Hip Capsular Reconstruction Utilizing Acellular Dermal Allograft for Capsular Insufficiency: A Revision Hip Arthroscopy Technique
Joseph C. Brinkman, Ty L. Monty, Chandler A. Sparks, Kyle N. Kunze, Shane J. NhoBackground:
Hip capsule integrity is essential for optimal outcomes after hip arthroscopy. Iatrogenic capsular insufficiency is a recognized cause of postoperative microinstability or macroinstability and a common indication for revision hip arthroscopy. Capsular reconstruction with allograft augmentation is a technique used to address capsular deficiency in this setting.
Indications:
This technique is indicated for patients with symptomatic instability and confirmed capsular insufficiency. Clinical suspicion based on history and physical examination should be confirmed with advanced imaging. Symptomatic, large capsular defects identified on imaging are appropriate for allograft augmentation.
Technique Description:
Suture anchors are placed at the 12 and 2 o’clock positions along the acetabular rim, and suture tapes are passed through the proximal and distal capsular remnants to span the defect. An acellular dermal allograft, sized approximately 20% larger than the measured defect, is prepared ex vivo with peripheral sutures to create a shuttling construct. The graft is introduced arthroscopically into the joint, positioned over the defect as a patch, and secured to the native capsule with arthroscopic knots and additional peripheral fixation to restore capsular integrity.
Results:
Biomechanical studies have demonstrated restoration of capsular stability following allograft reconstruction. Clinical outcomes in the revision setting have shown improved stability and patient-reported outcomes, with relatively low reported failure rates.
Discussion/Conclusion:
Failure to restore capsular integrity during hip arthroscopy may contribute to postoperative instability, pain, and functional limitations. Current evidence suggests that capsular reconstruction can reestablish stability and provide meaningful clinical improvement in appropriately selected patients. Acellular dermal allograft reconstruction represents a viable technique for addressing large capsular defects in revision hip arthroscopy.
Patient Consent Disclosure Statement:
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.