Anchor-Free Capsular Augmentation Using the Reflected Head of the Rectus Femoris in Hip Arthroscopy

Capsular integrity is a key factor in hip stability after arthroscopic procedures. Inadequate capsular closure may contribute to postoperative microinstability, persistent pain, and suboptimal outcomes, particularly in patients undergoing extensive capsulotomy or procedures affecting proximal capsular tissue. Most capsular augmentation techniques using the reflected head of the rectus femoris rely on suture anchors for tendon fixation. This technical note describes an anchor-free capsular augmentation technique using the reflected head of the rectus femoris. A capsule-tendon-capsule suture construct is created using a suture-passing device, allowing simultaneous capsular closure and reinforcement without additional implants. The technique is simple, reproducible, and cost-effective and preserves the dynamic stabilizing role of the rectus femoris while maintaining physiologic capsular excursion.