Modified Capsulotomy in Hip Arthroscopy for Femoroacetabular Impingement Syndrome

Background: Capsulotomy during hip arthroscopy provides access to both the central and peripheral compartments to address labral, femoral, or acetabular pathology, with interportal and T-type techniques being the most common. Interportal capsulotomy entails minimal capsular damage, while T-type offers greater exposure when needed at the cost of an additional capsular incision. We present the modified capsulotomy technique, which offers a compromise by adding a distal puncture along the femoral neck rather than a full perpendicular incision, thereby enabling distal femoral osteochondroplasty with less capsular disruption. Indications: Indications for the modified capsulotomy include severe femoroacetabular impingement syndrome (FAIS), labral reconstruction, and extensive chondral lesions where extensive exposure of the femur and acetabular rim is necessary. Technique Description: The modified capsulotomy technique involves a combination of an interportal capsulotomy and a distal puncture capsulotomy approximately 4 cm distal to the original incision. Arthroscopic instruments are placed through the modified capsulotomy for femoral osteochondroplasty, debridement, and synovectomy. Results: A small number of studies have investigated outcomes after specific capsulotomy techniques, and none have included the modified capsulotomy, given its recent use in practice. Outcomes after interportal and T-type capsulotomies have previously been reported at short-term follow-up, showing no significant differences in pain, most patient-reported outcomes, or in the achievement of clinically significant outcomes (CSOs) between the 2 techniques. However, some studies reported that patients undergoing T-type capsulotomy demonstrated lower postoperative modified Harris Hip Score at 2-year follow-up. Additionally, CSO achievement tended to be lower after T-type capsulotomy, although the difference was not statistically significant. Discussion/Conclusion: The use of the modified capsulotomy allows for a far distal femoral osteochondroplasty without the extension of a T-type capsulotomy. This prevents the need for an additional incision through the hip capsule. In combination with capsular plication, the capsule's integrity is preserved. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.