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Capsule Closure of Periportal Capsulotomy for Hip Arthroscopy.

ABSTRACT: Multiple approaches for management of the hip capsule during hip arthroscopy for femoroacetabular impingement syndrome have been reported. Capsular closure is advocated in the setting of larger capsulotomies, including interportal and T-capsulotomies, to reduce the risk of iatrogenic instability or microinstability of the hip. The periportal capsulotomy technique has been described for conservative management of the capsule that would not necessitate closure. However, hip arthroscopy for patients with ligamentous laxity or joint hypermobility may warrant capsule closure or plication even with use of conservative capsulotomy techniques. We introduce a technique for closure of periportal capsulotomy as a means to repair or plicate the hip capsule in the at-risk hypermobile patient.

SUBMITTER: Alrabaa RG

PROVIDER: S-EPMC9244759 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:PurposeTo assess the correlation between changes in hip capsule morphology with improvements in patient-reported outcome (PRO) scores after arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) using the periportal capsulotomy technique.MethodsTwenty-eight patients with cam morphology FAIS (without arthritis, dysplasia, or hypermobility) were prospectively enrolled before arthroscopic labral repair and femoroplasty through periportal capsulotomy (anterolateral/midanterior portals) without closure. Patients completed the Hip Disability and Osteoarthritis Outcomes Score (HOOS) and had nonarthrographic 3T magnetic resonance imaging (MRI) scans of the affected hip before and 1 year after surgery. Anterior capsule thickness, posterior capsule thickness, anterior-posterior capsule thickness ratio, and proximal-distal anterior capsule thickness ratio were measured on axial-oblique MRI sequences. Pearson correlation coefficients were calculated to determine the association between hip capsule morphology and PRO scores.ResultsPostoperative imaging showed that for all 28 patients (12 female), labral repairs and capsulotomies had healed within 1 year of surgery. Analysis revealed postoperative decreases in anterior hip capsule thickness (1395.4 ± 508.4 mm3 vs 1758.4 ± 487.9 mm3; P = .003) and anterior-posterior capsule thickness ratio (0.92 ± 0.33 vs 1.12 ± 0.38; P = .02). Higher preoperative anterior-posterior capsule thickness ratio correlated with lower preoperative scores for HOOS pain (R = -0.43; P = .02), activities of daily living (ADL) (R = -0.43; P = .02), and sport (R = -0.38; P = .04). Greater decrease from preoperative to postoperative anterior-posterior capsule thickness ratio correlated with greater improvement for HOOS pain (R = -0.40; P = .04), ADL (R = -0.45; P = .02), and sport (R = -0.46; P = .02).ConclusionsPeriportal capsulotomy without closure demonstrates capsule healing by 1 year after arthroscopic FAIS treatment. Changes in hip capsule morphology including decreased anterior-posterior capsule thickness ratio after surgery may be correlated with improvements in patient pain, function, and ability to return to sports.Level of evidenceLevel II, prospective cohort study.

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Capsule Closure of Periportal Capsulotomy for Hip Arthroscopy.

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