Outside-In Longitudinal Capsulotomy of the Hip for Treatment of Femoroacetabular Impingement

This article presents a detailed description of the longitudinal capsulotomy technique using an outside-in approach for the treatment of femoroacetabular impingement. Standard arthroscopic portals (anterolateral, mid-anterior, and distal anterolateral accessory) are utilized for access. The capsulotomy is initiated based on key anatomic landmarks, with meticulous dissection to prevent damage to the labrum and cartilage. The outside-in approach offers excellent visualization of both the acetabulum and the femoral neck, particularly for correcting cam and pincer deformities. Capsular closure is performed with side-to-side sutures, ensuring proper repair and ligament preservation. This technique, while less widespread, provides significant advantages, including reduced risk of neurologic injuries associated with traction and decreased likelihood of labral or cartilage damage. The approach also facilitates high-quality capsular management, allowing for effective correction of osseous deformities. This method is safe, reproducible, and cost-effective, offering an efficient solution for managing femoroacetabular impingement.