{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T20:22:11Z","timestamp":1773606131775,"version":"3.50.1"},"reference-count":22,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T00:00:00Z","timestamp":1617148800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T00:00:00Z","timestamp":1617148800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T00:00:00Z","timestamp":1617148800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T00:00:00Z","timestamp":1617148800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/100007307","name":"Arthrex Inc","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007307","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["arthroscopyjournal.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To compare the area of visualization, capsular stiffness, and strength between the pie\u2010crusting capsulotomy technique and the T\u2010capsulotomy technique following repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Eight matched pairs of fresh\u2010frozen cadaveric hips (n\u00a0= 16) were divided to either T\u2010capsulotomy or pie\u2010crusting capsulotomy followed by subsequent repair. The area of visualization was measured for all capsulotomy states using a digitizing probe. Hips were then distracted along the iliofemoral ligament in the intact, extended capsulotomy, and repair states. Afterwards, specimens were externally rotated to failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      An average force of 250.1 \u00b1 16.1 N was required to distract intact hips to 6 mm. Both extended capsulotomy techniques reduced the force required to distract the hip 6 mm with no statistical difference between the two (T\u2010capsulotomy [T\u2010cap]\u00a0= 114.3 \u00b1 63.4 N vs pie\u2010capsulotomy [Pie\u2010cap]\u00a0= 170.1 \u00b1 38.8 N),\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .07. Subsequent repair of the extended capsulotomies demonstrated the pie\u2010crust capsulotomy required significantly greater force to reach 6 mm of distraction than those with a repaired T\u2010capsulotomy (T\u2010cap\u00a0= 165.04 \u00b1 40.43N vs Pie\u2010cap\u00a0= 204.43 \u00b1 10.13N),\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .03. There was no significant difference in ultimate torque to failure between the 2 techniques (T\u2010cap\u00a0= 22.0 \u00b1 7.41 N\u00b7m vs Pie\u2010cap\u00a0= 27.01 \u00b1 11.13 N\u00b7m),\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .28. Visualization significantly increased with each extended capsulotomy, with an average increase of 62% (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001) and 48% (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001) for the pie\u2010 and T\u2010capsulotomies, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The pie\u2010crusting technique maintained similar strength and increased stiffness to the T\u2010capsulotomy following repair while using less suture. Both techniques provided similar visualization. Clinically, the pie\u2010crusting technique provides an alternative to the T\u2010capsulotomy with similar biomechanical and visual outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>Visualization during hip arthroscopy can be difficult with large cam morphology. Techniques to improve visualization while restoring the native biomechanics of the hip as best as possible are important.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2021.03.044","type":"journal-article","created":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T22:54:41Z","timestamp":1617231281000},"page":"2832-2837","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":5,"title":["Pie\u2010Crusting Capsulotomy Provides Similar Visualization With Increased Repair Stiffness Compared With a T\u2010Capsulotomy: A Biomechanical Study"],"prefix":"10.1002","volume":"37","author":[{"given":"Frank B.","family":"Wydra","sequence":"first","affiliation":[{"name":"Kerlan\u2010Jobe Institute Cedars\u2010Sinai Los Angeles California"},{"name":"Santa Monica Orthopaedic &amp; Sports Medicine Group Santa Monica California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Al\u2019Khafaji","sequence":"additional","affiliation":[{"name":"Kerlan\u2010Jobe Institute Cedars\u2010Sinai Los Angeles California"},{"name":"Santa Monica Orthopaedic &amp; Sports Medicine Group Santa Monica California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lee","family":"Haruno","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Cedars\u2010Sinai Los Angeles California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Chahla","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Rush University Medical Center Chicago Illinois U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trevor J.","family":"Nelson","sequence":"additional","affiliation":[{"name":"Orthopaedic Biomechanics Laboratory Cedars\u2010Sinai Los Angeles California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael B.","family":"Gerhardt","sequence":"additional","affiliation":[{"name":"Kerlan\u2010Jobe Institute Cedars\u2010Sinai Los Angeles California"},{"name":"Santa Monica Orthopaedic &amp; Sports Medicine Group Santa Monica California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melodie F.","family":"Metzger","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Cedars\u2010Sinai Los Angeles California"},{"name":"Orthopaedic Biomechanics Laboratory Cedars\u2010Sinai Los Angeles California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,3,31]]},"reference":[{"key":"e_1_2_3_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-016-4411-8"},{"key":"e_1_2_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2018.10.142"},{"key":"e_1_2_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eats.2018.10.015"},{"key":"e_1_2_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2020.08.004"},{"key":"e_1_2_3_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-014-3030-5"},{"key":"e_1_2_3_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/JSA.0000000000000089"},{"key":"e_1_2_3_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546518755717"},{"key":"e_1_2_3_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546518800710"},{"key":"e_1_2_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2017.06.030"},{"key":"e_1_2_3_11_2","first-page":"49","article-title":"Current 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