Routine Interportal Capsular Repair Does Not Lead to Superior Clinical Outcome Following Arthroscopic Femoroacetabular Impingement Correction With Labral Repair
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Résumé
PURPOSE: To evaluate the impact of routine capsular repair on clinical outcome in a consecutive series of patients undergoing arthroscopic correction of symptomatic femoroacetabular impingement. METHODS: Between 2009 and 2015, patients were assigned to 1 of 2 groups based on whether a capsular repair was performed as part of their index hip arthroscopic procedure. Exclusion criteria included previous underlying hip conditions, Tönnis >1, age >45 years, and labrum not repaired. Patients were assessed preoperatively and 2-years postoperatively using patient-reported outcome measures (PROMs), including the modified Harris hip score (mHHS), UCLA activity scale, short form-36, Western Ontario and McMaster Universities Osteoarthritis Index score, and measures of range of hip movements. The incidence of any subsequent revision surgery within 2 years was recorded. Sex and age groups were specifically analyzed. RESULTS: In total, 966 consecutive cases were included (96.4% follow-up rate): 508 in group A (no repair) and 458 in group B (repair). Average age for all cases was 28.1 ± 7.0 years (14.6-44.9). There were significant improvements in all PROMs following surgery for both groups (P < .001). Statistical significance between groups at 2 years was observed for Short Form-36 (P = .001) and WOMAC (P = .041), greater in group A. Both groups similarly met the minimal clinically important difference (mHHS P = .414 and .605; UCLA, P = .549 and .614; Short Form-36, P = .455 and .079; WOMAC, P = .425 and .750 for distribution and anchor-based methods, respectively). In total, 38 (7.8%) cases group A and 24 (5.4%) cases group B required repeat hip arthroscopy (HA) (P = .148); No (0%) cases in group A and 2 (0.45%) cases in group B required total hip replacement (P = .226). There was significantly lower rate of repeat HA among 25- to 34-year age group (8.6% vs 3.9%, P = .047) where capsular repair was performed. No significant difference in the rate of repeat HA between groups for male (P = .203) or female (P = .603) subjects. Adhesions were more common in the repair group (79.2%, 95% confidence interval [CI] 57.8-92.9 vs 55.3%, CI 38.3-71.4; P = .055), with further capsular repair/plication required more frequently in the unrepaired group (50%, CI 33.4-66.6 vs 25%, CI 10.8-44.3); however, differences between groups were not significant (P = .051). Internal rotation was larger in group A compared with group B at 2 years (36.2 vs 28.1, P = .000). Female patients with capsular repair had reduced PROM scores at 2 years compared with female patients without repair (WOMAC, P = .004, and mHHS, P = .037). CONCLUSIONS: Arthroscopic correction of femoroacetabular impingement with labral repair results in significant improvements in patient-reported outcomes at 2-years postsurgery, irrespective of whether the capsule is repaired. Routine capsular repair in a consecutive series of patients did not lead to superior outcomes compared with a nonrepaired group; similar proportions of cases in both groups were able to achieve minimal clinically important difference. In female patients, routinely repairing the capsule may lead to statistically inferior clinical outcome at 2-years postsurgery, although this may not be clinically significant. Routine capsular repair, however, may be beneficial in the younger, active patient, where a significant reduction in repeat arthroscopy was observed. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
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