EP3.21 Improved Clinical Outcomes with Capsular Closure in Comparison to Unrepaired Capsulotomy Following Hip Arthroscopy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract Purpose The purpose of this study was to perform a systematic review of randomized controlled trials comparing capsular closure versus unrepaired capsulotomy after hip arthroscopy (HA). Methods A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines by searching PubMed, the Cochrane Library, and Embase to identify randomized controlled trials comparing clinical outcomes between capsular closure (CC) and unrepaired capsulotomy (UR) groups following primary HA. The electronic search strategy used was: hip AND arthroscopy AND (capsule OR capsular) AND (closure OR repair) AND randomized. Outcomes measured were patient-reported outcomes (PROs) and rates of revision hip arthroscopy and conversion to total hip arthroplasty (THA). Results Five studies (4 Level I, 1 Level II) met inclusion criteria with a total of 281 hips in the CC group and 334 in the UR group. Mean patient age ranged from 28.0 to 36.9 years. Mean follow-up ranged from 12.0 to 24.0 months. Significantly greater improvements were found in the CC group compared to the UR group with three different PROs (modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living and -Sport Scale, Veterans RAND 12-Item Health Survey) across two studies. No other significant differences were found between the two groups in terms of PROs. No significant differences were found between the groups in revision hip arthroscopy rates. One study reported a significantly higher rate of conversion to THA in the UR group following T-capsulotomy (4/50) compared to the CC group (0/50). Conclusion There is some evidence that routine capsular closure following hip arthroscopy is associated with better clinical outcomes including higher PROs and lower rates of conversion to THA. These findings may not be generalizable to patients with signs of hip joint instability, in whom routine capsular closure/plication should be performed.