Mid- to long-term outcomes of capsular management in hip arthroscopy for FAIS: A multilevel meta-analysis
Nikolai Ramadanov1,2, Maximilian Voss1,2, Robert Hable3
1Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, Brandenburg an der Havel, Germany.
Purpose:
To compare mid- to long-term outcomes of the three major capsular management strategies-capsule preserved (CP), capsule repaired (CR) and capsule unrepaired (CU)-following hip arthroscopy (HAS) for femoroacetabular impingement syndrome (FAIS).
Methods:
A systematic search was conducted in PubMed, Embase, CENTRAL, and Epistemonikos for studies published up to 31 May 2025. Studies were eligible if they reported ≥2-year outcomes after HAS with clearly described capsular techniques. Outcomes included the modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Sports Subscale (HOS-SSS) and Visual Analogue Scale (VAS) for pain. Multilevel meta-analyses were performed using random-effects models with Hartung-Knapp adjustment. Failure-related outcomes (complications, reoperations, total hip arthroplasty [THA] conversions) were inconsistently reported across studies and could only be summarised descriptively.
Results:
Seven studies with a total of 948 patients were included. Pooled mean mHHS was 81.14 (95% confidence interval [CI]: 77.72-84.56), with CP: 84.90, CR: 80.66 and CU: 80.25 (p = 0.67). HOS-ADL pooled mean was 87.94 (95% CI: 84.79-91.09), with CP: 89.30, CR: 87.36, CU: 88.31 (p = 0.90). HOS-SSS pooled mean was 78.59 (95% CI: 72.69-84.48), with CP: 75.70, CR: 78.89, CU: 80.22 (p = 0.84). VAS pooled mean was 2.42 (95% CI: 2.08-2.77), with CP: 2.46, CR: 2.27, CU: 2.76 (p = 0.51). No statistically significant subgroup differences were detected. CR showed the highest cumulative numbers of reoperations and THA conversions, whereas CP and CU demonstrated lower but heterogeneous event counts.
Conclusion:
CP, CR and CU demonstrated comparable mid- to long-term patient-reported outcome measure (PROM) outcomes following HAS for FAIS. Failure-related events varied descriptively across techniques, but inconsistent reporting prevented comparative survivorship assessment.
Level Of Evidence:
Level II, systematic review and multilevel meta-analysis of predominantly Level III studies, with additional contributions from Level I and II studies.
