The effectiveness of peripheral compartment first access and periportal capsulotomy technique for arthroscopic management of femoroacetabular impingement: A prospective case series

Abstract

OBJECTIVE: The aim of this study was to evaluate the functional results of hip arthroscopy for femoroacetabular impingement (FAI) performed via the periportal capsulotomy technique combined with capsular thinning and peripheral compartment first access. METHODS: This prospective study included 34 patients (20 female, 14 male; mean age = 32.3 ± 12.5 years) treated for combined type FAI and labral tears between January 2016 and January 2018. In radiographic evaluation, center-edge angle (CEA) and alpha angle were measured preoperatively and postoperatively. Patients' functional status was assessed at 3, 6, 12, and 24 months using the modified Harris Hip Score (mHHS), Hip Disability and Osteoarthritis Outcome Score - Activities of Daily Living (HOOS-ADL), and Hip Disability and Osteoarthritis Outcome Score - Sports-Specific Subscale (HOOS-SSS), and visual analog scale (VAS). RESULTS: The mean alpha angle decreased from 55.5°±2.9° preoperatively to 48.3° ± 2.6° postoperatively. The mean CEA decreased from 39.2° ± 3.0° preoperatively to 32.9° ± 2.6° postoperatively. The mean duration of surgery was 96.7 ± 21.1 minutes; the mean traction time was 45.5 ± 14.6 minutes. The mean mHHS at the 3rd , 6th, 12th, and 24th months showed a statistically significant increase compared to the preoperative value (P < 0.05). The mean HOOS-ADL and HOOS-SSS at the postoperative 3rd, 6th, and 12th months demonstrated a statistically significant increase compared to the preoperative values (P < 0.05). The same scores measured at the 24th month, however, did not demonstrate a significant increase. The mean VAS scores at the 3rd and 6th months postoperative illustrated a significant decrease compared to the preoperative values (P < 0.05) whereas this significant decrease was not observed at the 12th and 24th months. CONCLUSION: The combined technique of periportal capsulotomy and capsular thinning used in this study seems to be a reliable surgical method with favorable functional results, a low complication rate, and a low risk of hip instability. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.