FP5.3 International Expert Consensus on Longitudinal Outside-In Capsulotomy (LOIC) in Hip Arthroscopy: A Modified Delphi Study

Abstract

Abstract ICLB05 - The Art of Navigation: Foundations of Efficient and Complication-Free Hip Arthroscopy, Session Room 6 (BMCC Level 3), October 8, 2026, 14:00 - 16:00 Objectives To establish an international consensus on the Longitudinal Outside-In Capsulotomy (LOIC) technique by defining its standardized nomenclature, technical execution, clinical indications, and safety profile, thereby providing a robust framework for its clinical implementation in hip arthroscopy. Methods A multidisciplinary steering committee conducted a comprehensive literature review and convened a panel of international experts using a modified Delphi method. The consensus process comprised three sequential rounds between November 2025 and January 2026. Experts evaluated 10 statements across 8 key clinical domains. Consensus was a priori defined as an agreement threshold of ≥80%. Results A total of 24 experts from 10 countries participated. Consensus was reached for all 10 statements across 8 clinical domains, including technical features and nomenclature, clinical indications and contraindications, preoperative preparation, intraoperative technical pearls, capsular closure, potential pitfalls and prevention of complications, postoperative rehabilitation, and technical advantages and disadvantages. Conclusions This study represents a comprehensive international effort to standardize the clinical practice of the LOIC technique. The LOIC technique offers well-defined advantages, most notably preservation of the biomechanical integrity of the iliofemoral ligament and a reduced reliance on extensive preoperative traction and intraoperative fluoroscopy. Although the consensus supports the technique's broad clinical indications and favorable safety profile, successful implementation remains dependent on a profound understanding of pericapsular anatomy and a stepwise progression along the learning curve.