AANA Lab Course 914 - Advanced Hip Arthroscopy-Capsular Management; Repair to Reconstruction, Benjamin Domb, MD

Capsular Management; Repair to Reconstruction, Benjamin Domb, MD

Pdf Summary

Dr. Benjamin G. Domb, Chair of the American Hip Institute Research Foundation and Fellowship Director, presents a comprehensive overview of capsular management in hip arthroscopy, emphasizing the importance of adequate surgical exposure, capsule preservation, and appropriate closure techniques. He outlines capsulotomy approaches—such as I, L, T, and H types—with preference for the “I” type due to excellent central compartment access while preserving key capsule structures like the zona orbicularis.<br /><br />Capsular preservation during surgery is critical, avoiding unnecessary tissue removal, and careful use of shavers and electrocautery is recommended. Capsular closure is generally advised for most patients, with shift/plication techniques reserved for cases involving connective tissue disorders (e.g., Ehlers-Danlos), ligamentous laxity, borderline dysplasia, or athletes needing high flexibility. The iliofemoral ligament’s biomechanical role in hip stability is highlighted, with literature showing that capsulotomy can increase joint laxity, which capsular plication may reverse.<br /><br />Data on arthroscopic treatment of borderline dysplasia, including in adolescent populations, indicate positive patient-reported outcomes and pain reduction post-capsular plication. Studies of athletes undergoing capsular plication also show significant functional improvement. Comparative research with a 5-year follow-up suggests routine capsular repair may reduce conversion to total hip arthroplasty (THA) and maintain better outcomes than leaving capsulotomy unrepaired.<br /><br />Indications for capsular reconstruction include factors predisposing to instability such as borderline dysplasia, increased femoral anteversion, ligamentous laxity, prior labral or capsular compromise, and insufficient capsule tissue. Additional considerations include ligamentum teres reconstruction and iliopsoas lengthening, only after restoring static stabilizers. For complex cases, peri-acetabular osteotomy may be necessary.<br /><br />In conclusion, Dr. Domb advocates for sufficient capsulotomy size, capsule preservation using retraction techniques, and routine capsular closure—via repair or plication—to enhance surgical outcomes and hip joint stability in most cases.

Keywords

hip arthroscopy

capsular management

capsulotomy techniques

capsule preservation

capsular closure

iliofemoral ligament

capsular plication

borderline dysplasia

ligamentous laxity

peri-acetabular osteotomy