Shane J. Nho, MD, MS

Patients who underwent primary hip arthroscopy with capsular repair for femoroacetabular impingement had high rates of survivorship at 10 years, according to published results.

Hip arthroscopy has recently become a common procedure to treat central and peripheral hip pathology including femoroacetabular impingement and labral tears. Capsulotomy is inherent in these procedures, and negotiating adequate visualization in conjunction with capsular preservation is a challenge. A capsular suspension technique eliminates the need for additional personnel for retracting, prevents iatrogenic injury to the capsule, eliminates the need for excessive capsular debridement and allows for capsular closure under minimal tension.

A 77-year-old woman presented with severe lateral-sided left hip pain as well as difficulty with ambulation. She reported that, despite using a cane, her ability to ambulate more than a few feet was significantly limited due to fatigue. Over the years, many family members frequently commented on her worsening “lurching limp.” She also noted difficulty with stair climbing, getting in and out of a car, and getting up from a sitting position due to her lateral-sided hip pain.

A 24-year-old woman presented to clinic with complaints of long-standing right groin pain. She reported an insidious onset of pain approximately 1 year prior to presentation with significant worsening during the past 3 months. The pain was constant and mechanical in nature, made worse with forward flexion and abduction. She denied fevers, chills, dysuria or hematuria. She had no prior history of hip injury or gynecological issues. She denied any recent alterations in her exercise regimen and led an overall sedentary lifestyle. Initial conservative management with oral NSAIDs did not alleviate her symptoms and she developed progressive pain and a feeling of joint fullness.

An active 59-year-old woman with no significant medical history presented to our institution 2 weeks after she fell onto her dominant right arm while horseback riding in New Zealand. The patient, who is a homemaker and described herself as an adventurous person, was touring set locations for The Lord of the Rings movie when the injury occurred. After evaluation at another facility that is not affiliated with our institution, the patient was placed in a sling for immobilization. She continued to have significant shoulder pain and presented to our facility for further diagnosis and treatment.

The role of the capsule in arthroscopic hip surgery has recently received a great deal of attention. Capsulotomy is necessary to navigate the joint for both diagnostic and therapeutic purposes. However, many authors now contend that iatrogenic instability may result if the capsulotomy is not closed (Figure 1). As the number of hip arthroscopies has dramatically increased up to 18-fold during the past decade, warranted concern has been emphasized about the size and type of capsulotomy performed and its routine closure, as Joshua D. Harris, MD, and colleagues noted in their 2013 article in Arthroscopy Techniques .

The proximal hamstring is a common location of athletic injuries. Athletes participating in sports that require sprinting, jumping, acceleration and deceleration are at increased risk.