Superior outcomes after arthroscopic treatment of femoroacetabular impingement and labral tears with closed versus open capsule

Abstract

Purpose: The purpose of the study was the clinical evaluation of the capsular management with arthroscopic treatment of femoroacetabular impingement and labral tears by comparing the functional outcomes of closed versus open capsule.

Methods: Patients with a median age of 38 years (18-55), clinical and radiological features of FAI and/or labral tear, and non-arthritic non-dysplastic hips were selected for arthroscopic treatment. Capsulotomy was performed primarily as an interportal section, then a distal extension preserving the zona orbicularis was added. The study compared two matched groups: patients with open capsule versus patients with closed capsule. Clinical outcomes were assessed by Non-Arthritic Hip Score, hip outcome scores of daily living activities and sports-specific scales. Scores were collected preoperatively and 6 months, 2 years and 5 years postoperatively. Rate of revision arthroscopy and conversion to total hip arthroplasty were used for comparing groups. Minimal clinically important differences were calculated for both groups.

Results: The study included 42 patients in the OC group and 44 patients in the CC group. Significant improvement of postoperative PROMs was recorded in both groups compared to preoperative scores. CC group significantly improved more than the OC group based on NAHS, HOS-ADL and HOS-SSS over all check points except for NAHS and HOS-ADL at 6 months, which were statistically non-significant. A non-significant difference was observed in the percentage of patients who met the MCID for all reported outcome scores at 5 years in both groups. The rate of reoperation was similar in both groups, but with different indications.

Conclusion: Arthroscopic treatment of FAI and labral repair with complete closure of the hip capsule led to significantly improved functional outcomes after 5 years follow-up compared with open capsule. Closed capsule can provide greater improvement in the sports-specific outcomes at early follow-up. Controlled capsulotomy limited by zona orbicularis did not produce instability at any postoperative stage. Similar proportions of patients achieved minimal clinically important difference, and similar rates of reoperation were reported in both groups.

Level of evidence: III.

Keywords: Arthroscopy; Capsulotomy; Hip capsule; Microinstability; Repair.