AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-Capsular Management – Capsulotomy, Capsular Windows, Exposure and Repair_Plication

Capsular Management – Capsulotomy, Capsular Windows, Exposure and Repair_Plication_Reconstruction-Michael B. Banffy, M.D.

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Pdf Summary

This presentation by Dr. Michael Banffy from Cedars Sinai – Kerlan Jobe Institute focuses on hip capsular management, specifically regarding exposure, capsulotomy, repair, plication, and reconstruction in the context of hip arthroscopy and instability.<br /><br />Key points include:<br /><br />- Among 82 studies reviewed, inter-portal capsulotomy was performed 55% of the time, T-capsulotomy 24%, with complete capsular repair in 50%, partial repair in 20%, and no repair in 22%. Iatrogenic hip instability was rare (0.3%) but likely underreported.<br /><br />- Complete capsular repair is associated with improved sport-specific outcomes and reduced pain and instability symptoms.<br /><br />- Patients with capsular insufficiency commonly experience persistent groin pain, apprehension, giving way during activities involving rotational and axial loads, especially with external rotation and hyperextension. Symptoms often have an insidious onset and gradual worsening.<br /><br />- Micro-instability may be pre-existing or develop postoperatively, with conditions such as hip dysplasia or femoroacetabular impingement (FAI), and anatomical variants contributing to instability.<br /><br />- The hip capsule does not always heal well after surgery; poor healing or non-healing leads to instability. Capsular plication and repair can improve outcomes by reducing pain and improving joint mechanics.<br /><br />- Revision surgeries for symptomatic instability post-arthroscopy that included capsular closure with other pathology correction showed significant improvements in modified Harris Hip Score (mHHS) and Hip Outcome Scores (HOS-ADL and HOS-Sports).<br /><br />- There are documented cases of iatrogenic dislocations after hip arthroscopy, attributed to capsular insufficiency, emphasizing the importance of proper capsular management.<br /><br />- In cases where the capsule is deficient or absent, reconstruction options must be considered.<br /><br />The presentation highlights the critical role of the iliofemoral ligament in maintaining hip stability and advocates for diligent capsular management to prevent and treat hip micro-instability and improve patient outcomes after hip arthroscopy.

Keywords

hip capsular management

hip arthroscopy

capsulotomy

capsular repair

capsular plication

hip instability

micro-instability

iliofemoral ligament

hip reconstruction

iatrogenic hip dislocation