Editorial Commentary: Let's Continue the Debate of Hip Capsule Management: Periportal Capsulotomy Without Closure Can Lead to High Rates of Achieving Meaningful Clinical Outcomes.

Abstract

Adequate visualization for femoroacetabular impingement syndrome treated by hip arthroscopy is critical to avoid leaving residual structural disease. Proponents of access to the hip via interportal and T-capsulotomy argue that performing a larger capsulotomy allows for appropriate management of intra-articular pathology, with capsular closure required to prevent iatrogenic instability. However, advocates of smaller capsular incisions have recently published literature that suggests management of intra-articular hip pathology with periportal capsulotomy incision confers to high rates of patients achieving meaningful clinical outcomes at midterm follow-up with no need for revision arthroscopy or conversion to total hip arthroplasty. Some periportal capsulotomy proponents argue that superior postoperative outcomes can be achieved without capsular closure, implying that a minimalistic approach to capsular incision does not lead to hip instability if not closed. While the long-standing debate of how to best address capsular management continues on, there is promising evidence that periportal capsulotomy without closure can result in satisfactory outcomes for patients undergoing hip arthroscopy for treatment of femoroacetabular impingement syndrome.