Capsular Management with Traction-Assisted T-Capsulotomy Technique During Hip Arthroscopy

ABSTRACT: Capsular management, from the initial capsulotomy to capsule closure is essential to success in hip arthroscopy to achieve optimal outcomes. Although an interportal capsulotomy is typically sufficient for resection of proximal cam lesions and for performing central compartment procedures, T-capsulotomy is usually performed when large cam deformity needs to be addressed because it provides a broader field of view. The purpose of this Technical Note is to summarize each step of capsule management and to define a traction-assisted T-capsulotomy technique that allows for accurate placement of the T-capsulotomy while also avoiding damage to the articular cartilage. Technique Video Video 1 We describe our technique for capsular management with a traction-assisted T-capsulotomy technique during a right sided hip arthroscopy. After periportal capsulotomy around the anterolateral (AL) portal, interportal capsulotomy is carried out toward the periportal capsulotomy line through the modified mid-anterior portal (mMAP). Traction sutures are placed on the superior aspect of the interportal capsulotomy to create a working space for central compartment arthroscopy. Labral repair is performed, and traction is released. The iliofemoral ligament, which T-capsulotomy will be performed parallel to, is identified and dissected. Traction sutures are passed on the distal portion of the interportal capsulotomy for a proximal to distal view. T-capsulotomy is now performed in a controlled manner at the midline of and parallel to the femoral neck using an arthroscopic blade. The view after a half T-capsulotomy is assessed, and a decision is made to perform a full T-capsulotomy to perform the desired cam resection. Additional traction stitches are passed along the medial and lateral limbs of the T-capsulotomy for an enhanced view. After adequate cam resection, primary closure of the T-capsulotomy is performed. This is followed by closure of the horizontal component of the capsulotomy, which may be performed with a different suture passer.

SUBMITTER: Gursoy S 

PROVIDER: S-EPMC8556758 | biostudies-literature |

REPOSITORIES: biostudies-literature