American Hip Institute Research Foundation, Chicago, Illinois.
American Hip Institute Research Foundation, Chicago, Illinois; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A.
Arthroscopy. 2021 Aug;37(8):2642-2654. doi: 10.1016/j.arthro.2021.04.004. Epub 2021 May 1.
To investigate the correlation between hip capsular management (repair or reconstruction) and biomechanical results in the setting of femoroacetabular impingement and microinstability.
A search of the PubMed and Embase databases was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies focused on hip biomechanics related to capsular release, repair of I- and T-capsulotomy, or capsular reconstruction. Studies were assessed for external/internal rotation of the femur, femoral head translation, rotational torque, and distraction force. Articles were excluded if they discussed treatment of the hip capsule related to surgical dislocation, mini-open surgery, arthroplasty, reorientation osteotomy, or traumatic dislocation.
Twenty-four biomechanical studies were included that evaluated rotation/translation (11 studies), distraction (3 studies), the capsular role in microinstability (simulated with anterior capsule pie crusting [2 studies] and cyclical loading [2 studies]), allograft reconstruction (3 studies), and anatomic properties (3 studies). Repair and reconstruction demonstrated improvements in maximum distractive force, total ROM, and torsional stability when compared to capsular release. Significant differences were observed between capsular repair and release in total ROM in the coronal plane with improved stability in the repair groups (standardized mean difference [SMD]: -1.3°, 95% confidence interval [CI] -1.68 , -0.854; P < .001). There was significantly increased total motion in the coronal plane in the capsular laxity state compared to the native state (SMD: 1.4° (95% CI 0.32, 2.49; P = .012).
Biomechanical evidence supports closure of the capsule after hip arthroscopy to reverse the significant effects of capsulotomy. Simulated capsule laxity models created altered joint motion and translation. Capsule reconstruction appears to restore the hip to its native capsule state.
Investigating the biomechanical outcomes of capsular repair and reconstruction will help surgeons better understand the rationale and implications of these capsular management strategies.
研究髋关节囊管理（修复或重建）与股骨髋臼撞击症和微不稳情况下生物力学结果之间的相关性。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，对 PubMed 和 Embase 数据库进行了检索。纳入的研究重点关注与囊袋松解、I 型和 T 型囊切开术修复或囊袋重建相关的髋关节生物力学。研究评估了股骨的内外旋转、股骨头平移、旋转扭矩和牵张力。如果文章讨论了与髋关节囊相关的治疗方法，如手术脱位、小切口手术、关节置换、重新定向截骨术或创伤性脱位，则将其排除在外。
共纳入 24 项生物力学研究，评估了旋转/平移（11 项研究）、牵伸（3 项研究）、囊在微不稳中的作用（通过模拟前囊皮饼化[2 项研究]和循环加载[2 项研究]）、同种异体重建（3 项研究）和解剖学特性（3 项研究）。与囊松解相比，修复和重建可改善最大牵张力、总活动度和扭转稳定性。在冠状面的总活动度方面，囊修复与松解之间存在显著差异，修复组稳定性更好（标准化均数差[SMD]：-1.3°，95%置信区间[CI]：-1.68 ，-0.854；P<.001）。与正常状态相比，在囊松弛状态下，冠状面的总运动明显增加（SMD：1.4°（95%CI 0.32，2.49；P=.012）。
生物力学证据支持髋关节镜检查后闭合关节囊，以逆转囊切开术的显著影响。模拟囊松弛模型创建改变了关节运动和平移。囊重建似乎使髋关节恢复到其原始囊状态。
研究囊修复和重建的生物力学结果将帮助外科医生更好地理解这些囊管理策略的原理和意义。
