Arthroscopic Hip Capsular Plication With Augmentation Using a Bioinductive Collagen Implant

Figures

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  Fig 1. Patient positioning on a Pivot Guardian Distraction System (Stryker, Kalamazoo, MI). This is a post-free setup that places the patient in approximately 15° of Trendelenburg while resting on a friction pad that uses the patient’s body weight for countertraction. This reduces the perineal complications of the traditional post tables; however, the angle of the pelvis must be taken into consideration when establishing portals to adjust for the change in joint orientation.

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  Fig. 2. Arthroscopic portals used in hip arthroscopy of a left hip in the supine position. For this procedure, we routinely use the AL as the primary viewing portal the MA portal as the working portal and the DALA portal to deliver the bioinductive implant. (AL, anterior lateral portal; ANT, anterior portal; ASIS, anterior superior iliac spine; DALA, distal anterior lateral accessory portal; MA, mid-anterior portal; PL, posterior lateral portal.)

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  Fig 3. Tagging stitch placed in the capsule via the MA portal while viewing from the AL portal in a right hip. This stitch can be secured outside of the portal with a clamp with to retract the capsular tissue aiding in the visualization of the capsulolabral junction, potentially decrease the size of the capsulotomy and to prevent iatrogenic injury to the tissue with subsequent introduction and removal of arthroscopic instruments. (AL, anterior lateral portal; MA, mid-anterior portal.)

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  Fig 4. Viewing from the AL portal with (A) sutures tapes placed in capsulotomy for plication are (B) tied to perform inferior capsular shift as described in Fig 4. and subsequently (C) bioinductive implant placed and secured in place with PLA staples via the MA portal. (AL, anterior lateral portal; MA, mid-anterior portal; PLA, polylactic acid.)

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  Fig 5. Capsular closure performed using an inferior shift mechanism to accentuate the screw home mechanism of the iliofemoral ligament. This is achieved by placing the medial (acetabular side) passes superior to the lateral (femoral side) passes in either a simple or figure-of-eight fashion. Reproduced with permission.5

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  Fig 6. Outside view of the delivery device inserted through DALA portal before deployment in the peripheral compartment. A half-pipe cannula sled device is placed into the portal first to assist in the delivery of the implant. A cannula is also placed in the MA portal to help facilitate the delivery of the PLA staple device when securing the implant to the capsular tissue. The arthroscope is placed in the standard AL viewing portal. (AL, anterior lateral portal; DALA, distal anterior lateral accessory portal; MA, mid-anterior portal; PLA, polylactic acid.)