Economopoulos Kostas J, Chhabra Anikar, Hassebrock Jeffrey D, Kweon Christopher
Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona.
Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, Washington.
JBJS Essent Surg Tech. 2021 Nov 8;11(4). doi: 10.2106/JBJS.ST.20.00037. eCollection 2021 Oct-Dec.
Recent literature has suggested that capsular closure following hip arthroscopy restores native hip-joint kinematics and may lead to better patient-reported outcomes, especially in high-level athletes.
Capsular closure of the hip occurs following standard hip arthroscopy, which typically includes labral repair and osteoplasty of the femoral neck and/or acetabulum accessed through an interportal capsulotomy. Viewing through an anterolateral portal with use of a 70° scope, a suture-passing device loaded with a #2 FiberWire (Arthrex) is passed down into the mid-anterior portal. The suture is then passed through the anterior aspect of the proximal leaflet of the capsulotomy. The suture-passing device is then passed through the distal leaflet, and the previously passed suture is grasped and brought out of the cannula. The capsular bites are typically made 1 cm from the edge of the capsule. This process is repeated 1.5 cm posteriorly to the initially placed suture. Typical capsular closure takes 2 to 3 sutures for complete closure. Once the sutures are passed, they are tied with use of half-hitches and excess suture is cut.
Alternatives include capsular plication, which is more frequently performed in the setting of capsular laxity preoperatively or connective-tissue disorders. Additionally, there is evidence suggesting that leaving the capsulotomy unrepaired may lead to similar results in select populations.
This procedure is performed largely secondary to the restoration of native anatomy and kinematics of the hip joint. Arthroscopy of the hip requires a capsulotomy in order to access the joint, unlike other, more superficial joints such as the shoulder. Capsular closure is often technically challenging and adds length to the procedure. However, recent literature has shown improved patient-reported outcomes with routine capsular closure specifically among high-level athletes.
Routine capsular closure has been associated with good mid-term patient-reported outcomes. Patients who undergo hip arthroscopy and routine capsular closure can expect to meet the minimal clinically important difference and the patient acceptable symptomatic state for the modified Harris hip score and the Hip Outcome Score Activities of Daily Living component. Patients who participate in high-level sports activities may experience a quicker return to play and more normal kinematics with routine capsular closure.
Clear off the capsule immediately following the capsulotomy.Utilize an over-the-top view to better visualize the capsule.Place the sutures from anterior to posterior.
近期文献表明，髋关节镜检查后的关节囊闭合可恢复髋关节的自然运动学，并可能带来更好的患者报告结局，尤其是在高水平运动员中。
髋关节镜检查后进行髋关节囊闭合，标准的髋关节镜检查通常包括盂唇修复以及通过关节囊间切开术进入的股骨颈和/或髋臼的骨成形术。使用70°关节镜从前外侧入路观察，将装有2号纤维线（Arthrex）的缝线传递装置经中间前入路向下插入。然后将缝线穿过关节囊切开近端瓣叶的前侧。接着将缝线传递装置穿过远端瓣叶，抓住先前穿过的缝线并带出套管。关节囊咬除通常在距关节囊边缘1厘米处进行。在最初放置缝线的后方1.5厘米处重复此过程。典型的关节囊闭合需要2至3针缝线才能完全闭合。缝线穿过后，使用半结系紧并剪掉多余的缝线。
替代方法包括关节囊折叠术，该方法在术前关节囊松弛或结缔组织疾病的情况下更常使用。此外，有证据表明，在特定人群中不修复关节囊切开术可能会导致类似的结果。
此手术主要是为了恢复髋关节的自然解剖结构和运动学。与其他更表浅的关节（如肩关节）不同，髋关节镜检查需要进行关节囊切开术才能进入关节。关节囊闭合在技术上通常具有挑战性，并且会延长手术时间。然而，近期文献表明，常规关节囊闭合可改善患者报告的结局，特别是在高水平运动员中。
常规关节囊闭合与中期良好的患者报告结局相关。接受髋关节镜检查和常规关节囊闭合的患者有望达到改良Harris髋关节评分和髋关节功能评分日常生活活动部分的最小临床重要差异和患者可接受的症状状态。参与高水平体育活动的患者通过常规关节囊闭合可能会更快恢复运动并拥有更正常的运动学表现。
关节囊切开后立即清理关节囊。利用上方视野更好地观察关节囊。缝线从前向后放置。
