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Emerging concepts in arthroscopic hip preservation surgery: Labral reconstruction and capsular preservation
Published in K. Mohan Iyer, Hip Preservation Techniques, 2019
Victoria Das, Michael B. Ellman, Sanjeev Bhatia
The type of capsulotomy employed during hip arthroscopy may also play a role in determining what the need for capsular repair is. In a double-blind, randomized control trial of 30 hips undergoing bilateral hip arthroscopy with a small, less than 3 cm, interportal capsulotomy, Strickland and colleagues noted no difference in capsular healing at 24 weeks postoperatively between repaired and unrepaired capsules on MRI.38 These findings suggest that a very limited capsulotomy has the capacity to heal on its own due to minimal disruption and no violation of the zona orbicularis. Although these findings are applicable to small interportal capsulotomies, most evidence suggests that larger capsulotomies, particularly T-capsulotomies that violate the zona orbicularis, necessitate routine capsular closure. In an investigation by Abrams, an unrepaired T-capsulotomy or large capsulectomy significantly increased the native external rotation of a cadaveric hip compared to the intact or interportal capsulotomy states.1
Lower Limb
Published in Harold Ellis, Adrian Kendal Dixon, Bari M. Logan, David J. Bowden, Human Sectional Anatomy, 2017
Harold Ellis, Adrian Kendal Dixon, Bari M. Logan, David J. Bowden
The ligament of the head of the femur, the ligamentum teres (31), is the important source of blood supply to the femoral head in the fetus and infant. It transmits the acetabular branch of the obturator artery. It becomes obliterated during early childhood, when periosteal vessels are of key importance before vessels traverse the epiphyseal plate. The blood supply to the femoral head remains of importance throughout life: avascular necrosis has many causes. The zona orbicularis of the capsule of the hip joint (13) transmits vessels from the lateral and medial circumflex femoral branches of the deep femoral artery (profunda femoris) to the head and neck of the femur (10). A subcapital fracture of the femoral head thus deprives the head of its blood supply and often leads to avascular necrosis.
Hip and proximal femur fractures
Published in Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou, Orthopaedic Trauma, 2014
Shafic Al-Nammari, Harry Krishnan, Andrew Sprowson, Sebastian Dawson-Bowling
A tough fibrous capsule encloses the joint; this is under maximum tension when the hip is extended. Superiorly and posteriorly it attaches directly to bone immediately peripheral to the labrum. Inferiorly and anteriorly it attaches to bone, the outer labral surface and the transverse acetabular ligament. Distally, the capsule attaches anteriorly to the intertrochanteric line, and posteriorly it attaches approximately 1.25 cm proximal to the intertrochanteric crest. Therefore the posterolateral one-third of the femoral neck is extracapsular. The capsule consists of two sets of fibres – the circular zona orbicularis and longitudinal fibres. The iliofemoral, pubofemoral and ischiofemoral ligaments reinforce the capsule (Fig. 17.1). The ligamentum teres is intra-articular and is attached proximally to the margins of the acetabular fossa and the transverse ligament. Distally it attaches to the femoral head at the fovea, carrying the artery of the ligamentumteres. Synovial membrane covers the intraarticular portion of the femoral neck and is reflected onto the internal surface of the capsule and the external surface of the ligamentum teres.
Development and calibration of a probabilistic finite element hip capsule representation
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Casey A. Myers, Clare K. Fitzpatrick, Daniel N. Huff, Peter J. Laz, Paul J. Rullkoetter
The calibrated mean stiffness values for the ischiofemoral, iliofemoral and pubofemoral ligaments (Table 1) were within the ranges found during mechanical testing of the isolated structures reported in the literature (Hewitt et al. 2001; Pieroh et al. 2016). In addition to accurately predicting whole joint behavior, this study agrees with prior work which has shown the anterior capsular ligaments, made up of the iliofemoral and a section of pubofemoral, demonstrates greater linear stiffness values than the posterior ligaments (Pieroh et al. 2016). Previous clinical studies have demonstrated dislocation rates for posterior approach can drop from 3–5% to approximately 0.65% when the capsule is repaired (Goldstein et al. 2001; White et al. 2001). The zona orbicularis and ischiofemoral ligaments provided the primary resistance to a motion association with a posterior dislocation. In addition, the medial aspect of the iliofemoral ligament provided the primary resistance to a motion associated with anterior dislocation, with some additional support from the lateral iliofemoral (Figure 5). Understanding which structures in the capsule contribute most to hip stability helps in deciding which areas to avoid or to repair during a surgical approach to minimize complications related to joint instability. In addition, knowledge of the mechanical properties of the hip ligaments assists in designing strategies to repair the capsule after traumatic injury.