Amoyaw Brendan, Sun Bryan, Bourgeault-Gagnon Yoan, Cohen Dan, Öhlin Axel, Maurice Corinne, Ayeni Olufemi R
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
Curr Rev Musculoskelet Med. 2025 May 5. doi: 10.1007/s12178-025-09977-4.
This scoping review aimed to identify the indications, techniques, outcomes, and knowledge gaps related to managing postoperative native hip instability. Specifically, it examined how capsular repair and reconstruction strategies address iatrogenic capsular insufficiency following hip preservation procedures, with the goal of clarifying optimal surgical decision-making and guiding future research.
Arthroscopic reconstruction emerged as the most commonly described technique for post-arthroscopic hip instability, frequently involving the use of dermal allografts, iliotibial band, or Achilles tendon grafts. Arthroscopic repair methods (i.e., capsular plication) were also widely reported, showing improved patient-reported outcomes in case series and retrospective cohorts. Open reconstruction and repair approaches were less common but demonstrated comparable potential for restoring hip stability in select patients. Postoperative protocols emphasized restricted weight-bearing, bracing, and controlled rehabilitation to prevent excessive capsular strain. Despite promising clinical improvements, published data were predominantly case reports, technical notes, and small retrospective studies. Instability should be carefully considered and properly assessed in patients experiencing persistent pain and sensations of abnormal hip "looseness" or locking following hip arthroscopy. Capsular repair and reconstruction are viable interventions for addressing hip capsular deficiency and alleviating symptoms of iatrogenic instability. In the absence of high-quality comparative trials, no definitive consensus exists on optimal graft selection or surgical technique, although dermal allografts and iliotibial band constructs have both shown positive outcomes. Larger, prospective and/or comparative studies are needed to refine patient selection, establish standardized protocols, and evaluate long-term efficacy.
本范围综述旨在确定与处理术后原发性髋关节不稳定相关的适应症、技术、结果和知识空白。具体而言，它研究了关节囊修复和重建策略如何解决保髋手术后医源性关节囊不足的问题，目的是明确最佳手术决策并指导未来研究。
关节镜重建是关节镜术后髋关节不稳定最常描述的技术，经常涉及使用真皮同种异体移植物、髂胫束或跟腱移植物。关节镜修复方法（即关节囊折叠）也有广泛报道，在病例系列和回顾性队列研究中显示患者报告的结果有所改善。开放重建和修复方法较少见，但在特定患者中显示出恢复髋关节稳定性的相当潜力。术后方案强调限制负重、支具固定和控制性康复，以防止关节囊过度紧张。尽管有令人鼓舞的临床改善，但已发表的数据主要是病例报告、技术说明和小型回顾性研究。对于髋关节镜术后持续疼痛以及髋关节有异常“松弛”或交锁感的患者，应仔细考虑并正确评估不稳定情况。关节囊修复和重建是解决髋关节囊缺陷和缓解医源性不稳定症状的可行干预措施。在缺乏高质量比较试验的情况下，对于最佳移植物选择或手术技术尚无明确共识，尽管真皮同种异体移植物和髂胫束构建物均显示出积极结果。需要开展更大规模的前瞻性和/或比较性研究，以优化患者选择、制定标准化方案并评估长期疗效。
