Editorial Commentary: Hip Arthroscopy Capsular Approaches: Periportal, Puncture, Interportal, T-Cut…Does It Really Matter?

When treating femoroacetabular impingement, appropriate visualization is needed to technically perform a complete osteoplasty. Adequate visualization typically requires some level of disruption of the hip capsule during the surgical approach. As a result, complications including microinstability or frank dislocation may result from any violation of the hip capsule. There is a trade-off involved in the various capsular approaches: the balance between appropriate visualization in order to adequately perform a complete femoral osteoplasty versus disruption of the capsule, potentially causing iatrogenic hip instability. If visualization is compromised, it is better to extend a capsulotomy than to have a burr, shaver, or electrocautery remove part of the capsular envelope. In the end, the solution is to use an approach that allows you to visualize and treat the femoroacetabular impingement pathology, yet maintain the integrity of the capsular envelope.