Hip Capsular Plication With Crossed Mattress Stitch Configuration for a Revision Hip Arthroscopy in the Setting of Capsular Insufficiency.
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ABSTRACT:
SUBMITTER: Browning RB
PROVIDER: S-EPMC8355413 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Biomechanical and clinical studies have shown that the hip joint capsule plays an important role in maintaining stability and hip mechanics, including rotation and translation. The recent literature has shown that capsule closure after hip arthroscopy helps to restore stability. Without restoration of the native anatomy, the hip joint may translate when patients engage in activities that place force across the hip, leading to either microinstability or frank dislocation. The purpose of this note is to describe our preferred technique of capsular closure or plication during hip arthroscopy.
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Project description:In the past decade, the number of hip arthroscopy procedures has exponentially increased, primarily for the treatment of femoroacetabular impingement syndrome and labral lesions. As the techniques have evolved, so has the acknowledgment of the potential complications, including iatrogenic instability that may result from soft-tissue laxity, subtle dysplastic morphologies, or residual defects from capsulotomies in which the capsular closure is insufficient. In most cases, direct capsular repair or plication can be performed at the conclusion of the procedure; however, larger defects, poor-quality tissue, or cases of gross ligamentous laxity may require reconstruction or augmentation. In such instances, several options exist. The purpose of this technical note is to describe a capsular repair augmentation with a bioinductive implant during revision hip arthroscopy.
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Project description:The most commonly reported reasons for persistent hip pain after hip arthroscopy are residual femoroacetabular impingement, dysplasia and dysplasia variants, or extra-articular impingement. There are some cases in which the underlying osseous pathomorphology has been appropriately treated, and the cause of persistent hip pain can be soft-tissue injuries such as chondrolabral tears or capsular abnormalities. Capsular defects after hip arthroscopy may suggest an alteration of the biomechanical properties of the iliofemoral ligament and lead to iatrogenically induced hip instability. There are a growing number of biomechanical and clinical studies showing the importance of capsular management during hip arthroscopy. We describe the workup, examination under anesthesia, diagnostic arthroscopy, and technique of capsular plication for iatrogenic instability of the hip.
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Project description:Hip arthroscopy has recently become a common procedure to treat central and peripheral hip pathology. Capsulotomies are necessary in these procedures, and negotiating adequate visualization, as well as capsular preservation, is a challenge. We describe a capsular suspension technique that allows for adequate visualization of the central and peripheral compartments while facilitating preservation of the native hip capsule. This technique eliminates the need for additional personnel for retraction, potentially decreases iatrogenic hip injury, eliminates the need for excessive capsular debridement, and allows for capsular closure under minimal tension.
| S-EPMC4680905 | biostudies-other
Project description:The utility of hip arthroscopy has recently progressed beyond diagnostic to therapeutic purposes addressing central and peripheral compartment pathologies. Capsulotomy provides freedom of visualization and instrumentation. The contribution to hip stability of both dynamic and static hip structures is not fully understood. However, both basic science biomechanical and clinical outcome studies have exhibited a relevant role of the capsule in hip stability. Though rare, iatrogenic post-arthroscopy subluxation and dislocation have been reported. Therefore many surgeons have cautioned against aggressive capsulotomy or capsulectomy without repair, because of the potential for precipitation of iatrogenic hip instability. We typically perform a "T" capsulotomy and recommend complete capsular closure in conjunction with labral repair and osseous femoral and acetabular treatment. A safe, efficient, and effective method to accomplish complete capsular closure is presented to reduce iatrogenic postoperative hip instability.
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Project description:With advancements in arthroscopic techniques and instrumentation, hip arthroscopy has become an increasingly used technique to treat soft-tissue and osseous pathologies about the hip. Patient predisposition to labral and capsular injuries can present as femoroacetabular impingement or hip dysplasia, sometimes in combination. Capsular management continues to be a topic of debate, with capsular repair becoming the standard of care in most cases. Furthermore, in cases of borderline dysplasia and microinstability, considerations for not only capsular repair but with plication has shown significant clinical success. Although plication in this setting has shown promise, given a 20% failure rate, we suggest capsular augmentation to bolster the repair. We present a technique of capsular augmentation using a bioinductive collagen implant (Smith & Nephew) to improve the capsular integrity following repair and plication. The benefits of this implant are easy delivery through standard arthroscopic portals and secure fixation to the capsular tissue. These implants have a proven track record in the shoulder and serve as a scaffold for improved tissue quality, and their application in hip arthroscopy has potential by increasing the integrity of the capsular repair. Future studies are needed to address the clinical outcomes of this technique.
| S-EPMC7372598 | biostudies-literature
Project description:Capsulotomy is typically performed during arthroscopic treatment for femoroacetabular impingement. As the frequency of hip arthroscopy continues to expand rapidly, increased attention is being paid to the implications of interportal capsulotomy and the need for repair. To minimize the risk of postoperative instability, capsular closure has been recommended to restore the anatomy and biomechanical function of the capsule. We present a reliable, efficient, and effective method for arthroscopic closure of the interportal capsulotomy after hip arthroscopy.
| S-EPMC4739034 | biostudies-literature
Project description:Hip arthroscopy techniques have continued to evolve for femoroacetabular impingement and other intra-articular pathologies. However, there is still debate about the importance and technique of routine capsular closure. We present an efficient and reliable technique for creating a watertight capsular closure to prevent iatrogenic macro and microinstability. This Technical Note details our stepwise technique using figure of eight sutures to obtain a complete and secure capsular closure.
| S-EPMC5443352 | biostudies-literature
Project description:PurposeTo identify clinical and radiographic factors associated with failure of revision hip arthroscopy (RHA).MethodsA database was used to identify patients who underwent primary hip arthroscopy and revision hip arthroscopy (RHA) from January 2007 to December 2017 for the indication of femoroacetabular impingement and failure of the index procedure, respectively. The primary outcome was defined as the change, or difference, in the preoperative to postoperative alpha angle between patients with successful RHA and those with failed RHA. Failure was defined as reoperation on the operative hip for any indication or a modified Harris Hip Score (mHHS) of less than 70 at the 1-year postoperative time point. All patients had a minimum of 2 years' follow-up from the date of revision hip surgery. Patients with a history of revision were divided into those with failed revisions and those with successful revisions. The inclusion criteria for failed revision included a history of subsequent revision surgery (or arthroplasty) or an mHHS of less than 70 at final follow-up.ResultsThe study included 26 patients, comprising 8 (31%) with failed RHA and 18 (69%) with successful revision. The failure group showed a significantly smaller decrease in the alpha angle with surgery, measured on the Dunn view, compared with the success group. When the preoperative alpha angle was held constant, each 1° increase in the difference between the preoperative and postoperative alpha angles achieved during surgery was associated with a 17% decrease in the odds of failure. Patients included in the success group had both a higher preoperative mHHS (44.2 ± 8.6 vs 34.7 ± 9.6) and a higher postoperative mHHS (83.2 ± 8.3 vs 62.3 ± 14.2) than patients with failed RHA. There was a statistically significant difference in the frequency of patients who achieved the patient acceptable symptomatic state of +74.0 between the failure (25%) and success (83%) groups; 88% of patients in the failure group met the minimal clinically important difference, whereas 100% of patients in the success group (n = 18) met it.ConclusionsComplete resection of cam lesions as determined by changes in the alpha angle, anterior offset, and head-neck ratio when measured on the Dunn 45° view correlates with positive clinical outcomes after RHA.Level of evidenceIII, Retrospective Comparative Study.
| S-EPMC7879168 | biostudies-literature
Project description:Hip arthroscopy is commonly performed for the treatment of femoroacetabular impingement and labral pathology. When arthroscopy for femoroacetabular impingement is performed, a capsulotomy is often utilized to maximize access and allow for improved visualization. When an extended interportal or T capsulotomy is performed, the iliofemoral ligament is transected, which can lead to micro or gross instability. The purpose of this Technical Note is to describe an alternative approach to the standard T capsulotomy using a pie crusting technique, which provides improved visualization of the femoral head-neck junction during the femoroplasty without the need for an extended capsulotomy and can also serve to create venting holes that prevent hematoma formation within the capsule.
| S-EPMC6408742 | biostudies-literature