FP5.2 Is capsular repair during hip arthroscopy for Femoroacetabular Impingement mandatory? A systematic review and meta-analysis of Randomized Controlled Trials

Abstract

Abstract ICLB05 - The Art of Navigation: Foundations of Efficient and Complication-Free Hip Arthroscopy, Session Room 6 (BMCC Level 3), October 8, 2026, 14:00 - 16:00 Purpose This systematic review and meta-analysis aimed to determine whether capsular repair after hip arthroscopy for femoroacetabular impingement (FAI) provides superior clinical outcomes, functional recovery, and complication profiles compared with non-repair. Despite the trend toward routine capsular closure, evidence regarding its benefit remains inconsistent. Methods Following PRISMA guidelines, a search of PubMed, Scopus, Embase, and MEDLINE identified 5 randomized controlled trials (RCTs) comparing capsular repair (CR) with non-repair (NR) in patients with FAI. Studies published between 2000 and September 2025 with a follow-up of ≥12 months were included. Data on patient demographics, surgical techniques, postoperative protocols, patient-reported outcome measures (PROMs), complications, and revision rates were extracted. Standardized mean differences (SMDs) were calculated using random-effects models. Heterogeneity was assessed using Cochran's Q statistics and Higgins' I2. Results Five RCTs (n=615) met the inclusion criteria: 334 patients in the NR group and 281 in the CR group. Most PROMs, including the modified Harris Hip Score (mHHS), the International Hip Outcome Tool (iHOT-12), and all subscales of the Copenhagen Hip and Groin Outcome Score (HAGOS), showed no significant differences between groups. However, the Hip Outcome Score (HOS) showed a significant advantage for capsular repair (SMD=0.53; p=0.033), a finding that may be partly influenced by differences in capsulotomy technique among the included trials. Revision surgery was more frequent in patients who did not undergo repair (18 vs. 5 cases). Heterogeneity was generally low across analyses. Conclusions Capsular repair after hip arthroscopy for FAI does not produce universally superior clinical outcomes, but it provides a significant improvement in sport-specific functional recovery scores, supporting its role in improving dynamic hip stability. Routine repair may not be necessary for all patients or techniques; rather, a personalized approach is recommended. Capsular repair should be prioritized in T-capsulotomy techniques, in young, athletic individuals and those with ligamentous laxity, borderline dysplasia, or risk factors for microinstability.