Capsular Repair During Hip Arthroscopy for Femoroacetabular Impingement Syndrome Improves Revision Rates and Hip Outcome Score Result but Not Overall Patient‐Reported Outcomes: A Systematic Review and Meta‐analysis of Randomised Clinical Trials
Arthroscopy The Journal of Arthroscopic and Related Surgery · 6 Nov 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is how far this paper should move patient care if its methods hold up; it does not measure the size of a treatment benefit.
Why it matters
Capsular management is a common decision in hip arthroscopy, and this review suggests repair matters most after larger (T-shaped) capsulotomies rather than routine interportal cuts.
The evidence
This meta-analysis pooled 5 randomised trials (615 patients) of hip arthroscopy for femoroacetabular impingement syndrome, comparing closing the capsule at the end of surgery with leaving it open. Most patient-reported scores (mHHS, iHOT-12, all HAGOS subscales) did not differ between groups. The Hip Outcome Score favoured repair (standardised mean difference 0.59), and revisions were numerically fewer with repair (8 of 281 vs 15 of 334), but both signals came mainly from a single trial's unrepaired T-capsulotomy arm.
Hip Outcome Score: Smd 0.59 (95% CI unavailable; HOS).
Why this rigour score?
Meta-analysis of RCTsDesign starting point: 60.8
Raised the score
- Prospectively registered+5.1
- Pools randomised trials+5.1
Lowered the score
No negative adjustments recorded.
Score capped at 40. The conclusions are not supported by the reported results.
Methods at a glance
Recorded assessment- Comprehensive literature searchMet
- Risk of bias assessedMet
- Bias considered in synthesisNot met
- Publication bias assessedMet
- Study exclusions justifiedNot met
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 60.8
- Compared against an accepted alternative
- +1.7
- Prospectively registered
- +5.1
- Pools randomised trials
- +5.1
- Comprehensive literature search
- +3.4
- Risk of bias assessed in the included studies
- +3.4
- Publication bias assessed
- +2.5
- Methodological cap
- −42
- Final rigour score rounded
- 40 / 100
Study design sets the starting point and a ceiling of 96. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
How the clinical score was reached
The question: 8/9. Three judgements of how much it matters to patients, which decision it informs and how closely it fits their care.
Patient consequence: moderate (2/3). A patient-experienced outcome of real but smaller or shorter-lived importance: early pain or function, speed of recovery, return to sport or work, minor complications, satisfaction, or a validated score at a short time point.
Decision relevance: high (3/3). The study compares the actual options a clinician chooses between (or a whole strategy), and its primary result directly indicates which to choose, or that they are interchangeable. A clinician could act on it without a further translation step.
Applicability: moderate (3/3). A recognisable practice population, but with a notable restriction: narrow eligibility, a single expert surgeon or centre, or an unusual protocol that would need adapting. Applicability only subtracts for a real mismatch, so moderate counts in full.
What it found: Inconclusive (×0.70). No difference from a trial the paper itself calls underpowered, or a prespecified margin was crossed. The extracted result showed no difference without a power calculation or certainty rating, so the appraisal's own judgement of the paper decided whether that settles the question.
The design ceiling: 98. The most a meta-analysis of rcts can score here, however relevant its question and clear its answer.
Clinical = 98 × 8/9 × 0.70 = 61.
For journal club
1.For a recreational athlete with a well-contained hip and a small interportal capsulotomy, how would you counsel them about the expected benefit of capsular repair versus the added operative time?
2.Which patient features (generalised laxity, borderline dysplasia, T-capsulotomy, high-demand sport) would push you toward routine capsular closure, and how would you explain the revision risk to those patients?
Original publication title
Capsular Repair During Hip Arthroscopy for Femoroacetabular Impingement Syndrome Improves Revision Rates and Hip Outcome Score Result but Not Overall Patient‐Reported Outcomes: A Systematic Review and Meta‐analysis of Randomized Clinical Trials