Hip Instability and Arthroscopic Techniques for Complete Capsular Closure and Capsular Plication

Cases of both traumatic and atraumatic hip instability have been well documented in the literature. Traumatic instability can result from high-energy injuries (motor vehicle accident). Alternatively, atraumatic microinstability can be seen in congenital bony conditions (developmental dysplasia of the hip) or soft-tissue disorders (Down syndrome, Ehlers–Danlos syndrome, connective tissue disorders). Capsular management is a controversial topic in hip arthroscopy and hip joint preservation surgery, and there have been a variety of techniques described, including capsulotomy, capsulectomy, complete capsular repair, or capsular plication. The roles of the hip capsule or iliofemoral ligament, ischiofemoral ligament, and pubofemoral ligaments are not fully understood. There has been increased attention to the structure and function of the hip capsule, as there has been recent concern for hip macroinstability or microinstability after hip arthroscopy. The authors of this article describe 2 different techniques that provide anatomic repair of the capsule and aim to decrease the capsular volume to minimize the risk of iatrogenic hip instability after hip arthroscopy.