EP3.30 Early Clinical Outcomes and MRI Findings Following Revision Hip Arthroscopy with Capsular Reconstruction

Abstract Purpose Capsular insufficiency is an increasingly recognized cause of failure following hip arthroscopy and can be treated with capsular reconstruction. However, postoperative imaging assessment remains poorly defined. This study evaluates early clinical and imaging outcomes following revision hip arthroscopy with capsular reconstruction and introduces a novel MRI-based grading system for postoperative assessment. Methods A retrospective review was performed on 12 consecutive patients undergoing revision hip arthroscopy with capsular reconstruction using 2- and 3-mm–thick ArthroFlex dermal allograft. Patient-reported outcomes (WOMAC and HOOS Jr) were collected pre- and postoperatively. Postoperative MRI at approximately 6 months was evaluated using a novel, author-developed classification system characterizing five capsular properties: continuity, thickness, redundancy, incorporation, and containment (each graded 0–3; total score 0–15). Global grades were defined as excellent (0–3), mild abnormality (4–7), moderate compromise (8–11), and severe failure (12–15). Results Mean WOMAC improved from 52.1 ± 16.3 preoperatively to 10.3 ± 12.1 postoperatively (p < 0.001). Mean HOOS Jr improved from 52.3 ± 10.3 to 87.2 ± 13.8 (p < 0.001). Ninety percent of patients (9/10) achieved minimal clinically important difference (MCID) thresholds for both outcome measures. Six patients have undergone postoperative MRI evaluation at a minimum of 6 months. Mean thickness of the reconstructed capsule was 3.13 ± 0.71 mm. The mean composite MRI score was 5.33 ± 1.63, corresponding to global grade 1 (mild abnormality). Two patients (33%) demonstrated circumferentially intact grafts without extravasation, with incomplete incorporation at 6 months. There were no cases of graft discontinuity or higher-grade failure (global grade 2 or 3). Conclusions Revision hip arthroscopy with capsular reconstruction demonstrates significant and clinically meaningful early improvement in patient-reported outcomes. Six-month postoperative MRI demonstrates predominantly intact reconstructions with variable attenuation, redundancy, and incomplete incorporation at early follow-up. A novel MRI-based classification system provides a structured framework for postoperative assessment. Larger sample sizes and longer-term follow-up are needed to further define the relationship between imaging findings and clinical outcomes. Level of Evidence Level IV, therapeutic case series