Table 1.

Indications, Contraindications, and Technical Pearls for Capsular Reconstruction

Indications

Symptomatic hip instability with radiographic evidence of capsular deficiency

Chronic iliopsoas inflammation due to anterior capsular deficiency

Contraindications

Coxarthrosis (Tönnis grade 3 or 4)—consider total hip arthroplasty

Acetabular dysplasia—consider periacetabular osteotomy with or without capsular reconstruction

Technical pearls

Perform appropriate graft sizing and preparation in accordance with preoperative MRI.

Minimize traction time while working in the peripheral compartment.

Use curved drill guides to optimize the trajectory for placement of all suture anchors along the acetabular rim.

Place the leg in gentle flexion and external rotation before tightening the graft distally.

Individualize the degree of capsular augmentation and desired position of stability for each patient.

MRI, magnetic resonance imaging.