Name: Arthroscopic Hip Capsular Imbrication and Closure Using PushLock® Anchors
Uploaded: 2018-10-10T00:00:00Z
Channel: Arthrex
Description: Carlos A. Guanche, MD, (Van Nuys, CA) presents cases during which he performed a capsular imbrication and closure with a short 2.9 mm Hip PushLock ® anchor for ligamentous laxity. Dr. Guanche outlines his rationale for performing this technique and describes the steps for successfully completing the procedure.

<p>Carlos A. Guanche, MD, (Van Nuys, CA) presents cases during which he performed a capsular imbrication and closure with a short 2.9 mm Hip PushLock<sup>®</sup> anchor for ligamentous laxity. Dr. Guanche outlines his rationale for performing this technique and describes the steps for successfully completing the procedure.</p>

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VPT1-01101-EN | A | Arthroscopic Hip Capsular Imbrication and Closure Using PushLock® Anchors

Carlos Guanche

Human

Surgeons presenting one or more clinical cases

Chirurg:innen präsentieren einen oder mehrere klinische Fälle

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Cirujanos que presentan uno o más casos clínicos.

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Arthroscopic Hip Capsular Imbrication and Closure Using PushLock® Anchors

I'm Carlos Guanche from Southern California Orthopedic Institute, and I'm going to present a case presentation of a technique that I've been using over the last couple of years that involves the arthroscopic plication of the capsule up to the acetabular surface, rather than the traditional side to side closure that we do. And this is a typical case presentation. This is a young female, very significantly distractible hip. You can see that there's a little bit of a partial tear of the ligamentum teres. And I've already done the capsulotomy. And in really getting ready to do the closure, you can see that there's some peripheral labrum fraying, but no significant detachment in this patient. There was also a very prominent anterior inferior iliac spine component. So I'm reshaping that. It also creates a nice vascular bed through the lateral portal. Here I'm inserting the lateral anchor which is a PushLock. And now, as we visualize from the lateral portal, we place a second anchor through the anterior portal. Once I release traction, then we look at the area of the joint. Make sure that there's no peripheral impingement lesions. And then we go right to the closure. In this case, I'm visualizing from the anterior portal and passing the sutures through the capsule in a mattress fashion. That's one suture that's been passed. And then this is the second one now that's being passed in anticipation for closure later. Once we pass these two sutures through the lateral portion of the capsule, we have a nice mattress that's prepared. We then switch and visualize through the anterior portal and essentially repeat the steps. In some situations we'll place three anchors and sometimes four. It depends on the amount of capsule or invocation. It depends on the amount of tissue laxity and also the quality of tissue obviously. So in this case again we're going to try to do a mattress closure with the two sutures. We've passed one. Now we're passing the second one, and then we can go right to closure of the capsule. At this point, and in most cases, I make sure that the traction is removed. I tend to flex the leg about 10 to 15 degrees to make it a little bit easier and to be able to really place the capsule with minimal tension. So now we've closed the lateral portal in this case. And then now we're going to switch and look from the lateral side and then basically close the entire thing. And now this is the final look. And we can kind of see that the two sutures have really well approximated the capsule right up to the sublabial foramen if you will. We can obviously use any kind of suture passer as well as we grasp the suture and bring it out in this situation. Now, we've passed one suture. I'm grabbing the second suture now and we can kind of see that. Here's a good shot of the labor repair on the more on the left side, and then the two loops of the suture prior to closure. And then there's the final closure. And in some situations I'll look at it from intra-articular as I'm doing here, just to document that we've advanced the capsule laterally as much as I wanted to. And then the final closure, a lot of times it's really hard to see inside the joint, and that's sort of the ideal situation. So in full extension, we've got a very solid approximation of the capsule with good solid tissue that's going to heal effectively in some situations. Of Ehlers-Danlos, for example, this is a patient who was a 28 year old gentleman with Ehlers-Danlos in his situation. What I did was I double loaded three PushLock anchors. So essentially we have 12 points of suture fixation. If we pass mattress sutures through all of these, then we have some really good solid tissue reconstruction without the need for any augmentation. We can see here the final closure in that patient with the 12 suture points of fixation.

Arthroscopic Hip Capsular Imbrication and Closure Using PushLock® Anchors

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