Title

New Findings in Hip Capsular Anatomy: Dimensions of Capsular Thickness and Pericapsular Contributions

Publication Date

2014

Journal Title

Arthroscopy

Abstract

Purpose: The purpose of this investigation was to provide a detailed description of the anatomy of the hip capsule and pericapsular structures. Methods: Dissections were performed on 11 nonpaired, fresh-frozen cadaveric hips by 2 independent observers: 1 fellowship-trained orthopaedic total joint surgeon and 1 chief orthopaedic surgery resident. Documentation of capsular thickness, origins, insertions, and attachments to pericapsular structures including the abductors, rectus femoris, piriformis, short external rotators, and iliocapsularis muscles was performed. Tendinous insertions of the surrounding pericapsular muscles were measured according to size and distance from reproducible osseous landmarks. Results: The capsule is thickest near the acetabular origin at the posterosuperior and superior hemi-quadrants and is thinnest near the femoral insertion in the posterior and posteroinferior hemi-quadrants. The iliocapsularis, indirect head of the rectus, conjoint, obturator externus, and gluteus minimus tendons all show consistent capsular contributions, whereas the piriformis does not have a capsular attachment. Osseous landmarks for tendinous attachments are defined and illustrated. The inter-relation of these structures is complex, yet their relations to the anterior hip capsule and contributions to its thickness are predictable. Conclusions: The dynamic pericapsular structures pertinent to the hip arthroscopist include the iliocapsularis, gluteus minimus, and reflected head of the rectus femoris. At the acetabulum, the thickest region of the capsule is posterosuperior and superolateral. At the femoral insertion, the thickest region is anterior.

Volume Number

30

Issue Number

10

Pages

1235-1245

Document Type

Article

EPub Date

2014/07/30

Status

Faculty; Northwell Health

Facility

School of Medicine; Northwell Health

Primary Department

Orthopedic Surgery

Additional Departments

Radiology

PMID

25064755

DOI

10.1016/j.arthro.2014.05.012