Capsular Preservation Using Suture Suspension Technique in Hip Arthroscopy for Femoroacetabular Impingement  Andrea M. Spiker, M.D., Christopher L. Camp, M.D., Brian T. Barlow, M.D., Shawn G. Anthony, M.D., Struan H. Coleman, M.D.  Arthroscopy Techniques  Volume 5, Issue 4, Pages e883-e887 (August 2016) DOI: 10.1016/j.eats.2016.04.014 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 The patient is positioned supine on a standard hip arthroscopy traction table using a large, padded peroneal post. After preparation and draping, key anatomic landmarks are identified. These include the anterior superior iliac spine with a line drawn distally to demarcate the lateral border of the neurovascular bundle, as well as the greater trochanter. These landmarks are used to guide localization of the anterolateral portal (ALP), anterior to the tip of the greater trochanter, and the midanterior portal (MAP), distal and anterior to the ALP but lateral to the line drawn from the anterior superior iliac spine on this right hip. Arthroscopy Techniques 2016 5, e883-e887DOI: (10.1016/j.eats.2016.04.014) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 With the camera in the anterolateral portal (ALP) in this right hip, the suspension suture is placed in the proximal cuff of the capsulotomy, through the midanterior portal (MAP), and the suture limbs are retrieved through the MAP. (A) The suture is tensioned and clamped to the peroneal post. (B) Electrocautery and an arthroscopic shaver are used through the MAP to elevate the proximal capsule from the bone, providing access to the subspine region of the acetabulum, which is easily seen when viewing this right hip from the ALP. Arthroscopy Techniques 2016 5, e883-e887DOI: (10.1016/j.eats.2016.04.014) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 The peripheral compartment suspension sutures are placed through the midanterior portal into the distal limb of the capsule after the hip is taken off traction and flexed to 30° to 40° in neutral rotation. (A) The free ends of the suture are retrieved through a small distal accessory portal, which is created with a No. 15 blade stab incision. These are tensioned and held by an assistant. (B) When one is viewing this right hip from the anterolateral portal, the femoral head and neck are easily exposed. This capsular suspension technique allows exposure of the femoral neck down to the intertrochanteric line. (C) In these simultaneous fluoroscopic (left) and arthroscopic (right) views of the right hip, a shaver is placed at the distal-most extent of the femoral neck exposure. Arthroscopy Techniques 2016 5, e883-e887DOI: (10.1016/j.eats.2016.04.014) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 Once the peripheral compartment work is completed, the distal suspension sutures are released and the capsule easily reduces. The interportal capsulotomy is closed with simple sutures in a simple, interrupted fashion from medial to lateral through the midanterior portal. As can be observed when viewing this right hip from the anterolateral portal, the robust closure has nicely secured the proximal and distal limbs as the final, lateral-most suture is about to be tied. Arthroscopy Techniques 2016 5, e883-e887DOI: (10.1016/j.eats.2016.04.014) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions