Should the Capsule Be Repaired or Plicated After Hip Arthroscopy for Labral Tears Associated With Femoroacetabular Impingement or Instability? A Systematic Review
Authors: Ortiz-Declet V, Mu B, Chen AW, Litrenta J, Perets I, Yuen LC, Domb BG
Journal: Arthroscopy. 2018 Jan;34(1):303–318
DOI: 10.1016/j.arthro.2017.06.030
Background
There is ongoing debate regarding whether to repair the hip capsule after arthroscopy for femoroacetabular impingement (FAI) or instability.
Methods
Systematic review of 34 studies, including biomechanical analyses, case reports, and clinical outcomes comparing capsular repair/plication versus non-repair.
Key Findings
- Biomechanical studies strongly support capsular repair to maintain hip joint stability.
- Clinical evidence indicates better outcomes and fewer complications with capsular repair or plication.
- Capsular closure results in superior outcomes compared to unrepaired capsulotomy, especially in patients without advanced arthritis.
- Capsular release may be appropriate for patients with stiff or inflamed hips.
Conclusions
Routine capsular repair is advisable, particularly in patients with instability or borderline dysplasia. Selective capsular release may be reserved for specific cases.
What Does This Mean for Providers?
Incorporate routine capsular repair or plication during hip arthroscopy for FAI or instability to optimize joint stability and improve outcomes. Consider capsular release cautiously and selectively for stiffness or inflammation.