Evidence of capsular defect following hip arthroscopy

Hip Preservation Center, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College, Rush University, Chicago, IL, USA, .
Knee Surgery Sports Traumatology Arthroscopy (Impact Factor: 3.05). 07/2013; 22(4). DOI: 10.1007/s00167-013-2591-z
Source: PubMed


The purpose of this study is to identify the incidence of capsular defects in patients undergoing revision hip arthroscopy.
A radiographic and anatomical analysis of MR arthrograms of patients undergoing revision arthroscopy was performed to assess for the presence of capsular defect. Intra-operative images and findings were reviewed. Patients with persistent cam and pincer lesions were excluded.
From October 2011 to October 2012, 25 patients underwent revision hip arthroscopy surgery, and 9 patients met our inclusion criteria. Within this series, all patients had post-surgical capsular irregularities and seven patients (78 %) had radiographic evidence of capsule and iliofemoral defects on MR arthrogram. Gross capsular defects were confirmed at revision surgery in two patients.
The findings of this study demonstrate post-surgical radiographic and anatomical evidence of capsular defects in a select group of patients following hip arthroscopy. LEVEL OF EVIDENCE: IV.

18 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Increase of range of motion and pain reduction for pain limited movement of the hip joint by arthroscopic arthrolysis of the peripheral compartment. Painful primary or secondary restriction of movement of the hip joint with adhesive capsulitis and after previous surgery or additional arthroscopically treatable intra-articular changes. Extensive periarticular ossification, severe arthrofibrosis and advanced arthritis of the hip. Arthroscopy of the peripheral compartment of the hip, initially using a lateral portal for the arthroscope and an anterolateral portal for instruments. After expansion of the portal entry site with a shaver and/or HF applicator and removal of scar tissue between the capsule and femoral neck, the capsule is reduced from anterolateral to anteromedial. After exchange of arthroscope and working portal, the lateral and dorsolateral arthrolysis is done. Administration of nonsteroidal anti-inflammatory drugs for prophylaxis of heterotopic ossifications. Thrombosis prophylaxis with heparin. Mobilization with full weight bearing. Intensive physiotherapeutic exercises for at least for 6 weeks and if needed for 12 postoperative weeks. After arthroscopic (n=38) or open (n=11) hip surgeries, 49 revision hip arthroscopies were performed from January 2009 to August 2013. Arthrolysis in the described technique was performed if adhesions were present. In 19 of these cases, a limitation of at least 30 % for one direction of movement was present pre-operatively. The following average values were obtained for the range of motion (preoperative/postoperative/increase): flexion 94A degrees/128A degrees/34 A degrees, abduction 18A degrees/40A degrees/22A degrees, internal rotation of 8A degrees/20A degrees/12A degrees, external rotation 18A degrees/38A degrees/20A degrees.
    Operative Orthopädie und Traumatologie 08/2014; 26(4). DOI:10.1007/s00064-013-0285-9 · 0.72 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Hip capsular management after hip arthroscopic surgery for femoroacetabular impingement (FAI) is controversial.
    The American Journal of Sports Medicine 09/2014; 42(11). DOI:10.1177/0363546514548017 · 4.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The hip capsule has been identified as an important static stabilizer of the hip joint. Despite the intrinsic bony stability of the hip socket, the capsule plays a key role in hip stability, particularly at the extremes of motion, and the iliofemoral ligament is the most important stabilizer in extension and external rotation. Patients who do not undergo capsular closure or plication may continue to complain of hip pain and dysfunction postoperatively, likely because of microinstability or muscle invagination into the capsular defect, and high-resolution magnetic resonance imaging or magnetic resonance arthrography will identify the capsular defect. Seen primarily in the revision setting, capsular defects can cause recurrent stress at the chondrolabral junction. An attempt at secondary closure can be challenging because of capsular limb adherence to the surrounding soft tissues. Therefore reconstruction may be the only possible surgical solution for this problem. We describe our new surgical technique for arthroscopic hip capsular reconstruction using iliotibial band allograft.
    Arthroscopy Techniques 02/2015; 4(1). DOI:10.1016/j.eats.2014.11.008
Show more