# Mid‐ to long‐term outcomes of capsular management in hip arthroscopy for FAIS: A multilevel meta‐analysis

## TL;DR

This study compares the long-term outcomes of three hip arthroscopy techniques for FAIS and finds no significant differences in patient-reported outcomes.

## Contribution

A multilevel meta-analysis comparing mid- to long-term outcomes of three capsular management strategies in hip arthroscopy for FAIS.

## Key findings

- No significant differences in patient-reported outcomes between capsule preserved, repaired, and unrepaired techniques.
- CR showed the highest cumulative numbers of reoperations and THA conversions.
- Inconsistent reporting of failure-related outcomes limited comparative survivorship assessment.

## Abstract

To compare mid‐ to long‐term outcomes of the three major capsular management strategies—capsule preserved (CP), capsule repaired (CR) and capsule unrepaired (CU)—following hip arthroscopy (HAS) for femoroacetabular impingement syndrome (FAIS).

A systematic search was conducted in PubMed, Embase, CENTRAL, and Epistemonikos for studies published up to 31 May 2025. Studies were eligible if they reported ≥2‐year outcomes after HAS with clearly described capsular techniques. Outcomes included the modified Harris Hip Score (mHHS), Hip Outcome Score—Activities of Daily Living (HOS‐ADL) and Sports Subscale (HOS‐SSS) and Visual Analogue Scale (VAS) for pain. Multilevel meta‐analyses were performed using random‐effects models with Hartung–Knapp adjustment. Failure‐related outcomes (complications, reoperations, total hip arthroplasty [THA] conversions) were inconsistently reported across studies and could only be summarised descriptively.

Seven studies with a total of 948 patients were included. Pooled mean mHHS was 81.14 (95% confidence interval [CI]: 77.72–84.56), with CP: 84.90, CR: 80.66 and CU: 80.25 (p = 0.67). HOS‐ADL pooled mean was 87.94 (95% CI: 84.79–91.09), with CP: 89.30, CR: 87.36, CU: 88.31 (p = 0.90). HOS‐SSS pooled mean was 78.59 (95% CI: 72.69–84.48), with CP: 75.70, CR: 78.89, CU: 80.22 (p = 0.84). VAS pooled mean was 2.42 (95% CI: 2.08–2.77), with CP: 2.46, CR: 2.27, CU: 2.76 (p = 0.51). No statistically significant subgroup differences were detected. CR showed the highest cumulative numbers of reoperations and THA conversions, whereas CP and CU demonstrated lower but heterogeneous event counts.

CP, CR and CU demonstrated comparable mid‐ to long‐term patient‐reported outcome measure (PROM) outcomes following HAS for FAIS. Failure‐related events varied descriptively across techniques, but inconsistent reporting prevented comparative survivorship assessment.

Level II, systematic review and multilevel meta‐analysis of predominantly Level III studies, with additional contributions from Level I and II studies.