Advertisement

Capsular Repair May Improve Outcomes in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review of Comparative Outcome Studies

      Purpose

      To review the existing literature in order to determine the effect of hip capsule repair on outcomes after hip arthroscopy for femoroacetabular impingement syndrome.

      Methods

      This study used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to find articles by using PubMed and Embase. Included studies were Level I through III studies that focused on patient outcomes as a function of hip capsular treatments: capsulotomy repair, partial repair, plication, and unrepaired capsulotomies. The Methodological Index for Non-randomized Studies was used for quality assessment of clinical outcome studies. After applying inclusion and exclusion criteria, a total of 16 comparative outcome studies evaluating 2,996 hips were included; they evaluated the following capsular management techniques: complete repair (n = 1,112, 37.1%), partial repair (n = 32, 1.1%), plication (n = 223, 7.4%), and unrepaired capsulotomy (n = 1629, 54.4%).

      Results

      Of the 16 studies, 13 included patient-reported outcome scores (PROs), 3 included imaging outcomes data, and 2 reported on reoperation. Of the studies, 10 directly compared patient-reported outcomes between a capsular repair group and an unrepaired group. Of the 10 studies that directly compared PROs between a group with unrepaired capsulotomy and a group with capsular repair, 8 studies demonstrated statistically significantly better PROs in the repaired group compared to the unrepaired group, and 2 studies found no difference between the groups. Reoperation rates demonstrated mixed results between groups, and no difference was found in regard to imaging outcomes.

      Conclusions

      Midterm outcome studies suggest that capsular repair is safe and effective in patients without arthritis who are undergoing hip arthroscopy, and it may result in superior PROs compared with those found after unrepaired capsulotomy. Studies consistently demonstrate similar or superior outcomes in cohorts after capsular repair compared to unrepaired capsulotomy, and no studies reported superior results in unrepaired capsulotomy patients.

      Level of Evidence

      Level IV, systematic review of Level I through Level III studies.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Matsuda D.K.
        • Khatod M.
        Rapidly progressive osteoarthritis after arthroscopic labral repair in patients with hip dysplasia.
        Arthroscopy. 2012; 28: 1738-1743
        • Austin D.C.
        • Horneff J.G.
        • Kelly J.D.
        Anterior hip dislocation 5 months after hip arthroscopy.
        Arthroscopy. 2014; 30: 1380-1382
        • Gupta A.
        • Suarez-Ahedo C.
        • Redmond J.M.
        • et al.
        Best practices during hip arthroscopy: Aggregate recommendations of high-volume surgeons.
        Arthroscopy. 2015; 31: 1722-1727
        • Jacobsen S.
        • Guth J.J.
        • Schimoler P.J.
        • et al.
        Biomechanical response to distraction of hip capsular reconstruction with human acellular dermal patch graft.
        Arthroscopy. 2020; 36: 1337-1342
        • Baha P.
        • Burkhart T.A.
        • Getgood A.
        • Degen R.M.
        Complete capsular repair restores native kinematics after interportal and T-capsulotomy.
        Am J Sports Med. 2019; 47: 1451-1458
        • Ng K.C.G.
        • El Daou H.
        • Bankes M.J.K.
        • Rodriguez Y Baena F.
        • Jeffers J.R.T.
        Hip joint torsional loading before and after cam femoroacetabular impingement surgery.
        Am J Sports Med. 2019; 47: 420-430
        • Han S.
        • Alexander J.W.
        • Thomas V.S.
        • et al.
        Does capsular laxity lead to microinstability of the native hip?.
        Am J Sports Med. 2018; 46: 1315-1323
        • Weber A.E.
        • Neal W.H.
        • Mayer E.N.
        • et al.
        Vertical extension of the T-capsulotomy incision in hip arthroscopic surgery does not affect the force required for hip distraction: Effect of capsulotomy size, type, and subsequent repair.
        Am J Sports Med. 2018; 46: 3127-3133
        • Bakshi N.K.
        • Bayer J.L.
        • Bigelow E.M.R.
        • Jameel O.F.
        • Sekiya J.K.
        The effect of capsulectomy on hip joint biomechanics.
        Orthop J Sports Med. 2017; 5 (2325967117733433)
        • Chahla J.
        • Mikula J.
        • Schon J.
        • et al.
        Hip capsular closure: A biomechanical analysis of failure torque.
        Am J Sports Med. 2017; 45: 434-439
        • Khair M.M.
        • Grzybowski J.S.
        • Kuhns B.D.
        • Wuerz T.H.
        • Shewman E.
        • Nho S.J.
        The effect of capsulotomy and capsular repair on hip distraction: A cadaveric investigation.
        Arthroscopy. 2017; 33: 559-565
        • Philippon M.J.
        • Trindade C.A.C.
        • Goldsmith M.T.
        • et al.
        Biomechanical assessment of hip capsular repair and reconstruction procedures using a 6 degrees of freedom robotic system.
        Am J Sports Med. 2017; 45: 1745-1754
        • Ortiz-Declet V.
        • Mu B.
        • Chen A.W.
        • et al.
        Should the capsule be repaired or plicated after hip arthroscopy for labral tears associated with femoroacetabular impingement or instability? A systematic review.
        Arthroscopy. 2018; 34: 303-318
        • Economopoulos K.J.
        • Chhabra A.
        • Kweon C.
        Prospective randomized comparison of capsular management techniques during hip arthroscopy.
        Am J Sports Med. 2020; 48: 395-402
        • Filan D.
        • Carton P.
        Routine interportal capsular repair does not lead to superior clinical outcome following arthroscopic femoroacetabular impingement correction with labral repair.
        Arthroscopy. 2020; 36: 1323-1334
        • Hassebrock J.D.
        • Makovicka J.L.
        • Chhabra A.
        • et al.
        Hip arthroscopy in the high-level athlete: Does capsular closure make a difference?.
        Am J Sports Med. 2020; 48: 2465-2470
        • Atzmon R.
        • Sharfman Z.T.
        • Haviv B.
        • et al.
        Does capsular closure influence patient-reported outcomes in hip arthroscopy for femoroacetabular impingement and labral tear?.
        J Hip Preserv Surg. 2019; 6: 199-206
        • Bolia I.K.
        • Fagotti L.
        • Briggs K.K.
        • Philippon M.J.
        Midterm outcomes following repair of capsulotomy versus nonrepair in patients undergoing hip arthroscopy for femoroacetabular impingement with labral repair.
        Arthroscopy. 2019; 35: 1828-1834
        • Kraeutler M.J.
        • Strickland C.D.
        • Brick M.J.
        • et al.
        A multicenter, double-blind, randomized controlled trial comparing magnetic resonance imaging evaluation of repaired versus unrepaired interportal capsulotomy in patients undergoing hip arthroscopy for femoroacetabular impingement.
        J Hip Preserv Surg. 2018; 5: 349-356
        • Bolia I.
        • Briggs K.K.
        • Philippon M.J.
        Superior clinical outcomes with capsular closure versus non-closure in patients undergoing arthroscopic hip labral repair.
        Orthop J Sports Med. 2018; 6 (2325967118S00009)
        • Domb B.G.
        • Chaharbakhshi E.O.
        • Perets I.
        • Walsh J.P.
        • Yuen L.C.
        • Ashberg L.J.
        Patient-Reported outcomes of capsular repair versus capsulotomy in patients undergoing hip arthroscopy: Minimum 5-year follow-up: A matched comparison study.
        Arthroscopy. 2018; 34: 853-863.e1
        • Strickland C.D.
        • Kraeutler M.J.
        • Brick M.J.
        • et al.
        MRI evaluation of repaired versus unrepaired interportal capsulotomy in simultaneous bilateral hip arthroscopy: A double-blind, randomized controlled trial.
        J Bone Joint Surg Am. 2018; 100: 91-98
        • Sugarman E.P.
        • Birns M.E.
        • Fishman M.
        • et al.
        Clinical outcomes comparing capsular repair vs. no repair following hip arthroscopy: A prospective, randomized, control study.
        Orthop J Sports Med. 2017; 5 (2325967117S00415)
        • Amar E.
        • Warschawski Y.
        • Sampson T.G.
        • Atoun E.
        • Steinberg E.L.
        • Rath E.
        Capsular closure does not affect development of heterotopic ossification after hip arthroscopy.
        Arthroscopy. 2015; 31: 225-230
        • Domb B.G.
        • Stake C.E.
        • Finley Z.J.
        • Chen T.
        • Giordano B.D.
        Influence of capsular repair versus unrepaired capsulotomy on 2-year clinical outcomes after arthroscopic hip preservation surgery.
        Arthroscopy. 2015; 31: 643-650
        • Frank R.M.
        • Lee S.
        • Bush-Joseph C.A.
        • Kelly B.T.
        • Salata M.J.
        • Nho S.J.
        Improved outcomes after hip arthroscopic surgery in patients undergoing t-capsulotomy with complete repair versus partial repair for femoroacetabular impingement: A comparative matched-pair analysis.
        Am J Sports Med. 2014; 42: 2634-2642
        • Litrenta J.
        • Mu B.H.B.
        • Ortiz-Declet V.M.
        • et al.
        Hip arthroscopy successfully treats femoroacetabular impingement in adolescent athletes.
        J Pediatr Orthop. 2020; 40: e156-e160
        • Thaunat M.
        • Sarr S.
        • Georgeokostas T.
        • et al.
        Femoroacetabular impingement treatment using the arthroscopic extracapsular outside-in approach: Does capsular suture affect functional outcome?.
        Orthop Traumatol Surg Res. 2020; 106: 569-575
        • Ukwuani G.C.
        • Waterman B.R.
        • Nwachukwu B.U.
        • et al.
        Return to dance and predictors of outcome after hip arthroscopy for femoroacetabular impingement syndrome.
        Arthroscopy. 2019; 35: 1101-1108.e3
        • Domb B.G.
        • Chaharbakhshi E.O.
        • Perets I.
        • Yuen L.C.
        • Walsh J.P.
        • Ashberg L.
        Hip arthroscopic surgery with labral preservation and capsular plication in patients with borderline hip dysplasia: Minimum 5-year patient-reported outcomes.
        Am J Sports Med. 2018; 46: 305-313
        • Chandrasekaran S.
        • Darwish N.
        • Martin T.J.
        • Suarez-Ahedo C.
        • Lodhia P.
        • Domb B.G.
        Arthroscopic capsular plication and labral seal restoration in borderline hip dysplasia: 2-year clinical outcomes in 55 cases.
        Arthroscopy. 2017; 33: 1332-1340
        • Matsuda D.K.
        • Gupta N.
        • Khatod M.
        • et al.
        Poorer arthroscopic outcomes of mild dysplasia with cam femoroacetabular impingement versus mixed femoroacetabular impingement in absence of capsular repair.
        Am J Orthop. 2017; 46: E47-E53
        • Weber A.E.
        • Kuhns B.D.
        • Cvetanovich G.L.
        • et al.
        Does the hip capsule remain closed after hip arthroscopy with routine capsular closure for femoroacetabular impingement? A magnetic resonance imaging analysis in symptomatic postoperative patients.
        Arthroscopy. 2017; 33: 108-115
        • Larson C.M.
        • Ross J.R.
        • Stone R.M.
        • et al.
        Arthroscopic management of dysplastic hip deformities: Predictors of success and failures with comparison to an arthroscopic FAI cohort.
        Am J Sports Med. 2016; 44: 447-453
        • Newman J.T.
        • Briggs K.K.
        • McNamara S.C.
        • Philippon M.J.
        Revision hip arthroscopy: A matched-cohort study comparing revision to primary arthroscopy patients.
        Am J Sports Med. 2016; 44: 2499-2504
        • Fukui K.
        • Briggs K.K.
        • Trindade C.A.C.
        • Philippon M.J.
        Outcomes after labral repair in patients with femoroacetabular impingement and borderline dysplasia.
        Arthroscopy. 2015; 31: 2371-2379
        • Larson C.M.
        • Stone R.M.
        • Grossi E.F.
        • Giveans M.R.
        • Cornelsen G.D.
        Ehlers-Danlos syndrome: Arthroscopic management for extreme soft-tissue hip instability.
        Arthroscopy. 2015; 31: 2287-2294
        • Wylie J.D.
        • Beckmann J.T.
        • Maak T.G.
        • Aoki S.K.
        Arthroscopic capsular repair for symptomatic hip instability after previous hip arthroscopic surgery.
        Am J Sports Med. 2016; 44: 39-45
        • Larson C.M.
        • Giveans M.R.
        • Samuelson K.M.
        • Stone R.M.
        • Bedi A.
        Arthroscopic hip revision surgery for residual femoroacetabular impingement (FAI): Surgical outcomes compared with a matched cohort after primary arthroscopic FAI correction.
        Am J Sports Med. 2014; 42: 1785-1790
        • Amenabar T.
        • O’Donnell J.
        Successful treatment of isolated, partial thickness ligamentum teres (LT) tears with debridement and capsulorrhaphy.
        Hip Int. 2013; 23: 576-582
        • Domb B.G.
        • Stake C.E.
        • Lindner D.
        • El-Bitar Y.
        • Jackson T.J.
        Arthroscopic capsular plication and labral preservation in borderline hip dysplasia: Two-year clinical outcomes of a surgical approach to a challenging problem.
        Am J Sports Med. 2013; 41: 2591-2598
        • Maldonado D.R.
        • Chen J.W.
        • Yelton M.J.
        • et al.
        Achieving successful outcomes of hip arthroscopy in the setting of generalized ligamentous laxity with labral preservation and appropriate capsular management: A propensity matched controlled study.
        Am J Sports Med. 2020; 48: 1625-1635
        • Slim K.
        • Nini E.
        • Forestier D.
        • Kwiatkowski F.
        • Panis Y.
        • Chipponi J.
        Methodological index for non-randomized studies (minors): Development and validation of a new instrument.
        ANZ J Surg. 2003; 73: 712-716
        • Griffin D.W.
        • Kinnard M.J.
        • Formby P.M.
        • McCabe M.P.
        • Anderson T.D.
        Outcomes of hip arthroscopy in the older adult: A systematic review of the literature.
        Am J Sports Med. 2017; 45: 1928-1936
        • Hozo S.P.
        • Djulbegovic B.
        • Hozo I.
        Estimating the mean and variance from the median, range, and the size of a sample.
        BMC Med Res Methodol. 2005; 5: 13
        • Higgins J.P.T.
        • Green S.
        Cochrane Handbook for systematic reviews of interventions. In: 5.10.
        The Cochrane Collaboration. 2011;
        • Cohen J.
        Statistical Power Analysis for the Behavioral Sciences.
        Routledge, New York2013
        • Neyeloff J.L.
        • Fuchs S.C.
        • Moreira L.B.
        Meta-analyses and Forest plots using a microsoft excel spreadsheet: Step-by-step guide focusing on descriptive data analysis.
        BMC Res Notes. 2012; 5: 52
        • Domb B.G.
        • Philippon M.J.
        • Giordano B.D.
        Arthroscopic capsulotomy, capsular repair, and capsular plication of the hip: Relation to atraumatic instability.
        Arthroscopy. 2013; 29: 162-173