EP3.7 A Comprehensive Capsular Management Strategy in Hip Arthroscopy Using Superior Capsular Suspension, Capsular Traction, and All-Inside Closure

Abstract Background Capsular management has become a defining factor in the success of hip arthroscopy. Increasing recognition of iatrogenic microinstability, capsulolabral adhesions, and persistent postoperative pain has intensified the debate between adequate exposure and preservation of capsular integrity. Current techniques often prioritize visualization at the expense of capsular tissue, potentially compromising joint stability and increasing the risk of revision. Purpose To describe a comprehensive capsular management strategy that integrates superior capsular suspension, controlled capsular traction during CAM correction, and all-inside closure to optimize visualization while preserving and restoring capsular integrity. Technique A superior accessory portal is established to achieve complete superior capsular suspension. One or two sutures elevate and maintain the capsule under tension, improving visualization while minimizing the need for aggressive capsular resection. An interportal capsulotomy is performed in all cases. When required, a limited periportal extension at the viewing portal is added while preserving anterior capsular continuity. This configuration provides adequate exposure for acetabular rim trimming and labral repair while maintaining sufficient tissue for subsequent restoration. During femoral osteochondroplasty for CAM correction, controlled capsular traction is applied to the capsular tissue overlying the femoral head–neck junction, allowing exposure of the deformity. This maneuver allows optimized exposure without compromising the capsular envelope. At the conclusion of the procedure, the sutures used for capsular suspension may be utilized for capsular closure, or suture passers can be employed to optimize suture positioning and facilitate an anatomic all-inside capsular repair under direct intra-articular visualization. Absorbable sutures promote capsular-to-capsular healing and restoration of the native capsular plane. Conclusion This integrated approach to capsular management provides a reproducible and adaptable strategy that balances surgical exposure with preservation and restoration of capsular integrity. By maintaining the native capsular envelope and promoting anatomic healing, this technique directly addresses key mechanisms associated with postoperative instability and adhesions and offers a practical solution applicable to contemporary hip arthroscopy.