Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association · 2021
Pie-Crusting Capsulotomy Provides Similar Visualization With Increased Repair Stiffness Compared With a T-Capsulotomy: A Biomechanical Study.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Wydra Frank B, Al'Khafaji Ian, Haruno Lee, Chahla Jorge, Nelson Trevor J, Gerhardt Michael B, Metzger Melodie F
Аннотация
PURPOSE: To compare the area of visualization, capsular stiffness, and strength between the pie-crusting capsulotomy technique and the T-capsulotomy technique following repair.
METHODS: Eight matched pairs of fresh-frozen cadaveric hips (n = 16) were divided to either T-capsulotomy or pie-crusting capsulotomy followed by subsequent repair. The area of visualization was measured for all capsulotomy states using a digitizing probe. Hips were then distracted along the iliofemoral ligament in the intact, extended capsulotomy, and repair states. Afterwards, specimens were externally rotated to failure.
RESULTS: An average force of 250.1 ± 16.1 N was required to distract intact hips to 6 mm. Both extended capsulotomy techniques reduced the force required to distract the hip 6 mm with no statistical difference between the two (T-capsulotomy [T-cap] = 114.3 ± 63.4 N vs pie-capsulotomy [Pie-cap] = 170.1 ± 38.8 N), P = .07. Subsequent repair of the extended capsulotomies demonstrated the pie-crust capsulotomy required significantly greater force to reach 6 mm of distraction than those with a repaired T-capsulotomy (T-cap = 165.04 ± 40.43N vs Pie-cap = 204.43 ± 10.13N), P = .03. There was no significant difference in ultimate torque to failure between the 2 techniques (T-cap = 22.0 ± 7.41 N·m vs Pie-cap = 27.01 ± 11.13 N·m), P = .28. Visualization significantly increased with each extended capsulotomy, with an average increase of 62% (P < .001) and 48% (P < .001) for the pie- and T-capsulotomies, respectively.
CONCLUSIONS: The pie-crusting technique maintained similar strength and increased stiffness to the T-capsulotomy following repair while using less suture. Both techniques provided similar visualization. Clinically, the pie-crusting technique provides an alternative to the T-capsulotomy with similar biomechanical and visual outcomes.
CLINICAL RELEVANCE: Visualization during hip arthroscopy can be difficult with large cam morphology. Techniques to improve visualization while restoring the native biomechanics of the hip as best as possible are important.
METHODS: Eight matched pairs of fresh-frozen cadaveric hips (n = 16) were divided to either T-capsulotomy or pie-crusting capsulotomy followed by subsequent repair. The area of visualization was measured for all capsulotomy states using a digitizing probe. Hips were then distracted along the iliofemoral ligament in the intact, extended capsulotomy, and repair states. Afterwards, specimens were externally rotated to failure.
RESULTS: An average force of 250.1 ± 16.1 N was required to distract intact hips to 6 mm. Both extended capsulotomy techniques reduced the force required to distract the hip 6 mm with no statistical difference between the two (T-capsulotomy [T-cap] = 114.3 ± 63.4 N vs pie-capsulotomy [Pie-cap] = 170.1 ± 38.8 N), P = .07. Subsequent repair of the extended capsulotomies demonstrated the pie-crust capsulotomy required significantly greater force to reach 6 mm of distraction than those with a repaired T-capsulotomy (T-cap = 165.04 ± 40.43N vs Pie-cap = 204.43 ± 10.13N), P = .03. There was no significant difference in ultimate torque to failure between the 2 techniques (T-cap = 22.0 ± 7.41 N·m vs Pie-cap = 27.01 ± 11.13 N·m), P = .28. Visualization significantly increased with each extended capsulotomy, with an average increase of 62% (P < .001) and 48% (P < .001) for the pie- and T-capsulotomies, respectively.
CONCLUSIONS: The pie-crusting technique maintained similar strength and increased stiffness to the T-capsulotomy following repair while using less suture. Both techniques provided similar visualization. Clinically, the pie-crusting technique provides an alternative to the T-capsulotomy with similar biomechanical and visual outcomes.
CLINICAL RELEVANCE: Visualization during hip arthroscopy can be difficult with large cam morphology. Techniques to improve visualization while restoring the native biomechanics of the hip as best as possible are important.