What did the study look at?
In hip arthroscopy (keyhole surgery on the hip joint using a camera), the surgeon has to cut the capsule surrounding the joint in order to see inside; this is called a capsulotomy. Because the capsule contains ligaments that contribute to hip stability, the authors stress that it should be opened carefully and closed at the end of the operation.
For small bony bumps at the femoral head-neck junction (cam deformity) located higher up, a horizontal cut between two portals (interportal capsulotomy) is usually enough. For large or more lateral cam deformities, a "T"-shaped cut (T-capsulotomy) may be used because it gives a broader view. According to the authors, if this cut drifts off-centre, both visualisation and closure of the capsule can be compromised. The aim of the paper was to summarise each step of capsular management and to describe a traction-assisted T-capsulotomy technique.
How was it done?
This is a surgical technique paper (Technical Note), not a comparative study measuring patient outcomes. The technique is shown step by step in a video of a right hip and with cadaveric dissection images. The main steps described are:
- Under general anaesthesia the patient lies on their back on a traction table that does not need a perineal post; the joint is distracted by about 1 cm.
- Two portals are created and a horizontal capsular cut, no more than 2 cm long, is made about 1 cm from the labrum.
- Traction sutures on the upper edge of the capsule create working space inside the joint, and a labral repair is done if needed.
- After traction is released, the iliofemoral ligament is identified. One traction suture is passed on the inner and one on the outer side of the lower edge of the capsule, allowing a top-to-bottom view.
- The T-cut is made in a controlled way with an arthroscopic blade, at the midline and parallel to the femoral neck. A half-T is made first and extended downwards if the view is not adequate.
- Once the cam deformity has been removed, the vertical limb of the T and then the horizontal cut are closed with sutures.
What did it find?
As a technique paper, it does not report numerical results. The advantages the authors list are:
- The traction sutures give a better view for making the T-cut exactly at the midline and parallel to the femoral neck.
- Better visualisation of the head-neck junction during the cut helps prevent damage to the joint cartilage.
- A midline cut allows the front and upper-outer extent of a cam deformity to be seen completely.
The paper also notes pitfalls: if the horizontal cut is made too close to the labrum or the capsule is over-trimmed, the remaining tissue may not be suitable for closure, and tying the closing sutures with the hip bent may increase the risk of a loss of hip extension after surgery (flexion contracture).
The authors' conclusion
The authors conclude that accurate and complete management of the capsule is essential for successful hip arthroscopy. The traction-assisted method allows a reliable and efficient T-capsulotomy at the midline, parallel to the femoral neck, and makes it easier to see and remove large cam deformities.
Limitations
- Passing traction sutures may lengthen the operation.
- Viewing the capsule from below requires extra orientation by the surgeon.
- Using an arthroscopic blade with this technique requires more surgical experience than a cut made from above with a radiofrequency probe.
- Specially designed suture-passing devices may be needed to pass sutures through the lower edge of the capsule without damaging the cartilage.
Reference
Gürsoy S, Singh H, Vadhera AS, Perry AK, Nho SJ, Chahla J. 2021. Capsular Management with Traction-Assisted T-Capsulotomy Technique During Hip Arthroscopy. Arthroscopy Techniques. 10(10):e2271–e2278. Licence: CC BY-NC-ND 4.0.
DOI: 10.1016/j.eats.2021.07.002
Free full text: PubMed Central PMC8556758
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
