Abstract
Purpose
To determine if routine capsular closure following hip arthroscopy for FAI in non-dysplastic
patients 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 PRISMA guidelines for clinical studies reporting PROs following arthroscopic
hip labral repair for FAI. A quality assessment was performed using the MINORS grading
system. Inclusion criteria consisted of comparative clinical studies investigating
routine capsular closure to non-closure 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,
non-comparative 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 which
underwent capsular repair and 157 hips which underwent capsulotomy with no repair.
There were two level III studies and one level II study, with an average MINORS score
of 16.7. All studies cited femoroacetabular impingement 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 mHHS values ranging from 80.8 to 87, while
the non-repair group reported scores ranging from 76 to 81.7. Additionally, the repair
group reported postoperative HOS-SSS values ranging from 68.1 to 9, while the non-repair
group reported scores ranging from 65.3 to 76.1. The studies also reported MCID for
mHHS, with the repair group reporting percentages ranging from 71 to 100 and the no
repair group reporting percentages ranging from 52 to 95.6. All three studies also
observed a lower rate of hip survivorship in the non-repair group, rangingfrom 94.6
to 100 the repair group and 90.8 to 100 in the non-repair group. There were no significant
differences in the rate of revision arthroscopy between groups.
Conclusion
Non-dysplastic patients who undergo capsular repair have greater improvements in PROs
and higher survivorship rates at early- and mid-term follow-up than patients who do
not undergo capsular repair.
Level of Evidence
Level III, systematic review of level II and III studies
Keywords
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Article Info
Publication History
Accepted:
November 10,
2022
Received in revised form:
November 9,
2022
Received:
October 31,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
This study was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki. This study was carried out in accordance with relevant regulations of the US Health Insurance Portability and Accountability Act (HIPAA). Details that might disclose the identity of the subjects under study have been omitted. This study was approved by the IRB. (IRB ID: 5276)
This study was performed at the American Hip Institute Research Foundation.
Identification
Copyright
© 2022 Published by Elsevier on behalf of the Arthroscopy Association of North America
