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Hip arthroscopy, capsular suture, capsulotomy, femoral-acetabular impingement
Background and aim of the work: In the last decade, arthroscopic treatment of hip diseases has significantly spread and evolved and currently it represents the gold standard for the treatment of femoral- acetabular impingement. In the recent years, the function of the joint capsule (and therefore the results of an arthroscopic capsulotomy) has been hugely developed, opening a heated debate. The Literature is still torn about the need for a capsular suture, but more recent studies are more oriented in its execution at the end of the surgical procedure. According to these recent studies, the joint capsule performs an essential function of primary stability, and its closure is therefore necessary to restore the native anatomy and physiology. Nevertheless, capsular management remains a controversial topic. This is a retrospective study with the aim of assessing the influence of capsular suture on the patient’s functional outcome in a cohort of patients with femoral-acetabular impingement arthroscopically treated. Hypothesis: Our hypothesis is that an adequate capsular suture positively influences the patient’s functional outcome. Methods and Results: 50 patients treated with hip arthroscopy for femoral-acetabular impingement have been retrospectively enrolled at the Orthopaedic Clinic of Academic Hospital of Udine during a period of two-years (2017-2018); collected data have been analysed and compared with a retrospective model. Patients have been divided into two equivalent groups, 25 treated with capsular suture, 25 without performing the suture. Patient’s post-operative functional outcome has been analysed using the modified Harris Hip Score (mHHS), the Non-Arthritic Hip Score (NAHS) and the Hip Outcome Score-Sport Scale (HOS-SS). The functional outcome in patients where capsular sutures were performed was better than in non-sutured patients, in all three analysed scales. Conclusions: Capsular suture with a single side-to-side stitch at the end of the procedure can positively influence the patient’s functional outcome.
2. Ran Atzmon, Zachary T Sharfman, Barak Haviv, Michal Frankl, Gilad Rotem, Eyal Amar, Michael Drexler, Ehud Rath, Does capsular closure influence patient-reported outcomes in hip arthroscopy for femoroacetabular impingement and labral tear?, Journal of Hip Preservation Surgery, Volume 6, Issue 3, August 2019,
3. Benjamin G. Domb, Christine E. Stake, Zachary J. Finley, Tian Chen, Brian D. Giordano, Influence of capsular repair versus unrepaired capsulotomy on 2-year clinical outcomes after arthroscopic hip preservation surgery. Arthroscopy. 2015 Apr; 31(4): 643–650.
4. Baha P, Burkhart TA, Getgood A, Degen RM. Complete capsular repair restores native kinematics after interportal and T-capsulotomy. Am J Sports Med. 2019 May;47(6):1451-8. Epub 2019 Apr 4.
5. Westermann, R. W., Bessette, M. C., Lynch, T. S., & Rosneck, J. (2018). Does Closure of the Capsule Impact Outcomes in Hip Arthroscopy? A Systematic Review of Comparative Studies. The Iowa orthopaedic journal, 38, 93–99.
6. Nho, S.J., Beck, E.C., Kunze, K.N. et al. Contemporary Management of the Hip Capsule During Arthroscopic Hip Preservation Surgery. Curr Rev Musculoskelet Med 12, 260–270 (2019).
7. Nam D, Osbahr DC, Choi D, Ranawat AS, Kelly BT, Coleman SH. Defining the origins of the iliofemoral, ischiofemoral, and pubofemoral ligaments of the hip capsuloligamentous complex utilizing computer navigation. HSS J. 2011;7(3):239–43.
8. Ito H, Song Y, Lindsey DP, SafranMR, Giori NJ. The proximal hip joint capsule and the zona orbicularis contribute to hip joint stability in distraction. J Orthop Res. 2009;27(8):989–95.
9. Domb BG, Philippon MJ, Giordano BD. Arthroscopic capsulotomy, capsular repair, and capsular plication of the hip: relation to atraumatic instability. Arthroscopy 2013; 29: 162–73.
10. Kuhns BD, Weber AE, Levy DM et al. Capsular management in hip arthroscopy: an anatomic, biomechanical, and technical review. Front Surg 2016; 3: 13.
11. Martin HD, Savage A, Braly BA et al. The function of the hip capsular ligaments: a quantitative report. Arthroscopy 2008; 24: 188–95.
12. Alzaharani A, Bali K, Gudena R et al. The innervation of the human acetabular labrum and hip joint: an anatomic study. BMC Musculoskelet Disord 2014; 15: 41.
13. Ekhtiari S, de Sa D, Haldane CE et al. Hip arthroscopic capsulotomy techniques and capsular management strategies: a systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25: 9–23.
14. Di Benedetto P, Barbattini P, Povegliano L, et al. Extracapsular vs standard approach in hip arthroscopy. Acta Biomed. 2016;87(suppl 1):41-45.
15. Pierannunzii L., Di Benedetto P., Carulli C., Fiorentino G., Munegato D., Panascì M, Santori N. (2019). Mid-term outcome after arthroscopic treatment of femoroacetabular impingement: development of a predictive score. HIP International, 29(3), 303–309.
16. Rachel M. Frank, Simon Lee, Charles A. Bush-Joseph, Bryan T. Kelly, Michael J. Salata, Shane J. Nho, Improved outcomes after hip arthroscopic surgery in patients undergoing T-capsulotomy with complete repair versus partial repair for femoroacetabular impingement: a comparative matched-pair analysis. Am J Sports Med. 2014 Nov; 42(11): 2634–2642.
17. Eyal Amar, Yaniv Warschawski, Thomas G. Sampson, Ehud Atoun, Ely L. Steinberg, Ehud Rath, Capsular closure does not affect development of heterotopic ossification after hip arthroscopy. Arthroscopy. 2015 Feb; 31(2): 225–230.
18. Asheesh Gupta, Carlos Suarez-Ahedo, John M. Redmond, Michael B. Gerhardt, Bryan Hanypsiak, Christine E. Stake, Nathan A. Finch, Benjamin G. Domb, Best Practices During Hip Arthroscopy: Aggregate Recommendations of High-Volume Surgeons. Arthroscopy. 2015 Sep; 31(9): 1722–1727
19. Abrams GD, Hart MA, Takami K et al. Biomechanical evaluation of capsulotomy, capsulectomy, and capsular repair on hip rotation. Arthroscopy 2015; 31: 1511–7.
20. Myers CA, et al. Role of the acetabular labrum and the iliofemoral ligament in hip stability: an in vitro biplane fluoroscopy study.AmJ Sports Med. 2011;39 (Suppl): 85S–91S
21. Khair MM, et al. The effect of capsulotomy and capsular repair on hip distraction: a cadaveric investigation. Arthroscopy. 2017;33(3): 559–65
22. Ryan J.A., Meyers K.N., DiBenedetto P., Wright T.M. and Haas S.B. (2010) Failure of the Patellar Tendon with the Patella Everted Versus Noneverted in a Matched-Pair Cadaver, Model. HSS Journal , 6, 134-137.