterior subluxation and microinstability of the hip

Fig. 4.

Illustration demonstrating an interportal capsulotomy created in order to access the central compartment of the intraarticular hip joint. This incision allows for improved access and direct visualization of acetabular pathology

Fig. 5

Illustration demonstrating creation of the vertical limb of a T-capsulotomy. This incision is created in order to augment access the peripheral compartment of the intraarticular hip joint. The incision allows for improved access and direct visualization of femoral pathology

Fig. 6

Illustration demonstrating commencement of capsulotomy closure, which begins with closure of the vertical limb followed by interportal capsule closure. Depending various factors including hip range of motion, capsular integrity, capsular laxity, and plication may be used to ensure biomechanical stability of the hip