|Beitragstitel||MICHA - A Minimal Invasive Capsulotomy in Hip Arthroscopy|
In the last decade hip arthroscopy has become very popular in the treatment of femoroacetabular impingement. T-shaped opening or partial resection of the capsule are widely used to appropriately visualise the neck or the acetabular rim. In this procedure the iliofemoral ligament, the strongest ligament of our body, could be severely damaged, resulting in painful iatrogenic hip instability. This may be of high significance in athletes or in cases of FAI combined with gerneral laxity or borderline dysplasia.
The iliofemoral ligament can not be seen from inside the articulation because of the synovial layer. Starting from our extraarticular approach, published in 2010, the ligament is identified by careful dissection of some superficial circular fibres. Capsulotomy ist carried out along the superior border of the superior bundle of the iliofemoral ligament. If a rim trimming and a refixation of the labrum or cartilage is necessary, the deep fibres of the capsule may be released from the acetabular rim. At the end of the procedure the capsule is completely closed by 2-4 sutures. In cases of laxity capsular plication can be performed.
We studied our first 100 cases, operated between April 2015 and April 2016 by a single surgeon. 99 of them had a femoral neck plasty, 47 a rim trimming and labrum refixation. In 22 cases acetabular microfracturing has been done. Median duration of the operation was 128 minutes (83-225), in the first 20 cases the median was 134 and in the last 20 cases 126 minutes. There were no major complications, but in two cases superficial skin erosions in the groin have been observed. In 81 patients the procedure could be performed through a single longitudinal capsulotomy, in 3 cases an additional short incision, in 12 cases an L-shaped and in 4 cases a T-shaped capsulotomy and even partial resection of the capsule was performed. In these 4 cases we could not close the cap-sule completely. The goal of operation has been reached in all cases. There were no revisions done so far.
In the majority of cases our MICHA-technique allows a iliofemoral ligament sparing capsulotomy to enter the hip. There is steep learning curve, but the described technique allows for a minimal inva-sive arthroscopic approach to all compartements and most of the pathologies of the hip.