Does Capsular Closure Affect Clinical Outcomes in Hip Arthroscopy? A Prospective Randomized Controlled Trial

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Hip Arthroscopy

Background:

• Iatrogenic hip instability after capsulotomy is a growing concern.
• Emphasis is increasing on capsular closure during hip arthroscopy.
• Prospective data on the impact of capsular closure on outcomes are lacking.

Purpose of the Study:

• To evaluate patient outcomes after interportal capsulotomy repair versus no repair.
• To test the hypothesis that capsular repair restores normal anatomy and achieves similar clinical outcomes to no repair.

Main Methods:

• A randomized controlled trial (Level 1 evidence) was conducted.
• Adult patients with femoroacetabular impingement undergoing hip arthroscopy were randomized to capsular repair (CR) or no repair (NR).
• Clinical outcomes were assessed using multiple validated hip outcome scores and surveys.

Main Results:

• Both CR and NR groups showed significant improvements in Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Hip Outcome Score-Sport Specific (HOS-SS) scores at 2 years.
• No significant differences were observed between groups for most outcome measures.
• The NR group demonstrated significant worsening in HOS-ADL, modified Harris Hip Score (mHHS), and Veterans RAND 12-Item Health Survey (VR-12) Physical subscale between 1 and 2 years compared to the CR group.

Conclusions:

• The capsular repair (CR) group showed significant improvement in the VR-12 Physical subscale at 2 years postoperatively compared to the no repair (NR) group.
• Capsular closure does not appear to have detrimental effects on functional outcomes after hip arthroscopy.
• Restoration of native anatomy through capsular closure is recommended when feasible during hip arthroscopy.