AANA Lab Course 905 - 2nd Annual Fellows Course-Peripheral Compartment_ Extensile Interportal Capsulotomy and Repair, Joshua D. Harris, M.D.

Peripheral Compartment_ Extensile Interportal Capsulotomy and Repair, Joshua D. Harris, M.D.

Pdf Summary

This presentation by Dr. Joshua Harris highlights the crucial role of capsular management in hip arthroscopy, specifically focusing on interportal and T capsulotomies and their repair. Capsular integrity is essential for joint stability, and failure to properly manage the capsule can lead to recurrent dislocations, as shown by historical cases where most capsules were left unrepaired.<br /><br />Key takeaways include the necessity of appropriate patient selection and skillful surgical execution for successful outcomes. Dr. Harris advocates for performing a T capsulotomy in about 95% of cases and routinely repairing both interportal and T capsulotomies in about 95% of his practice, with exceptions for certain patient profiles such as those with tight or stiff hips, older age, or no radiographic signs of arthritis (Tonnis grade 0).<br /><br />Capsular repair techniques include side-to-side suturing, capsular subtraction, capsular shift, augmentation, and reconstruction, with careful consideration to not overuse capsular repairs in cases of more than mild dysplasia or connective tissue disorders like Ehlers-Danlos syndrome, which may not respond predictably to repair.<br /><br />Meticulous surgical tips include making the capsular cut large enough to visualize pathology without unnecessary enlargement, avoiding zona incisions, careful capsular preparation to preserve tissue, and using external rotation recoil as a test for repair adequacy. Postoperative rehabilitation protocols should minimize extension and external rotation to protect repair integrity.<br /><br />Diagnostic aids such as MR arthrography and examination under anesthesia help guide management decisions. When necessary, capsular augmentation or reconstruction using graft materials (e.g., bovine Achilles or dermal grafts) should be considered.<br /><br />Overall, Dr. Harris emphasizes that proper capsular management—comprising careful patient selection, precise surgical technique, and structured rehabilitation—is vital to optimize patient outcomes in hip arthroscopy and to avoid complications like instability and incomplete healing.

Keywords

hip arthroscopy

capsular management

interportal capsulotomy

T capsulotomy

capsular repair

joint stability

patient selection

surgical technique

capsular augmentation

postoperative rehabilitation