EP3.36 Iliofemoral Ligament–Preserving Skip Capsulotomy Versus Interportal Capsulotomy in Hip Arthroscopy: A Propensity Score–Matched Cohort Study

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ID: 331211
2026
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Abstract
Abstract Background Capsular management during hip arthroscopy may affect postoperative stability and functional recovery. The iliofemoral ligament is the primary static stabilizer of the hip, and its transection during interportal capsulotomy has raised concerns regarding postoperative microinstability, particularly in hips with borderline acetabular coverage. Purpose To compare the clinical outcomes of iliofemoral ligament–preserving skip capsulotomy with conventional interportal capsulotomy in patients undergoing hip arthroscopy for cam-type pathology, including those with borderline developmental dysplasia of the hip (BDDH). Methods Consecutive patients who underwent hip arthroscopy with labral repair and femoral osteochondroplasty between 2020 and 2023 were retrospectively reviewed. Propensity score matching based on age, sex, body mass index, preoperative Tönnis grade, and diagnosis yielded 31 matched pairs. The primary outcome was the International Hip Outcome Tool–12 (iHOT-12). Secondary outcomes included the modified Harris Hip Score, non-arthritic hip score, achievement of minimal clinically important difference, patient acceptable symptom state (PASS), substantial clinical benefit (SCB), and return-to-sport metrics. Subgroup analyses were performed for femoroacetabular impingement syndrome (FAIS) and BDDH with cam morphology. Results Both techniques resulted in significant postoperative improvements. In the matched cohort, the skip capsulotomy group demonstrated higher iHOT-12 scores at 2 years (91.1 ± 10.8 vs 81.1 ± 15.0; P = .004), greater improvement from baseline (59.6 ± 20.5 vs 46.2 ± 16.9; P = .007), and higher PASS and SCB achievement rates. Early postoperative patient-reported outcome measures and time to return to sport were superior in the skip group. Among patients with FAIS alone, differences diminished by 1 year. Conversely, in patients with BDDH and cam morphology, improved outcomes persisted for 2 years. Complication rates and radiographic correction parameters were comparable between groups. Conclusion Iliofemoral ligament–preserving skip capsulotomy was associated with accelerated early recovery and improved postoperative outcomes compared with interportal capsulotomy, with sustained benefits in patients with borderline acetabular morphology.
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Authors Masayoshi Saito, Hajime Utsunomiya, Sachiyuki Tsukada, Takuya Kusakabe, Hiroyuki Ogawa, Naoyuki Hirasawa, Yutaka Inaba, Naomi Kobayashi
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.321
URL
https://doi.org/10.1093/jhps/hnag043.321
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