Capsular Management During Hip Arthroscopy: From Femoroacetabular Impingement to Instability

Interportal capsulotomy of right hip. The camera is in the proximal anterolateral portal, and the beaver blade introduced from the modified anterior portal. The capsulotomy is initially extended from the modified anterior portal medially to the level of the psoas tendon. It is connected to the proximal anterolateral portal entry. The camera is then positioned through the modified anterior portal and the capsulotomy extended posteriorly with the beaver blade positioned in the proximal anterolateral portal. The capsulotomy is variably extended based on the labral and chondral injury; however, it can be extended posteriorly to the level of the piriformis tendon.

T-capsulotomy of right hip. The camera is positioned in the modified anterior portal. The intermuscular plane between the gluteus minimus and iliocapsularis is identified. The blade is introduced through the distal anterolateral portal and used to incise the capsule in this plane, and it can be extended distally to the level of the intertrochanteric line as needed. The capsular flaps are preserved and retracted to allow for complete exposure of the cam deformity and direct visualization of the retinacular vessels.

Capsular repair of right hip. The camera is positioned in the modified anterior portal. The T-cut can then be anatomically repaired by use of 3 or 4 side-to-side stitches placed from distally to proximally. The medial flap is captured with a suture passer placed in the distal anterolateral portal. The lateral flap is captured with a tissue penetrator placed in the proximal anterolateral portal. This allows for side-to-side tissue approximation, suture shuttling, and repair.