Radiographic and anatomic landmarks to approach the anterior capsule in hip arthroscopy

Hip arthroscopy (HA) is considered to be a very difficult and demanding surgical procedure, special instruments, an image intensifier and a fracture table or hip distractor are required to access the hip joint, the most common and worldwide used HA technique is entering blindly to the central compartment with the use of fluoroscopy and continuous distraction; with the potential danger if performed in unskillful hands of labral penetrations, labral resections and scuffing of the femoral head cartilage. Our technique describes the arthroscopic management of femoroacetabular impingement (FAI), performing a preoperative planning using radiographic and anatomic landmarks to approach the anterior capsule without the use of fluoroscopy. Access to the hip joint is made extra-articularly from the peritrochanteric compartment palpating the greater trochanter and posteriorly penetrating the iliotibial band sliding the arthroscopic sheath and obturator from the trochanteric border to the anterior femoral neck to visualize the anterior capsule bursa and anterior capsule fibers and posteriorly following our previous landmarks perform an anterior oblique Inverted 'T' or 'H' capsulotomy with a radiofrequency wand to access the cam-type impingement and distraction is made under direct controlled arthroscopic vision. Our technique in HA aiming the anterior capsule using radiographic and anatomic landmarks is safe, reliable and reproducible in FAI with big cams, deep sockets and cases with mild arthritis where the capsule is thick, stiff and calcified.