Biomechanical Evaluation of 4 Suture Techniques for Hip Capsular Closure

Yoichi Murata; Naomasa Fukase; Alex W Brady; Brenton W Douglass; Anna R Bryniarski; Grant J Dornan; Hajime Utsunomiya; Soshi Uchida; Marc J Philippon

doi:10.1177/23259671221089946

Biomechanical Evaluation of 4 Suture Techniques for Hip Capsular Closure

Orthop J Sports Med. 2022 Jun 21;10(6):23259671221089946. doi: 10.1177/23259671221089946. eCollection 2022 Jun.

Authors

Yoichi Murata¹, Naomasa Fukase¹, Alex W Brady¹, Brenton W Douglass¹, Anna R Bryniarski¹, Grant J Dornan¹, Hajime Utsunomiya², Soshi Uchida², Marc J Philippon¹

Affiliations

¹ Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA.
² Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan.

Abstract

Background: The most reliable suture technique for capsular closure after a capsulotomy remains unknown.

Purpose: To determine which suture technique best restores native stability after a 5-cm interportal capsulotomy.

Study design: Controlled laboratory study.

Methods: Ten human cadaveric hip specimens were tested using a 6-degrees-of-freedom robotic arm in 7 states: intact, capsular laxity, 5-cm capsulotomy, standard suture, shoelace, double shoelace, and Quebec City slider (QCS). Rotational range of motion (ROM) was measured across 9 tests: flexion, extension, abduction, abduction at 45° of flexion, adduction, external rotation, internal rotation, anterior impingement, and log roll. Distraction (ie, femoral head translation [FHT]) was measured across a range of flexion and abduction angles.

Results: When compared with the native state, the 5-cm capsulotomy state showed the largest laxity increases on all tests, specifically in external rotation ROM (+13.4°), extension ROM (+11.5°), and distraction FHT (+4.5 mm) (P < .001 for all). The standard suture technique was not significantly different from the 5-cm capsulotomy on any test and demonstrated significantly more flexion ROM than the double shoelace suture (+1.41°; P = .049) and more extension ROM (+5.51°; P = .014) and external rotation ROM (+6.03°; P = .021) than the QCS. The standard suture also resulted in significantly higher distraction FHT as compared with the shoelace suture (+1.0 mm; P = .005), double shoelace suture (+1.4 mm; P < .001), and QCS (+1.1 mm; P = .003). The shoelace, double shoelace, and QCS techniques significantly reduced hip laxity when compared with the 5-cm capsulotomy state, specifically in external rotation ROM (respectively, -8.1°, -7.8°, and -10.2°), extension ROM (-6.3°, -7.3°, and -8.1°), and distraction FHT (-1.8, -2.2, and -1.9 mm) (P ≤ .003 for all). These 3 techniques restored native stability (no significant difference from intact) on some but not all tests, and no significant differences were observed among them on any test.

Conclusion: Hip capsule closure with the standard suture technique did not prevent postoperative hip instability after a 5-cm capsulotomy, and 3 suture techniques were found to be preferable; however, none perfectly restored native stability at time zero.

Clinical relevance: The shoelace, double shoelace, and QCS suture techniques are recommended when closing the hip capsule.

Keywords: Quebec City slider; biomechanical study; double shoelace suture; hip arthroscopy; hip capsule closure; hip distraction; hip range of motion; iliofemoral ligament; shoelace suture.