Conceptual evolution in arthroscopic capsulotomy techniques and capsular management strategies for the hip

Table 1 Comparison of different hip arthroscopic capsulotomy techniques and their biomechanical impacts

Technique	Approach	Incision direction and relationship to iliofemoral ligament	Impact on iliofemoral ligament	Evidence level	Ref.
Interportal transverse capsulotomy	Inside-out	Transverse, perpendicular to fibers	Reported to disrupt the iliofemoral ligament; increased external rotation laxity	Category 1 and 3	[22,24,25,27]
T-capsulotomy	Inside-out	Transverse + longitudinal	Divides the ligament into four portions; considered to cause substantial disruption of restraint	Categories 3 and 4	[21,27,28,69,70]
Limited puncture capsulotomy	Inside-out (modified)	Limited longitudinal through hollow exchange rod	Reduces area of capsular injury, with a limited longitudinal incision	Category 1	[31]
Skip capsulotomy	Inside-out (modified)	Multiple short, non-communicating incisions	Designed to avoid transverse transection of iliofemoral ligament; continuity of fibers is preserved	Categories 4 and 6	[32,33]
Outside-in longitudinal capsulotomy	Outside-in	Longitudinal, parallel to iliofemoral ligament fibers	Minimizes transverse ligament injury; designed to preserve the fiber continuity	Categories 1, 4, and 5	[44,45,48,53,64]