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

https://doi.org/10.1016/j.arthro.2021.03.063Get rights and content

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.

Section snippets

Study Identification and Search Strategy

This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to find the articles by using PubMed and Embase. Two orthopedic surgeon reviewers (AEJ, BRS) performed the search and data extraction through August 1, 2020, and came to a consensus about the eligibility of relevant studies. Differences regarding study inclusion were settled by discussion. Reference lists from relevant articles were retrieved to identify additional studies. The following

Study Identification

After our initial search in PubMed and Embase with the selected keywords, we identified 1,452 studies (Fig 1). After removing review articles, duplicates, technique reports, case reports, and opinion articles, we obtained 972 total articles. We then evaluated abstracts and removed studies that were irrelevant based on our inclusion criteria. We identified 66 articles for full-text review. An additional 50 studies were excluded leaving 16 studies (Fig 1).

Study Quality

There were 11 Level III studies, 3 Level

Discussion

The main finding of this review was that capsular repair is safe and effective in patients without arthritis who are undergoing hip arthroscopy, and it may result in superior patient-reported outcomes compared to unrepaired capsulotomy. The results of this systematic review aligned with previous studies. Of the 10 comparative outcome studies that evaluated PROs between capsular repair and unrepaired capsulotomies, 8 found more favorable results in the capsular repair groups. There was

Conclusions

Midterm outcome studies suggest that capsular repair is safe and effective in patients without arthritis who are 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 groups with unrepaired capsulotomy, and no studies reported superior results with unrepaired capsulotomies.

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  • Cited by (0)

    The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

    Dr. Domb reports grants and other from American Orthopedic Foundation, during the conduct of the study; personal fees from Amplitude, grants, personal fees and non-financial support from Arthrex, personal fees and non-financial support from DJO Global, grants, personal fees and non-financial support from Medacta, grants, personal fees, non-financial support and other from Stryker, grants from Breg, personal fees from Orthomerica, grants and non-financial support from Medwest Associates, grants from ATI Physical Therapy, personal fees and non-financial support from St. Alexius Medical Center, grants from Ossur, non-financial support from Zimmer Biomet, outside the submitted work; In addition, Dr. Domb 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 Dr. Domb is a board member of American Hip Institute Research 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. Dr. Lall reports grants, personal fees and non-financial support from Arthrex, non-financial support from Iroko, non-financial support from Medwest, non-financial support from Smith & Nephew, grants and non-financial support from Stryker, non-financial support from Vericel, non-financial support from Zimmer Biomet, personal fees from Graymont Medical, outside the submitted work; and Dr. Lall is the Co-Medical Director of Hip Preservation at St. Alexius Medical Center, the Clinical Instructor at the University of Illinois College of Medicine, and member of the AANA Learning Center Committee. Dr. Maldonado reports non-financial support from Arthrex, non-financial support from Stryker, non-financial support from Smith & Nephew, non-financial support from Ossur, outside the submitted work; and Dr. Maldonado is an editorial board member of the Journal of Arthroscopy. Dr. Saks reports grants from Arthrex, personal fees from DJO Global, outside the submitted work. Dr. Shapira reports non-financial support from Arthrex, non-financial support from Stryker, non-financial support from Smith & Nephew, non-financial support from Ossur, outside the submitted work.

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