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A higher proportion of patients may reach the MCID with capsular closure in patients undergoing arthroscopic surgery for femoroacetabular impingement: a systematic review and meta-analysis

Abstract

Purpose

The purpose of this review is to provide a summary of the techniques and outcomes of various capsular management strategies in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI). The information this review provides on capsular management strategies will provide surgeons with operative guidance and decision-making when managing patients with FAI lesions arthroscopically.

Methods

Three databases MEDLINE, EMBASE, and PubMed were searched from database inception to November 2nd 2021, for literature addressing capsular management of patients undergoing hip arthroscopy for FAI. All level I–IV data on capsular management strategy as well as postoperative functional outcomes were recorded. A meta-analysis was used to combine the mean postoperative functional outcomes using a random-effects model.

Results

Overall, there were a total of 36 studies and 4744 patients included in this review. The mean MINORS score was 10.7 (range 8–13) for non-comparative studies and 17.6 (range 15–20) for comparative studies. Three comparative studies in 1302 patients examining the proportion of patients reaching the MCID for the mHHS score in patients undergoing interportal capsulotomy with either capsular repair or no repair found that the capsular repair group had a higher odds ratio of reaching the MCID at 1.46 (95% CI 0.61–3.45, I2 = 67%, Fig. 2, Table 3); however, this difference was not significant with a p value of 0.39. When looking at only level 1 and 2 studies, four studies in 1308 patients reporting on the mHHS score in patients undergoing capsular closure regardless of capsulotomy type, found a pooled standardized mean difference in the mHHS score of 2.1 (95% CI 1.7–2.55, I2 = 70%, Fig. 3), while four studies in 402 patients reporting on the mHHS score in patients not undergoing capsular closure regardless of capsulotomy type found a pooled standardized mean difference in the mHHS score of 1.46 (95% CI 1.2–1.7, I2 = 30%, Fig. 4).

Conclusion

This review may demonstrate improved postoperative outcomes in patients undergoing complete capsular closure regardless of capsulotomy type based on postoperative mHHS score. Furthermore, this review may suggest improved postoperative outcomes after closure of an interportal capsulotomy. There are limited published outcome data regarding T-type capsulotomy without closure. This review provides surgeons with operative guidance on capsular management strategies when treating patients with FAI lesions arthroscopically.

Level of evidence

IV.

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Fig. 1
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Abbreviations

FAI:

Femoroacetabular impingement

VAS:

Visual Analogue Scale

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

MINORS:

Methodological Index for Non-Randomized Studies

MCID:

Minimal clinically important difference

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Funding

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Authors and Affiliations

Authors

Contributions

DC participated in the design of the study, carried out the systematic review, extracted data, provided illustrations, and drafted the manuscript. MCG carried out the systematic review, extracted data, and drafted the manuscript. AK extracted data, provided illustrations, and aided with drafting the manuscript. JK carried out the systematic review, extracted data, completed the statistical analysis, and revised the manuscript. DSE participated in the study design and participated in drafting and revising the manuscript. NS participated in the editing and revision of the manuscript. OA conceived of the study and participated in the revision of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Olufemi R. Ayeni.

Ethics declarations

Conflict of interest

Dr. Olufemi R Ayeni declares that he has a non-financial conflict of interest as he is associated with the Speakers Bureau for Conmed and Stryker Canada. All other authors declare that they have no competing interests.

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There were no animal or human participants included in this study and therefore informed consent and ethics approval was not required.

Research involving human and animal participants

This study does not contain any studies with human participants or animals performed by any of the authors.

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Appendix

Appendix

See Additional Tables 3, 4, 5, 6.

Table 3 Search strategy
Table 4 Postoperative rehabilitation protocol
Table 5 Functional outcomes
Table 6 Surgical details and conversion to THA

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Cohen, D., Comeau-Gauthier, M., Khan, A. et al. A higher proportion of patients may reach the MCID with capsular closure in patients undergoing arthroscopic surgery for femoroacetabular impingement: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 30, 2425–2456 (2022). https://doi.org/10.1007/s00167-022-06877-9

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Keywords

  • Femoroacetabular impingement
  • Hip arthroscopy
  • Capsule
  • Management
  • Outcomes