2015 ISAKOS Biennial Congress ePoster #807
Arthroscopic Reconstruction of the Hip Capsule: Surgical Technique
Christiano A.C. Trindade, MD, Vail, CO UNITED STATES
Gregory Alan Sawyer, MD, Providence, RI UNITED STATES
Karen K. Briggs, MPH, MBS, Vail, CO UNITED STATES
Kiyokazu Fukui, MD, PhD, Kahoku-Gun JAPAN
Marc J. Philippon, MD, Vail, CO UNITED STATES
Steadman Philippon Research Institute, Vail, CO, USA
FDA Status Cleared
Summary: The technique of arthroscopic capsular reconstruction provides a surgical solution to a challenging post-operative complication. Seen primarily in the revision setting, capsular defects can lead to micro-instability and cause recurrent stress at the chondrolabral junction.
The hip capsule, consisting of the iliofemoral, ilioischial, and pubofemoral ligaments, has been identified as an important static stabilizer of the hip joint. During routine hip arthroscopy, management of the capsule at the conclusion of the procedure is trending towards either capsular closure or capsular plication. Patients who have not undergone closure of their capsulotomy may continue to complain of hip pain and dysfunction post-operatively, likely secondary to micro-instability. High resolution MRI or MR arthrogram will identify the capsular defect and
can take place with the patient regarding treatment options.
Reconstruction of the hip capsule has been described for cases of instability following total hip arthroplasty with good results. There are currently no reports in the literature on capsular reconstruction in the native hip joint. We would like to describe our new surgical technique for arthroscopic hip capsular reconstruction using iliotibial band allograft.
Seven patients have been referred to the senior author (MJP) for continued pain and dysfunction following previous hip arthroscopy. A 3T MRI was performed identifying a large capsular defect. These patients underwent revision arthroscopy with capsular reconstruction using iliotibial band allograft. In the joint, the defect was sized, and the graft was prepared on the back table. The allograft tissue is folded three times upon itself to provide comparable thickness to the native hip capsule. Suture anchors are placed in the subspinal region of the acetabulum and the allograft is secured to the bone. Side-to-side absorbable sutures are used to secure the allograft to the residual native capsule, completing the reconstruction. At the conclusion of the procedure, it is vital to gently take the hip through a range of motion to determine the necessary post-operative precautions to protect the graft.
This technique of arthroscopic capsular reconstruction provides a surgical solution to a challenging post-operative complication. Seen primarily in the revision setting, capsular defects can lead to micro-instability and cause recurrent stress at the chondrolabral junction. Most frequently occurring following procedures with large capsulotomies without closure, an attempt at secondary closure can be challenging due to capsular limb adherence to the surrounding soft tissues. Therefore, reconstruction maybe the only possible surgical solution. Although only performed in seven revision hip arthroscopies to date, we feel that this arthroscopic technique has great promise to restore stability to the hip joint.
Arthroscopic hip capsular reconstruction using iliotibial band allograft is a promising technique for treatment of micro-instability in the revision setting.