EP2.45 Proximal capsular augmentation with the indirect head of the rectus femoris for longitudinal capsulotomy in primary hip arthroscopy

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Abstract Purpose: Traditional capsular closure techniques still have some shortcomings, especially the repair of the proximal capsule is weak, which can easily lead to postoperative capsular non-union. We introduce a technique of performing capsular anatomic repair and using the indirect head of the rectus femoris for proximal reinforcement in cases of capsular longitudinal incision. Methods: We present the technique through a case of BDDH hip arthroscopy. The patient was placed in the supine position, and the standard anterolateral approach, anteromedial auxiliary approach, and DALA approach were used. First, the arthroscope was placed in the anterolateral aspect of the hip joint capsule to expose the indirect head of the rectus femoris, and the fat in front of the hip joint capsule was cleared to expose the iliofemoral ligament of the joint capsule. Then, the joint capsule was incised along the longitudinal axis of the femoral neck, and the incision was extended over the labrum proximally and over the zona distally. Traction sutures were placed at the proximal and distal ends of the incision for later use. After entering the joint, routine exploration and repair of the labrum, femoral head, and acetabulum were performed. During the closure of the joint capsule, the distal traction sutures of the zona were tied in a side-to-side manner, and the superficial suture ends of the proximal joint capsule traction sutures were passed through the superficial layer of the indirect head of rectus femoris, followed by overlapping sutures. Results: The hip capsule was found healed well in the MRI follow-up, the patient’s functional scores IHOT-12 improved significantly from 59 to 83 after surgery, and no significant complications occurred. Conclusions: Anatomical repair of the zona and reinforcement of the proximal joint capsule with indirect head of rectus femoris provides a good technical option for the repair and good healing of the joint capsule.

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