Purpose
To determine whether routine capsular closure following hip arthroscopy for femoroacetabular
impingement (FAI) in patients without dysplasia results in improved patient-reported
outcomes (PROs) and increased survivorship rates.
Methods
A literature search of the PubMed, Embase, and Cochrane Library databases was performed
using the Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines
for clinical studies reporting PROs following arthroscopic hip labral repair for FAI.
A quality assessment was performed using the Methodological Index for Non-randomized
Studies grading system. Inclusion criteria consisted of comparative clinical studies
investigating routine capsular closure with nonclosure in patients undergoing hip
arthroscopy for the treatment of FAI and labral tears. Exclusion criteria included
non-English language, minimum follow-up of less than 2 years after surgery, technique
articles, case reports, noncomparative case series of fewer than 10 patients, failure
to report surgical technique, absence of postoperative PROs, or partial repair. Data
collection included study characteristics, demographics, indications, radiographic
metrics, perioperative findings, surgical technique, baseline and most recent PROs,
and subsequent surgeries.
Results
A total of 531 articles were reviewed, of which 3 were included with 249 hips that
underwent capsular repair and 157 hips that underwent capsulotomy with no repair.
There were 2 Level III studies and 1 Level II study, with an average The Methodological
Index for Non-randomized Studies score of 16.7. All studies cited FAI and labral tear
as an indication for surgery. All studies demonstrated improved PROs from baseline
to most recent follow-up. Postoperatively, the repair group reported modified Harris
Hip Score values ranging from 80.8 to 87, whereas the nonrepair group reported scores
ranging from 76 to 81.7. In addition, the repair group reported postoperative Hip
Outcome Score – Sports-Specific Subscale values ranging from 68.1 to 9, whereas the
nonrepair group reported scores ranging from 65.3 to 76.1. The studies also reported
minimal clinically important difference for modified Harris Hip Score, with the repair
group reporting percentages ranging from 71 to 100 and the nonrepair group reporting
percentages ranging from 52 to 95.6. All 3 studies also observed a lower rate of hip
survivorship in the nonrepair group, ranging from 94.6 to 100 in the repair group
and 90.8 to 100 in the nonrepair group. There were no significant differences in the
rate of revision arthroscopy between groups.
Conclusions
Patients without dysplasia who undergo capsular repair have greater improvements in
PROs and greater survivorship rates at early- and mid-term follow-up than patients
who do not undergo capsular repair.
Level of Evidence
III, systematic review of level II and III studies.
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References
- Systematic review and meta-analysis of outcomes after hip arthroscopy in femoroacetabular impingement.Am J Sports Med. 2019; 47: 488-500
- The incidence of hip arthroscopy in patients with femoroacetabular impingement syndrome and labral pathology increased by 85% between 2011 and 2018 in the United States.Arthroscopy. 2022; 38: 82-87
- Trends in hip arthroscopy utilization in the United States.J Arthroplasty. 2013; 28: 140-143
- Trends in hip arthroscopy.J Bone Joint Surg. 2012; 94: e23
- Contemporary management of the hip capsule during arthroscopic hip preservation surgery.Curr Rev Musculoskelet Med. 2019; 12: 260-270
- Biomechanics of the hip capsule and capsule management strategies in hip arthroscopy.Sports Med Arthrosc. 2015; 23: 164-168
- An anatomic arthroscopic description of the hip capsular ligaments for the hip arthroscopist.Arthroscopy. 2011; 27: 628-636
- Role of the acetabular labrum and the iliofemoral ligament in hip stability: An in vitro biplane fluoroscopy study.Am J Sports Med. 2011; 39: 85S-91S
- New aspects of the morphology and function of the human hip joint ligaments.Am J Anat. 1991; 192: 1-13
- Diagnosis and management of traumatic and atraumatic hip instability in the athletic patient.Clin Sports Med. 2006; 25: 309-326
- Update to femoroacetabular impingement arthroscopic management.Orthop Traumatol Surg Res. 2010; 96: 222-227
- Capsular management in hip arthroscopy: An anatomic, biomechanical, and technical review.Front Surg. 2016; 3: 1-10
- Biomechanical evaluation of capsulotomy, capsulectomy, and capsular repair on hip rotation.Arthroscopy. 2015; 31: 1511-1517
- Capsular management in hip arthroscopy.Clin Sports Med. 2016; 35: 373-389
- Hip capsular deficiency—a cause of post-surgical instability in the revision setting following hip arthroscopy for femoroacetabular impingement.Curr Rev Musculoskelet Med. 2021; 14: 351-360
- Hip dislocation or subluxation after hip arthroscopy: A systematic review.Arthroscopy. 2016; 32: 1428-1434
- Editorial Commentary: Not repairing the hip capsule after arthroscopy—what were we thinking?.Arthroscopy. 2018; 34: 319-320
- Does capsular closure affect clinical outcomes in hip arthroscopy? A prospective randomized controlled trial.Orthop J Sport Med. 2021; 9: 1-9
- Does capsular closure influence patient-reported outcomes in hip arthroscopy for femoroacetabular impingement and labral tear?.J Hip Preserv Surg. 2019; 6: 199-206
- Capsular closure versus unrepaired interportal capsulotomy after hip arthroscopy in patients with femoroacetabular impingement, results of a patient-blinded randomised controlled trial.HIP Int. 2021; Apr 1211207000211005762
- Routine interportal capsular repair does not lead to superior clinical outcome following arthroscopic femoroacetabular impingement correction with labral repair.Arthroscopy. 2020; 36: 1323-1334
- Hip capsular closure.Am J Sports Med. 2017; 45: 434-439
- 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
- Prospective randomized comparison of capsular management techniques during hip arthroscopy.Am J Sports Med. 2020; 48: 395-402
- 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
- Midterm outcomes following repair of capsulotomy versus nonrepair in patients undergoing hip arthroscopy for femoroacetabular impingement with labral repair.Arthroscopy. 2019; 35: 1828-1834
- Femoroacetabular impingement treatment using the arthroscopic extracapsular outside-in approach: Does capsular suture affect functional outcome?.Orthop Traumatol Surg Res. 2020; 106: 569-575
- 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
- Complete capsular closure provides higher rates of clinically significant outcome improvement and higher survivorship versus partial closure after hip arthroscopy at minimum 5-year follow-up.Arthroscopy. 2021; 37: 1833-1842
- Routine capsular closure with hip arthroscopic surgery results in superior outcomes: A systematic review and meta-analysis.Am J Sports Med. 2022; 50: 2007-2022
- Effect of capsular closure after hip arthroscopy for femoroacetabular impingement syndrome on achieving clinically meaningful outcomes: A meta-analysis of prospective and comparative studies.Orthop J Sport Med. 2021; 9: 1-8
- Systematic review of hip arthroscopy for femoroacetabular impingement: The importance of labral repair and capsular closure.Arthroscopy. 2019; 35: 646-656.e3
Article info
Publication history
Published online: November 14, 2022
Accepted:
November 10,
2022
Received:
October 31,
2022
Footnotes
The authors report the following potential conflicts of interest or sources of funding: A.D.C. reports grants and personal fees from Arthrex; and grants and personal fees from Smith & Nephew, outside the submitted work. B.G.D. reports grants and other from the American Orthopedic Foundation, during the conduct of the study; personal fees from Amplitude; grants, personal fees, and nonfinancial support from Arthrex; personal fees and nonfinancial support from DJO Global; grants, personal fees, and nonfinancial support from Medacta; grants, personal fees, nonfinancial support, and other from Stryker; grants from Breg; personal fees from Orthomerica; grants and nonfinancial support from Medwest Associates; grants from ATI Physical Therapy; personal fees and nonfinancial support from St. Alexius Medical Center; grants from Ossur; nonfinancial support from Zimmer Biomet; nonfinancial support from DePuy Synthes Sales; nonfinancial support from Medtronic; nonfinancial support from Prime Surgical; and nonfinancial support from Trice Medical, outside the submitted work; In addition, B.G.D. has a patent 8920497 - Method and instrumentation for acetabular labrum reconstruction with royalties paid to Arthrex, a patent 8708941 - Adjustable multi-component hip orthosis with royalties paid to Orthomerica and DJO Global, and a patent 9737292 - Knotless suture anchors and methods of tissue repair with royalties paid to Arthrex and B.G.D. is a board member of American Hip Institute Reuter Foundation, AANA Learning Center Committee, the Journal of Hip Preservation Surgery, the Journal of Arthroscopy; has had ownership interests in the American Hip Institute, Hinsdale Orthopedic Associates, Hinsdale Orthopedic Imaging, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center. ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2022 by the Arthroscopy Association of North America
