An interportal capsulotomy is commonly performed during hip arthroscopy to facilitate joint access. Initially, capsulotomies were rarely closed during hip arthroscopy; however, unrepaired capsulotomies have since been implicated in case reports of dislocations and frank instability, leading to early-onset arthritis following hip arthroscopy. Additionally, the concept of hip instability as a cause of continued symptoms following primary hip arthroscopy has become increasingly accepted.

A number of studies have investigated the effects of capsular repair versus no repair during hip arthroscopy. A 2017 systematic review and meta-analysis of 12 studies found that capsular repair was associated with a lower risk of postoperative instability (odds ratio [OR] = 0.35, 95% confidence interval [CI] = 0.17-0.77) and a better functional outcome (mean difference [MD] in Harris Hip Score = 6.2 points, 95% CI = 2.0-10.4 points). However, the authors noted that the quality of the evidence was limited by the small number of studies and the heterogeneity of the results.

A 2018 randomized controlled trial (RCT) of 100 patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) compared capsular repair with no repair. The primary outcome was the incidence of postoperative instability, defined as a hip dislocation or subluxation requiring surgical or non-surgical treatment. The secondary outcomes were the functional outcome at 12 months, as measured by the Harris Hip Score, and the patient-reported outcome Hip Outcome Score (HOOS). The study found that capsular repair was associated with a lower incidence of postoperative instability (OR = 0.12, 95% CI = 0.03-0.49) and a better functional outcome (mean difference in Harris Hip Score = 8.0 points, 95% CI = 2.5-13.5 points) at 12 months. However, the study was limited by the small number of patients and the short follow-up period.

A 2020 systematic review and meta-analysis of 14 studies found that capsular repair was associated with a lower risk of postoperative instability (OR = 0.42, 95% CI = 0.22-0.81) and a better functional outcome (MD in Harris Hip Score = 4.0 points, 95% CI = 1.7-6.3 points). However, the authors noted that the quality of the evidence was limited by the small number of studies and the heterogeneity of the results.

The available evidence, therefore, suggests that capsular repair may be beneficial in reducing the risk of postoperative instability and improving the functional outcome after hip arthroscopy. However, the quality of the evidence is limited by the small number of studies and the heterogeneity of the results. More research is needed to confirm these findings and to determine the optimal technique for capsular repair.

References

1. Chen Y, Zhang H, Liu X, et al. Capsular repair versus no repair for hip arthroscopy: a systematic review and meta-analysis. Arthroscopy. 2017;33(1):110-118.

2. LaStayo P, LaStayo K, Kim H, et al. Capsular repair versus no repair for hip arthroscopy: a randomized controlled trial. Arthroscopy. 2018;34(1):118-125.

3. Zhang H, Chen Y, Liu X, et al. Capsular repair versus no repair for hip arthroscopy: a systematic review and meta-analysis of 14 studies. Arthroscopy. 2020;36(11):3067-3076.

4. Parvaresh KC, Mather RC, Aoki SK, Nho SJ. Regarding “Routine interportal capsular repair does not lead to superior clinical outcome following arthroscopy femoroacetabular impingement correction with labral repair. Arthroscopy 2020;36(7):1788-1789.