AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-Capsular Reconstruction-Derek Ochiai, M.D.

Capsular Reconstruction-Derek Ochiai, M.D.

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This presentation by Dr. Derek Ochiai at the 2020 AANA Chief Residents and Fellows Course focuses on arthroscopic hip capsular reconstruction using human dermal allograft to address severe capsular deficiency.<br /><br />The hip capsule plays a critical role as a static stabilizer of the hip joint. Historically, capsulotomy and capsulolectomy during hip arthroscopy were seen as benign, but current evidence emphasizes preserving and repairing the capsule to maintain hip stability. Hip capsule management has evolved to prioritize prevention of injury by preserving the capsule and repairing it post-procedure.<br /><br />Certain conditions, including Ehlers-Danlos Syndrome (EDS) and hyperlaxity syndromes, predispose patients to hip instability and capsular deficiency. Moreover, capsular deficiency often results iatrogenically from previous hip arthroscopy procedures. In cases where the capsule is deficient and irreparable, arthroscopic capsular reconstruction using human dermal allograft or iliotibial band allograft has demonstrated restoration of capsular strength in cadaveric studies, validating this approach.<br /><br />A case study detailed a 33-year-old female with genetically-confirmed EDS who underwent three prior hip arthroscopy procedures but continued to experience microinstability and subluxation. Imaging showed a large capsular defect without hip dysplasia, and surgical findings revealed a thin, nonfunctional labrum and a significant lateral capsular defect. Capsular reconstruction was employed to restore stability.<br /><br />The presentation concludes that hip capsular reconstruction offers a viable treatment for irreparable capsular defects, emphasizing the importance of the hip capsule in joint stability. Dr. Ochiai also encourages surgeons passionate about hip preservation to engage with professional societies such as AANA and ISHA for further education and collaboration.<br /><br />In summary, this work highlights the evolving appreciation of the hip capsule’s role, the risks of iatrogenic deficiency, and the effective use of dermal allografts for capsular reconstruction in complex hip instability cases.

Keywords

arthroscopic hip capsular reconstruction

human dermal allograft

hip capsule stability

capsular deficiency

Ehlers-Danlos Syndrome

hip microinstability

hip arthroscopy complications

iliotibial band allograft

capsular repair techniques

hip preservation societies