Periportal Capsular Repair Restores Resistance to Axial Traction in Pediatric Hip Arthroscopy Patients

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BACKGROUND: Controversy exists surrounding the necessity of capsular repair in patients undergoing hip arthroscopy. In adults, studies show capsulotomy decreases the hip joint's resistance to axial distraction, and capsular repair restores this resistance to native-state levels. However, no literature exists evaluating these distraction characteristics in pediatrics, particularly when utilizing a periportal approach. The purpose of this study is to assess whether periportal capsulotomy compromises the hip joint's resistance to axial distraction, and whether capsular repair can restore native state resistance in the pediatric population. METHODS: Patients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome underwent intraoperative axial distraction testing. This was conducted in the native, capsulotomy, and repaired capsular states, using fluoroscopic imaging at 0-, 25-, 50-, 75-, and 100- lbs of applied traction. Comparisons were made between the various capsular states at different force intervals. RESULTS: Fifty hips were included for analysis with a mean age of 16.8±1.3 years. Relative to the native state, hips in the open capsulotomy state distracted to significantly greater distances at 25, 50, 75, and 100 lbs ( P <0.001). Once repaired, hips distracted to significantly lesser distances at 25, 50, 75, and 100 lbs compared with the capsulotomy state ( P ≤0.001). When comparing the repaired versus native states, repaired hips distracted more at 25 lbs ( P <0.001), distracted similarly at 50 lbs ( P =0.751), and significantly less at 75 and 100 lbs ( P <0.001). CONCLUSION: This study provides the first in-vivo biomechanical data investigating intraoperative distraction in pediatric patients undergoing periportal capsulotomy with capsular repair. Despite minimizing iliofemoral ligament disruption with a periportal approach, the capsulotomy resulted in increased distraction compared with the native hip, with restoration of this resistance to distraction with capsular repair. To minimize the potential risk of iatrogenic hip instability after hip arthroscopy in pediatric patients, a capsular repair should be considered even when utilizing a periportal capsulotomy approach. LEVEL OF EVIDENCE: Level III-case series.

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