PMID- 34262982 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220424 IS - 2325-9671 (Print) IS - 2325-9671 (Electronic) IS - 2325-9671 (Linking) VI - 9 IP - 6 DP - 2021 Jun TI - Effect of Capsular Closure After Hip Arthroscopy for Femoroacetabular Impingement Syndrome on Achieving Clinically Meaningful Outcomes: A Meta-analysis of Prospective and Comparative Studies. PG - 23259671211017467 LID - 10.1177/23259671211017467 [doi] LID - 23259671211017467 AB - BACKGROUND: Recent literature has demonstrated conflicting evidence as to whether capsular closure after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) results in superior outcomes compared with capsulotomy without repair. Additionally, these studies have not explored the effect of capsular management on clinically significant outcome improvement. PURPOSE: To perform a meta-analysis of prospective and comparative studies to determine whether capsular management influences the rate of clinically significant outcome improvement after hip arthroscopy for FAIS. STUDY DESIGN: Systematic review; Level of evidence, 3. METHODS: PubMed, OVID/Medline, EMBASE, and Cochrane databases were queried in September 2020 for studies with evidence levels 1 to 3 that directly compared capsular management cohorts and reported rates of achieving the minimal clinically important difference (MCID) at a minimum follow-up of 2 years. Studies of level 4 evidence, those not describing or directly comparing capsular management techniques as well as those not reporting the MCID were excluded. Methodological quality was assessed using the methodological index for nonrandomized studies tool. Mantel-Haenszel fixed-effects models were constructed to quantitatively evaluate the association between capsular management and achievement of the MCID by generating effect estimates in the form of relative risk (RR) with 95% CIs. RESULTS: A total of 6 studies with 1611 patients were included. The overall pooled rate of MCID achievement for the modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADL), and HOS Sports Subscale (HOS-SS) were 84.4%, 80.3%, and 82.5%, respectively, at a mean follow-up of 40.8 months (range, 24-87.6 months). Capsular closure was associated with a significantly higher rate of MCID achievement for the mHHS (RR, 1.06; 95% CI, 1.01-1.10; P = .001) and trended toward statistical significance for the HOS-ADL (RR, 1.11; 95% CI, 1.0-1.24; P = .055) and the HOS-SS (RR, 1.09; 95% CI, 0.99-1.21; P = .094). CONCLUSION: Although capsular closure appeared to result in higher rates of clinically significant outcome improvement in hip function, there was no definitively increased likelihood of achieving clinically significant improvement in relevant hip outcome scores with capsular closure. CI - (c) The Author(s) 2021. FAU - Kunze, Kyle N AU - Kunze KN AD - Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA. RINGGOLD: 25062 FAU - Vadhera, Amar AU - Vadhera A AD - Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA. FAU - Devinney, Annie AU - Devinney A AD - Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA. FAU - Nwachukwu, Benedict U AU - Nwachukwu BU AD - Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA. RINGGOLD: 25062 FAU - Kelly, Bryan T AU - Kelly BT AD - Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA. RINGGOLD: 25062 FAU - Nho, Shane J AU - Nho SJ AD - Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA. FAU - Chahla, Jorge AU - Chahla J AD - Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA. LA - eng PT - Journal Article PT - Review DEP - 20210628 PL - United States TA - Orthop J Sports Med JT - Orthopaedic journal of sports medicine JID - 101620522 PMC - PMC8243105 OTO - NOTNLM OT - MCID OT - capsule OT - clinically significant outcome OT - closure OT - femoroacetabular impingement syndrome OT - hip arthroscopy OT - repair COIS- One or more of the authors has declared the following potential conflict of interest or source of funding: J.C. has received consulting fees from Arthrex, Conmed Linvatec, Ossur, DePuy Synthes, and Smith & Nephew; educational support and nonconsulting fees from Arthrex and Smith & Nephew; grant support from Arthrex; speaking fees from Linvatec; and hospitality payments from Medwest. S.J.N. has received research support from Allosource, Arthrex, Athletico, DJO, Linvatec, Miomed, Smith & Nephew, and Stryker; royalties from Ossur, Springer, and Stryker; educational support from Elite Orthopedics; and consulting fees from Stryker. B.U.N. has received educational support from Arthrex, Smith & Nephew, and Medwest; grant support from Arthrex; royalties from Remote Health; and hospitality payments from Stryker and Zimmer Biomet. B.T.K. has received consulting or speaking fees from Arthrex and Synthes GmbH; royalties from Arthrex; other financial/material support from Organicell and Parvizi Surgical; and has stock in HS2. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. EDAT- 2021/07/16 06:00 MHDA- 2021/07/16 06:01 PMCR- 2021/06/28 CRDT- 2021/07/15 06:24 PHST- 2021/01/04 00:00 [received] PHST- 2021/02/18 00:00 [accepted] PHST- 2021/07/15 06:24 [entrez] PHST- 2021/07/16 06:00 [pubmed] PHST- 2021/07/16 06:01 [medline] PHST- 2021/06/28 00:00 [pmc-release] AID - 10.1177_23259671211017467 [pii] AID - 10.1177/23259671211017467 [doi] PST - epublish SO - Orthop J Sports Med. 2021 Jun 28;9(6):23259671211017467. doi: 10.1177/23259671211017467. eCollection 2021 Jun.