Clinical outcomes of capsular repair versus non-repair after hip arthroscopy for femoroacetabular impingement: a meta-analysis

Abstract Background Arthroscopic surgery is a validated procedure for femoroacetabular impingement (FAI). Capsular closure in hip arthroscopy has recently gained importance. This systematic review compared arthroscopy outcomes for FAI between patients with and without capsule closure. Methods The present systematic review followed the PRISMA statement. Web of Science, PubMed, and Embase were accessed in June 2025. All clinical investigations comparing arthroscopy outcomes in FAI with or without capsule repair were included. Results Data from 3332 patients were retrieved, of whom 1454 were women. The mean follow-up duration was 30.6 ± 15.4 months. The mean age was 33.6 ± 6.2 years, and the mean BMI was 24.3 ± 0.8 kg/m2. The capsule closure group evidenced greater Hip Outcome Score—Activities of Daily Living (HOS-ADL) (MD = 5.8; P = 0.03), greater Hip Outcome Score—Sport-Specific Subscale (HOS-SSS) (MD = 5.1; P = 0.02), and greater modified Harris Hip Score (mHHS) (MD = 3.3; P = 0.003). No difference was found in the visual analogue scale (VAS) (P = 0.9). Concerning complications, the capsule closure group evidenced a lower rate of progression to total hip arthroplasty (THA) (OR = 0.47; P = 0.03). No difference was found in the re-operation rate (P = 0.06). Conclusions Capsular closure during arthroscopy for FAI might improve PROMs and reduce the risk of progression to total hip arthroplasty, particularly in young patients. However, these findings must be interpreted with caution. Further high-quality, multicenter randomised trials are required to confirm these results and optimise surgical protocols. Level of evidence Level III, systematic review.