Capsular management in hip arthroscopy

Hip arthroscopy is widely used in the management of nonarthritic hip disorders, including femoroacetabular impingement syndrome (FAIS), labral pathology, and focal chondral injury.Capsulotomy, frequently required for adequate visualization and instrumentation, may alter the native biomechanics and stability of the hip.The hip capsule, composed primarily of the iliofemoral, ischiofemoral, and pubofemoral ligaments, serves as a major static stabilizer that resists abnormal rotational, anterior, and distractive forces.Biomechanical studies have demonstrated that capsulotomy, capsulectomy, and capsular deficiency can increase abnormal rotation and translation of the femoral head in a size-dependent manner, whereas repair or reconstruction can substantially restore native restraint.The preponderance of clinical studies, systematic reviews, and meta-analyses suggests that capsular closure or repair is associated with improved patient-reported outcomes and a reduced risk of revision surgery in selected patient groups, although the magnitude of benefit is not uniform across all populations or capsulotomy patterns, and recent randomized trial data remain nuanced.Capsular management should therefore be individualized according to capsulotomy size and configuration, the presence of dysplasia, generalized laxity, microinstability, or revision pathology, the degree of preoperative stiffness, and the extent of tissue deficiency.This narrative review summarizes the anatomy and function of the hip capsule, its biomechanical role in joint stability, the indications for and techniques of capsular closure, repair, plication, and reconstruction, the contemporary clinical evidence, and a practical patient-specific decision-making framework.