Surgical Technique: Arthroscopic Capsular Reconstruction

Abstract

The hip, a ball and socket joint, provides excellent functional mobility to the lower extremity while at the same time imparting excellent inherit stability. Various extra-articular and intraarticular pathologies occur in the hip such as femoroacetabular impingement (FAI), dysplasia, traumatic instability, labral tears, osteoarthritis, and capsular pathology, among others. When conservative efforts of treatment have been exhausted, hip arthroscopy has evolved over the past few decades to provide aminimally invasive option to treat such disease processes. Unlike other superficial joints in which arthroscopy is performed, the hip is a deep structure with a relatively thick capsule; in order to facilitate movement of arthroscopic instruments, a capsulotomy is necessary. The hip capsule is made up of some of the strongest ligaments in the body that provide a fundamental role in joint stability and functional mobility. Although primary capsular pathology requiring intervention is rare, iatrogenic capsular pathology either through insufficient repair or capsulectomy is a cause of the failed primary hip arthroscopy. During revision hip arthroscopy, a systematic approach is necessary to address common causes of pain and dysfunction including residual bony impingement, adhesions, labral pathology or deficiency, and/or capsular defects. Capsular deficiency can be addressed through repair or reconstruction dependent on the size of capsular defect and tissue mobility. When primary repair is not possible, capsular reconstruction techniques using allograft have demonstrated promising early outcomes.