There is considerable disagreement about the need for closure of the capsule after hip arthroscopy. Those in favour of closure consider that it is essential for the part of the capsule between the two arthroscopic portals, since it ensures sound healing and subsequent stability of the joint. On the opposing view, however, the distance between the two arthroscopic portals is so small that, on the one hand, it has no adverse effect on the stability of the joint and, on the other, the capsule is considered to have a strong capacity for healing, so that this defect corrects itself.
A recently published study set out to assess the appearance of the joint capsule on MRI in patients with femoroacetabular impingement, who underwent simultaneous bilateral hip arthroscopy and in whom a capsulotomy was made between the two arthroscopic portals. Each hip was randomised to undergo, or not to undergo, surgical closure of the capsulotomy.
The study was double-blind, randomised and controlled, and included 15 patients (30 hips) with a mean age of 29.2 years. The patients underwent bilateral hip arthroscopy using two portals and one capsulotomy, estimated at 3cm in length. In each patient, surgical closure was carried out on one hip while on the opposite hip no closure was carried out. The patients underwent MRI at six and 24 weeks postoperatively and the images were analysed by two radiologists specialising in the musculoskeletal system. Both the patients and the radiologists were blinded to the treatment of each hip. The dimensions of the capsule were measured at the level of the healed capsulotomy.
At six weeks postoperatively a continuous structure of the hip joint capsule was observed in eight hips treated with closure of the capsule and three hips treated without closure. Of the 19 hips with a discontinuous capsule at six weeks, 17 were available for re-examination at 24 weeks. All 17 of these hips showed progress and healing of the capsule, with an MRI appearance of a continuous capsular structure, with no defects and no differences in the dimensions of the capsule between the hips in the cohort.
The authors concluded that arthroscopic repair of small capsulotomies between the portals of entry into the joint may give a good appearance of a continuous capsule at six weeks, but shows no difference from the images of the hips that did not undergo closure of the capsule on MRI at 24 weeks postoperatively.
Source: “The Journal of Bone and Joint Surgery”, January 2018
