Purpose
To measure and compare the torque to failure and stiffness of the capsular repair
construct consisting of four-suture simple stitches to a two-figure of eight stitches
repair construct in external rotation following an interportal capsulotomy.
Methods
Six pairs of fresh-frozen cadaveric hemipelves were divided into two capsular repair
groups. All hips underwent a 40-mm interportal capsulotomy from the 12 o’clock position
to the 3 o’clock position. Capsular closure was performed using either the two stitches
in a figure of eight or with four simple stitches. Afterward, each hemipelvis was
securely fixed to the frame of a mechanical testing system with the hip in 10° of
extension and externally rotated to failure. Significance was set at P < .05.
Results
The average failure torque was 86.2 ± 18.9 N·m and 81.5 ± 8.9 N·m (P = .57) for the two stitches in a figure of eight and the four simple stitches, respectively.
Failure stiffness was also not statistically different between groups and both capsular
closure techniques failed at similar degrees of rotation (P = .65).
Conclusion
Hip capsular repair using either the four simple stitch or two-figure of eight configurations
following interportal capsulotomy demonstrated comparable failure torques and similar
stiffness in a cadaveric model.
Clinical Relevance
Adequate and comprehensive capsular management in hip arthroscopy is critical. Capsular
repair following capsulotomy in femoroacetabular impingement surgery has been associated
with higher patient-reported outcomes when compared to capsulotomy without repair.
Therefore, determining which capsular closure construct provides the higher failure
torque is important.
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References
- Mid to long-term outcomes of hip arthroscopy: A systematic review.Arthroscopy. 2021; 37: 1011-1025
- Hip arthroscopy for femoroacetabular impingement in adolescents: 10-year patient-reported outcomes.Am J Sports Med. 2021; 49: 76-81
- Survivorship and outcomes 10 years following hip arthroscopy for femoroacetabular impingement: Labral debridement compared with labral repair.J Bone Joint Surg Am. 2017; 99: 997-1004
- Prospective analysis of hip arthroscopy with 10-year followup.Clin Orthop. 2010; 468: 741-746
- Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: A prospective randomized study.Arthroscopy. 2013; 29: 46-53
- In search of the spherical femoroplasty: cam overresection leads to inferior functional scores before and after revision hip arthroscopic surgery.Am J Sports Med. 2018; 46: 2061-2071
- Indications and outcomes of secondary hip procedures after failed hip arthroscopy. A systematic review.Arthroscopy. 2020; 36: 1992-2007
- Contemporary management of the hip capsule during arthroscopic hip preservation surgery.Curr Rev Musculoskelet Med. 2019; 12: 260-270
- Should the capsule be repaired or plicated after hip arthroscopy for labral tears associated with femoroacetabular impingement or instability? A systematic review.Arthroscopy. 2018; 34: 303-318
- The pie-crusting technique for capsular management during hip arthroscopy.Arthrosc Tech. 2019; 8: e93-e96
- Periportal capsulotomy: Technique and outcomes for a limited capsulotomy during hip arthroscopy.Arthroscopy. 2019; 35: 1120-1127
- Pie-crusting capsulotomy provides similar visualization with increased repair stiffness compared to a T-capsulotomy: A biomechanical study.Arthroscopy. 2021; 37: 2832-2837
- Achievement of meaningful clinical outcomes is unaffected by capsulotomy type during arthroscopic treatment of femoroacetabular impingement syndrome: Results from the Multicenter Arthroscopic Study of the Hip (MASH) Study Group.Am J Sports Med. 2021; 49: 713-720
- Capsular management techniques and hip arthroscopy.Sports Med Arthrosc Rev. 2021; 29: 22-27
- complete capsular repair restores native kinematics after interportal and t-capsulotomy.Am J Sports Med. 2019; 47: 1451-1458
- Hip capsular closure: a biomechanical analysis of failure torque.Am J Sports Med. 2017; 45: 434-439
- Hip arthroscopy capsular closure: The figure of eight technique.Arthrosc Tech. 2017; 6: e505-e509
- Capsular repair during hip arthroscopy demonstrates restoration of axial distraction resistance in an in vivo intraoperative testing model.J Bone Joint Surg Am. 2021; 103: 1977-1985
- A quantitative analysis of hip capsular thickness.Knee Surg Sports Traumatol Arthrosc. 2015; 23: 2548-2553
- Arthroscopic capsulotomy, capsular repair, and capsular plication of the hip: Relation to atraumatic instability.Arthrosc J Arthrosc Relat Surg. 2013; 29: 162-173
- Biomechanical assessment of hip capsular repair and reconstruction procedures using a 6 degrees of freedom robotic system.Am J Sports Med. 2017; 45: 1745-1754
- Hip capsular management in patients with femoroacetabular impingement or microinstability: A systematic review of biomechanical studies.Arthroscopy. 2021; 37: 2642-2654
- A quantitative assessment of the insertional footprints of the hip joint capsular ligaments and their spanning fibers for reconstruction.Clin Anat. 2014; 27: 489-497
- Vertical extension of the T-capsulotomy incision in hip arthroscopic surgery does not affect the force required for hip distraction: Effect of capsulotomy size, type, and subsequent repair.Am J Sports Med. 2018; 46: 3127-3133
- Methods to improve arthroscopic and orthopaedic biomechanical investigations: a few of our favorite things.Arthroscopy. 2019; 35: 2967-2969
Article info
Publication history
Published online: June 21, 2022
Accepted:
May 31,
2022
Received:
January 23,
2022
Footnotes
See commentary on page 3149
The authors report the following potential conflicts of interest or sources of funding: M.B.B. reports consulting and speaker fees from Stryker, Smith & Nephew, and Vericel, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2022 by the Arthroscopy Association of North America
