Capsular management is a critical component of hip arthroscopy access that allows for adequate exposure of the hip joint. Today we'll walk through the basics of capsular management and demonstrate how to manipulate the capsule effectively. During hip arthroscopy access, the capsulotomy is an imperative step that allows access into the joint for central compartment work. There are several types of capsulotomies depending on the amount of exposure required, which include periportal, interportal, and T-shaped capsulotomies. The periportal is the least capsular invasive and involves only cannular punctures during the procedure. Typically, for labral repair, an interportal capsulotomy seen here is utilized, which uses an arthroscopic blade that creates an incision in the capsule between the anterior lateral and anterior portal. Of note, it is imperative to not perform the capsulotomy too close to the acetabular rim as a cuff of the capsule should remain for capsular closure. Prior to work on labrum or the acetabulum, this cuff of capsule closest to the acetabular rim is tagged with a polyethylene suture for retraction. Capsular tagging with suture for retraction allows for the necessary visualization needed for compartment work while also protecting the capsule from iatrogenic damage. During intraarticular work, in cases requiring femoroplasty and CAM-type impingement, focus can be turned towards the peripheral compartment. To access the proximal femoral neck, further exposure can be obtained with the T-type capsulotomy. Starting midline between the interportal incision, the capsulotomy is taken down distally and perpendicular to the previous interportal incision. This is taken down distally until the capsular reflection. After this cut, a suture is passed through each side of the vertical incision for retraction during the femoroplasty. Prior to closure, retraction sutures can be removed accordingly. The femoroplasty can now be performed with the proper retraction and exposure. Following the femoroplasty, a dynamic exam is performed under fluoroscopy to evaluate the resection in multiple views. Capsular placation is performed to close the capsule, which is done in reverse order in terms of entry. The vertical segment of the T-capsulotomy is closed first, then subsequent throws across the interportal capsulotomy will be done as sutures are tied as the cameras slowly advance back out of the hip capsule. Between 4-5 sutures can be used to properly placate the capsule. A spinal needle can be used to palpate the capsular repair to ensure that the repair was properly placated.

hip arthroscopy

capsulotomy techniques

labral repairs

femoroplasty

capsular closure