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

Abstract 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 (FAIS). Methods This study used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to find articles using PubMed and Embase. Included studies were Level I through III studies and 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 (MINORS) 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 which 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 Thirteen of the 16 included studies reported patient reported outcome scores (PROs), three of 16 studies included imaging outcomes data, and two studies reported on reoperation. Ten studies directly compared patient reported outcomes between a capsular repair group and an unrepaired group. Out of the ten studies that directly compared PROs between an unrepaired capsulotomy group and capsular repair group, eight studies demonstrated statistically significantly better PROs in the repair group compared to the unrepaired group and two studies found no difference between groups. Reoperation rates demonstrated mixed results between groups and no difference was found in regard to imaging outcomes. Conclusions Mid-term outcome studies suggest that capsular repair is safe and effective in nonarthritic patients undergoing hip arthroscopy and may result in superior patient-reported outcomes compared with unrepaired capsulotomy. Studies consistently demonstrated similar or superior outcomes in the capsular repair cohorts compared to unrepaired capsulotomy, and no studies reported superior results in unrepaired capsulotomy patients.