Dual Portal Closure of Periportal Capsulotomy for Hip Arthroscopy

Capsular management in hip arthroscopy is an area of ongoing research, where ease of access to the hip joint is balanced with the preservation of capsular integrity and stability. Traditional techniques such as interportal and T capsulotomies allow broad exposure but may increase the risk of postoperative instability or microinstability if not repaired. Periportal capsulotomy aims to limit disruption of the iliofemoral ligament while still allowing sufficient access for safe and efficient treatment of hip pathology and typically does not necessitate closure. However, in patients who are at higher risk for postoperative instability such as those with borderline dysplasia or joint hypermobility, closure of the periportal capsulotomy may be warranted. We describe a technique for intracapsular closure of both the anterolateral and modified midanterior periportal capsulotomies in which closure of the anterolateral portal capsulotomy is facilitated by passage of the capsule closure suture at the beginning of the case while the hip is in traction. This approach minimizes the risk of postoperative instability without significant additional operative time.