Capsular Closure Following Hip Arthroscopy for Femoroacetabular Impingement

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^1-4.

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^5,6. Additionally, there is evidence suggesting that leaving the capsulotomy unrepaired may lead to similar results in select populations⁷.

This procedure is performed largely secondary to the restoration of native anatomy and kinematics of the hip joint^3,8. 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^9,10.

Routine capsular closure has been associated with good mid-term patient-reported outcomes¹⁰. 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.