Hip Capsular Reconstruction Made Easy: The Timing and the Technique

Figures

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  Fig 1. Viewing from the anterolateral portal, an arthroscopic image of the left hip in a 20-year-old woman, having undergone acetabuloplasty and labral refixation with 2 anchors (arrows), as well as femoroplasty (asterisk) via the capsulotomy, which was not closed.

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  Fig 2. Anteroposterior radiograph showing anterior dislocation of left hip.

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  Fig 3. (A-C) Three-dimensional images of the left hip reveal relatively normal bony geometry.

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  Fig 4. Standard portals for left hip. Viewing is performed from the anterolateral portal (AL) with a 70° scope. The anterior portal (A) is the working portal with an 8.5-mm Clear-Trac cannula. Anchors are placed from a percutaneous distal site (P), ensuring adequate divergence of the anchors at the acetabular rim.

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  Fig 5. Viewing the left hip from the anterolateral portal, the trapezoidal capsular defect (arrows) is identified with the femoral head (FH) exposed.

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  Fig 6. Viewing the left hip from the anterolateral portal, the Arthrex arthroscopic measurement probe (transparent arrow) is used to measure the length of the capsular defect margin (black arrows).

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  Fig 7. Viewing the left hip from the anterolateral portal, the acetabular rim (AR) has been lightly decorticated and a 1.8-mm Q-Fix suture anchor has been placed at the margins of the capsular defect (arrows).

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  Fig 8. Viewing the left hip from the anterolateral portal, a graft (asterisk) has been delivered into the joint and preliminarily secured with a single half-hitch for the suture in the lateral-most anchor (black arrows), while the medial anchor knot is tied with a knot pusher (transparent arrow).

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  Fig 9. Viewing the left hip from the anterolateral portal, the Speed Stitch device (arrow) is poised to grab the capsule (asterisk) at the margin of the defect.

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  Fig 10. Viewing the left hip from the anterolateral portal, the suture has been passed through the graft (asterisk) with a Truepass device (arrow).

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  Fig 11. View of the left hip from the anterolateral portal. (A) A 70° Accupass device (arrow) is penetrating the graft (black asterisk) close to the junction with the native capsule (white asterisk). (B) The tip of the Accupass (black arrow) has now been delivered up through the capsule (asterisk), delivering the monofilament suture (white arrow) to be used to shuttle in the No. 2 Ultrabraid suture.

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  Fig 12. Viewing the left hip from the anterolateral portal, the completed capsular reconstruction with a 1.5-mm ArthroFLEX decellularized dermis patch (asterisk) is being probed.