Main Article Content
Hip arthroscopy, capsular suture, capsulotomy, femoral-acetabular impingement, athletes
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 athletes. The function of the joint capsule has been better understood, opening a heated debate.
The aim of the present retrospective study is to assess the influence of different capsulotomy techniques and a possible capsular suture role on the patient's functional outcome in a cohort of patients with femoral-acetabular impingement arthroscopically treated.
36 patients (competitive athletes) treated with hip arthroscopy for femoral-acetabular impingement have been retrospectively enrolled during a period of two years (2016-2018). Patients have been divided into three equivalent groups, 12 without a suitable capsular management (T-Capsulotomy technique), 12 performing a Longitudinal Capsulotomy but without a final suture and 12 treated with a conservative Longitudinal Capsulotomy and a capsular suture. Patient’s post-operative functional outcome has been analysed using the modified Harris Hip Score (mHHS), the Hip Outcome Score-Activity of Daily Living (HOS-ADL) and the Hip Outcome Score-Sport Scale (HOS-SS). Return to sport.
In our series there was no statistically significant difference in functional scores, however longitudinal capsulotomy seems to be associated with a higher percentage of return to sports activity (91,6% vs 75%).
The new longitudinal shape capsulotomy technique and a capsular suture with a single side-to-side stitch at the end of the procedure in athletes can positively influence the patient's functional outcome.
2. Pogliacomi F., Pedrini M.F., Pourjafar S., Pellegrini A., Paraskevopoulos A., Costantino C., Ceccarelli F. Pubalgia and soccer: real problem or overestimated? Medicina dello Sport. 2015; 68(4): 651-62.
3. Pogliacomi F., Costantino C., Pedrini M.F., Pourjafar S., De Filippo M., Ceccarelli F.
Anterior groin pain in athletes as a consequence of intra-articular diseases: aetiopathogenensis, diagnosis and principles of treatment. Medicina dello Sport. 2014; 67(3): 341-68.
4. Pogliacomi F., Costantino C., Pedrini M.F., Pourjafar S., De Filippo M., Ceccarelli F. Anterior groin pain in athlete as consequence of bone diseases: aetiopathogenensis, diagnosis and principles of treatment. Medicina dello Sport. 2014; 67(1): 1-27.
5. Pogliacomi F., Calderazzi F., Paterlini M., Pompili M., Ceccarelli F. Anterior iliac spines fractures in the adolescent athlete: surgical or conservative treatment? Medicina dello Sport. 2013, 66(2), 231-40.
6. Pogliacomi F, Calderazzi F, Paterlini M, Ceccarelli F. Surgical treatment of anterior iliac spines fractures: our experience. Acta Biomed 2014 Sep 24;85 Suppl 2:52-8.
7. Calderazzi F, Nosenzo A, Galavotti C, Menozzi M, Pogliacomi F, Ceccarelli F. Apophyseal avulsion fractures of the pelvis. A review. Acta Biomed 2018 Nov 15;89(4):470-476.
8. 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.
9. 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.
10. 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.
11. Westermann RW, Bessette MC, Lynch TS, Rosneck J. Does closure of the capsule impact outcomes in hip arthroscopy? A systematic review of comparative studies. Iowa Orthop J. 2018; 38:93–9
12. Riff AJ, et al. Systematic review of hip arthroscopy for femoroacetabular impingement: the importance of labral repair and capsular closure. Arthroscopy. 2019;35(2):646–656
13. Frank RM, et al. 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;42(11):2634–42
14. 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.
15. 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.
16. 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
17. Uchida S, Pascual-Garrido C, Ohnishi Y, Utsunomiya H, Yukizawa Y, Chahla J, et al. Arthroscopic shoelace capsular closure technique in the hip using Ultratape. Arthrosc Tech. 2017;6(1): 157–61.
18. Di Benedetto P, Zangari A, Giardini P, Mancuso F, Castriotta L, Causero A. Capsular closure after hip arthroscopy: our experience. Acta Biomed. 2020 May 30;91(4-S):92-97.
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. Khair MM, et al. The effect of capsulotomy and capsular repair on hip distraction: a cadaveric investigation. Arthroscopy. 2017;33(3): 559–65
21. 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
22. Bolia I, Briggs KK, Philippon MJ. Superior clinical outcomes with capsular closure versus non-closure in patients undergoing arthroscopic hip labral repair. Orthop J Sports Med. 2018
23. Waterman BR, et al. Intra-articular volume reduction with arthroscopic plication for capsular laxity of the hip: a cadaveric comparison of two surgical techniques. Arthroscopy. 2019;35(2):471–7.