In all aspects of orthopedic surgery, restoring native patient anatomy has demonstrated improved outcomes in comparison to non-anatomic reconstructions. Particular attention has been paid to the hip capsule, as the complex of the iliofemoral, pubofemoral, ischiofemoral ligaments, zona orbicularis and iliocapsularis, all play an essential role in hip stability, mechanics, and maintenance of intra-articular pressures. An anatomic approach toward hip arthroscopy, also includes labral repair or reconstruction with preservation of the chondrolabral junction and cam resection. Multiple recent studies have demonstrated improved patient-reported outcomes at long-term (>10 year) follow-up, as well as reduced revision rates and less progression to total hip replacement with complete capsular repairs compared to incomplete closure or no capsular management following hip arthroscopy. We perform an interportal capsulotomy with labral-sided capsular traction sutures for the central compartment, followed by the T-capsulotomy along the femoral neck with femoral-sided traction sutures for the peripheral compartment. At the end of every case, we ensure an anatomic complete capsular closure of the entire T-capsulotomy using a combination of self-retrieving suture guns and curved self-suture passers, often tying seven or more sutures.
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