Less-Invasive Capsulotomy Strategy in Hip Arthroscopy: The Gluteus Minimus Sign as a Visual Landmark for the Joint Capsule Based on Cadaveric Analysis.

Abstract

Hip arthroscopy requires a capsulotomy to achieve adequate visualization and access; however, an excessive incision can increase the risk of postoperative instability. This technical note describes a less-invasive capsulotomy technique guided by the "gluteus minimus sign," a fibrous membrane connecting the main tendon of the gluteus minimus to the joint capsule. Cadaveric analysis confirmed that this fibrous membrane corresponds to the anterosuperior region of the femoral neck. Most gluteus minimus functions can be preserved by limiting the anterior extension of the capsulotomy to within this sign. When additional anterior exposure is necessary, superficial tendon fibers can be incised using an arthroscopic knife. This technique offers a safe, anatomically informed, and strategically targeted capsulotomy that balances preservation of joint stability with adequate surgical access.