An Anatomic Study of the Damage to Capsular Hip Stabilizers During Subspine Decompression Using a Transverse Interportal Capsulotomy in Hip Arthroscopy

PURPOSE:

To quantify the damage to the soft tissue stabilizers of the hip after a transverse interportal capsulotomy and subspine trimming in hip arthroscopy.

METHODS:

Eight human cadaveric hemipelvises underwent hip arthroscopy through a transverse interportal capsulotomy. Arthroscopic subspine trimming performed on all specimens was classified according to an anatomic index. The width of the proximal capsule was measured before and after subspine trimming. The extent of damage to the iliofemoral ligament (IFL) after dissection was recorded. Potential damage to pericapsular structures was assessed by measuring the distance between the capsulotomy and rectus femoris and iliocapsularis muscle with an electronic caliper.

RESULTS:

In all specimens, ≥50% of the width of the IFL was damaged. The subspine trimming was successfully performed in 7 of 8 specimens (87.5%) according to the proposed index. The sizes of the trimmed bone area measured in the anteroposterior and proximal-distal axis were 21.2 ± 7.5 and 13.1 ± 9 mm, respectively (mean ± standard deviation). The width of the proximal capsule at the anterior and posterior corner of the capsulotomy was 19.8 ± 5.2 and 11.8 ± 1.7 mm, respectively. After subspine trimming, the mean width of the anterior and posterior proximal capsular attachments was 6.4 ± 1.4 and 7.0 ± 1.6 mm, respectively. On average, 13.4 mm of anterior capsule was damaged after anterior inferior iliac spine trimming, versus 4.7 mm of the posterior capsule. The distances from the capsulotomy to the rectus femoris direct and reflected head were 6.8 ± 4.9 and 6.3 ± 7.7 mm, respectively, and to the iliocapsularis muscle, 11.5 ± 7.8 mm.

CONCLUSION:

High rates of damage to the IFL were observed with the interportal capsulotomy. Increased tissue damage at the anterior capsule was observed after subspine trimming. The width of the proximal capsular attachment was ≥5 mm in all specimens.

CLINICAL RELEVANCE:

Surgeons should be aware of the potential damage to the native capsule and pericapsular structures when using a transverse interportal capsulotomy for the arthroscopic subspine decompression.

LEVEL OF EVIDENCE:

IV: cadaveric study, case series.

 2019 Nov 7. pii: S0749-8063(19)30618-8. doi: 10.1016/j.arthro.2019.06.040. [Epub ahead of print]