Arthroscopic Double Shoelace Capsular Plication Technique for the Treatment of Borderline Hip Dysplasia Associated With Capsular Laxity

Hip arthroscopy is an innovative surgical tool that is minimally invasive; however, the working space is very limited because of small surgical wounds. Recent literature has shown that capsular repair after capsulotomy during hip arthroscopy facilitates the restoration of hip joint stability. Previous Technical Notes have introduced the shoelace capsule closing technique using a single Ultratape. However, even with the shoelace capsule closing technique, we periodically have encountered difficult cases with extensive capsular laxity. In this Technical Note, we introduce an improved hip capsule plication technique using 2 pieces of Ultratape for treating borderline hip dysplasia with capsular laxity. This double shoelace capsule plication technique theoretically reduces tearing risks during closure of delicate and fragile capsules. Level of evidence: 1 (hip); 2 (other)

Hip Arthroscopic Osteochondral Autologous Transplantation for Treating Osteochondritis Dissecans of the Femoral Head

Osteochondritis dissecans (OCD) of the femoral head is not a common source of hip pain. Hip arthroscopy is becoming a more frequent indication for intra-articular pathologies of the hip. Osteochondral autologous transplantation is a promising technique that theoretically can reconstruct osteochondral lesions of the femoral head. We describe our technique for arthroscopic antegrade osteochondral autologous transplantation for the treatment of OCD of the femoral head. The advantages of this technique include that it is a less invasive method with the ability to assess and treat intra-articular pathologies associated with OCD of the femoral head at same time. Case series and outcomes after this technique are not currently reported in the literature; however, it could be a less invasive method and provide favorable clinical outcomes for patients with OCD lesions of the femoral head

Arthroscopic Technique to Reduce Suture Button Migration During Anterior Cruciate Ligament Reconstruction Procedure

Suture button–based femoral cortical suspension constructs of anterior cruciate ligament grafts can facilitate a fast and secure fixation. However, there are several case reports showing button malpositioning resulting from the inability to visualize the “flipped” button. Many current surgical techniques do not allow direct visualization of EndoButtons (Smith & Nephew, Andover, MA) in their final position, making it difficult to ensure that both buttons are fully flipped and that there is no soft-tissue interposition between the button and femur. We describe an arthroscopic technique for making femoral tunnels through the outside-in method that reduces the migration of the EndoButton through a lateral femoral portal. This technique may assist surgeons in understanding how to deal with and potentially avoid EndoButton migration during anterior cruciate ligament reconstruction

Arthroscopic Shoelace Capsular Closure Technique in the Hip Using Ultratape

Hip arthroscopy is promising tool for assessing and treating intra-articular pathologies including labral tears, cartilage injuries, and ligamentum teres tears of the hip. Interportal capsulotomy allows for better visualization and accessibility of the arthroscope and working instruments. The hip capsule has been defined as a crucial stabilizer of the hip joint. Thus, capsular closure is recognized as an important procedure to prevent postoperative instability after hip arthroscopic surgery. Despite the routine capsular closure during hip arthroscopy, there is a small subset of patients who complain of hip pain and dysfunction after surgery most likely because of disruption of hip closure site after routine complete capsular closure with strong suture for treating hip instability.This technical note describes the arthroscopic shoelace capsular suture technique using Ultratape for treating femoroacetabular impingement with capsular laxity and borderline hip dysplasia

Arthroscopic Focal Subspinal Decompression and Management of Pincer-Type Femoroacetabular Impingement

Femoroacetabular impingement syndrome is a common hip pathology significantly affecting not only the intra- and extra-articular structures but also the biomechanical function of the joint. Cam and pincer bony lesions have been extensively studied. However, during recent years, other types of extra-articular impingement between the pelvic and femoral bone have been investigated. When a prominent or morphologically abnormal anterior-inferior iliac spine (AIIS) impinges repetitively on the femoral side during motion, the subspinal acetabular region becomes prominent and extends toward the intra-articular part of the joint. This results in restriction of the range of motion of the hip and pain, especially with flexion. Therefore, during hip arthroscopy, it is necessary to evaluate the subspinal region (triangular area located at 1:30 to 2:30 o'clock using the acetabular clock face system). For the correction of the acetabular bone pathology to be complete, the surgeon should focus both on the pincer and subspinal impingement lesions. This article describes our preferred technique to successfully address subspinal and pincer acetabular impingement during hip arthroscopy. The pearls and pitfalls of this technique are discussed

Right Versus Left Hip Arthroscopy for Surgeons on the Learning Curve

Hip arthroscopy is a technically demanding procedure that is currently characterized by a “steep” learning curve. Therefore, achieving an advanced technical level is often challenging, especially for the amateur hip arthroscopist. Hand laterality when training in hip arthroscopy is an aspect that has been omitted. In addition, the technical differences regarding the handling of the surgical instruments when performing hip arthroscopy on the left versus right hip can influence the technical excellence. This Technical Note summarizes our preferred hip arthroscopy technique by comparing the surgeon's hand position when operating on the left versus right hip. We also emphasize how the surgeon's hand laterality affects the instrument manipulation during the procedure and potentially the clinical outcomes