Table 2.

Pearls and Pitfalls of Hip Arthroscopy to Treat Microinstability

Pearls Examine the patient under anesthesia in 20° of abduction. Perform an arthroscopic drive-through test to assess the degree of capsular laxity. Recognize that capsulolabral adhesions may indicate microinstability due to inadequate capsular closure from a previous operation. Use a shorter, 90-mm cannula in the anterolateral portal when maneuvering instruments in the extracapsular space. Take larger, more medial bites of capsular tissue on the distal side of a capsulotomy to achieve an inferomedial shift.

Pitfalls Do not forget to record the time of traction. Do not over-distract the hip, which may be excessively lax. Do not resect >30% of the femoral neck diameter during osteochondroplasty. Do not perform a T-capsulotomy without the intention of closing both the vertical and horizontal limbs at the end of the case. Do not tie capsular sutures in flexion; pass them in flexion but tie in extension.