Periportal Capsulotomy: Technique and Outcomes for a Limited Capsulotomy During Hip Arthroscopy

Purpose: To present the technique and outcomes of a limited periportal capsulotomy without capsular closure for arthroscopic treatment of femoroacetabular impingement (FAI). Methods: Retrospective review of a prospectively collected database of patients undergoing primary hip arthroscopy for symptomatic FAI was performed to analyze patients who underwent periportal capsulotomy. Periportal capsulotomy was performed through dilation of the midanterior and anterolateral portals without completion of a full interportal capsulotomy, preserving the iliofemoral ligament. Arthroscopic labral treatment and osteochondroplasty were completed as indicated without necessitating capsular closure. Patient demographics, surgical details, and complications were recorded. Pre- and postoperatively, patients completed the modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score (HOOS), 12-item Short-Form survey, and visual analog scale. Postoperative outcome data was analyzed at 1- and 2-year follow-up. Results: One hundred and forty-two patients treated with the periportal capsulotomy technique were included (mean age, 35.5 ± 11.7; body mass index, 25.4 ± 4.1; 50.7% men). There were no major postoperative complications including hip instability or reoperation. Significant improvements in mean patient-reported outcomes from preoperative scores were seen at the 1- and 2-year follow-ups (modified Harris Hip Score, 18.4 ± 19.1, 21.1 ±17.7, HOOS symptoms, 20.1 ± 21.2, 22.8 ± 23.5, HOOS pain, 23.4 ± 21.2, 27.6 ± 19.3, HOOS activities of daily life, 21.2 ± 20.8, 24.3 ± 21.6, HOOS sport, 32.5 ± 27.0, 36.5 ± 26.9, HOOS quality of life, 37.9 ± 26.7, 46.0 ± 22.8, and 12-item Short-Form survey physical component score, 16.4 ± 15.3, 20.8 ±13.2, respectively). Only the HOOS quality of life demonstrated further improvement from 1- to 2 years postoperatively (P =.043). Conclusions: Periportal capsulotomy provides safe and sufficient access to the hip joint for arthroscopic treatment of FAI without necessitating capsular closure. Using this technique, patients showed significant clinical improvement and no postoperative instability at 1 and 2 years after surgery. Level of Evidence: Level IV, therapeutic case series.