Patient-Reported Outcomes of Capsular Repair Versus Capsulotomy in Patients Undergoing Hip Arthroscopy: Minimum 5-Year Follow-up—A Matched Comparison Study

Domb, Benjamin G.; Chaharbakhshi, Edwin O.; Perets, Itay; Walsh, John P.; Yuen, Leslie C.; Ashberg, Lyall

doi:10.1016/j.arthro.2017.10.019

Cited by 110 publications

(107 citation statements)

References 35 publications

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“…After each study was eliminated one by one, the metaanalysis of the combined effect size was performed again, and the results of the new combined effect size were compared with the results before the elimination. Among them, heterogeneity of postoperative HOS-SSS changed after the elimination of one item (Domb 2018), which is the reason for the large heterogeneity of this study. The source of heterogeneity may be the number of samples (Table 7).…”

Section: Hip Outcome Score-activities Of Daily Living (Hos-adl)mentioning

confidence: 92%

“…Then, we excluded 13 articles based on inclusion criteria, which did not have relevant outcomes. Ultimately, seven studies 2,3,[13][14][15][16][17] were finally included in the meta-analysis. Figure 1 shows the flow diagram of the included studies.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…The stability of the hip depends on the restraint of the capsule, the complex structure of bone and cartilage between the proximal femur and the acetabulum 2 . Among them, the joint capsule is composed of the iliofemoral, pubofemoral, ischiofemoral ligaments, zona orbicularis, and iliocapsularis, which is an important factor for the stability of the natural joint, guaranteeing the stability of the static and dynamic motion of the bone and joint around the hip joint 3 .…”

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confidence: 99%

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Effect of Capsular Closure on Outcomes of Hip Arthroscopy for Femoracetabular Impingement: A Systematic Review and Meta‐analysis

Liu

Zhang

Gui

et al. 2020

Orthopaedic Surgery

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Objective To evaluate the effect of hip arthroscopy with or without capsular closure in femoracetabular impingement (FAI) by meta‐analysis. Methods Pertinent studies were identified by searching Pubmed, EMBASE databases with the last search update on 16 February 2020. Studies that reported hip arthroscopy for FAI were collected. Meta‐analysis was performed by the use of Review Manager 5.3 software. The odds ratios (OR) and mean differences (MD) were used to compare dichotomous and continuous variables. Additionally, the I2 was used to assess heterogeneity among studies, and the fixed‐effects model or the random‐effects model was selected for the quantitative analysis. Outcomes were evaluated by forest plots. For statistical analysis, P < 0.05 was considered significant. Results There was no significant difference among the preoperative mHHS (MD = –2.66，95% CI [−7.25, 1.92], I2 = 80%, P = 0.25), preoperative (MD = ‐4.94, 95% CI [−11.56, 1.67], I2 = 50%, P = 0.14) and postoperative HOS‐SSS (MD = ‐1.00, 95% CI [−6.98, 4.98], I2 = 66%, P = 0.74), patient satisfaction (MD = 0.03, 95% CI [−0.25, 0.31], I2 = 19%, P = 0.84; OR = 0.94, 95% CI [0.59, 1.50], I2 = 0%, P = 0.78), complications (OR = 1.23, 95%CI [0.56, 2.67], I2 = 0%, P = 0.61), revisions (OR = 1.77, 95% CI [0.87, 3.60], I2 = 36%, P = 0.11), and surgery time (SMD = –0.38, 95% CI [−1.16, 0.40], I2 = 92%, P = 0.34) between the capsule closure group and the non‐closure group. For the comparison of postoperative mHHS (MD = –2.66, 95% CI [−7.25, 1.92], I2 = 80%, P = 0.25) and HOS‐ADL (MD = ‐4.20, 95% CI [−5.75, −2.65], I2 = 24%, P < 0.00001), the score of the non‐closure group was significantly better than that of the closure group. Conclusions Remain capsule unclosed after hip arthroscopy for FAI may, to some extent, has a better postoperative functional score than the non‐closure treatment.

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Section: Hip Outcome Score-activities Of Daily Living (Hos-adl)mentioning

confidence: 92%

Section: Study Selection and Characteristicsmentioning

confidence: 99%

mentioning

confidence: 99%

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Effect of Capsular Closure on Outcomes of Hip Arthroscopy for Femoracetabular Impingement: A Systematic Review and Meta‐analysis

Liu

Zhang

Gui

et al. 2020

Orthopaedic Surgery

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“…In joint preservation surgery, there are ongoing debates as to whether to repair the capsule 6,10,54,56,[85][86][87] . The decision to repair the capsule should not be a simple yes-or-no choice, as there should not be a general one-size-fits-all solution.…”

Section: Overviewmentioning

confidence: 99%

Hip Joint Capsular Anatomy, Mechanics, and Surgical Management

Jeffers

Beaulé

2019

The Journal of Bone and Joint Surgery

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ä Hip joint capsular ligaments (iliofemoral, ischiofemoral, and pubofemoral) play a predominant role in functional mobility and joint stability. ä The zona orbicularis resists joint distraction (during neutral positions), and its aperture mechanism stabilizes the hip from adverse edge-loading (during extreme hip flexion-extension). ä To preserve joint function and stability, it is important to minimize capsulotomy size and avoid disrupting the zona orbicularis, preserve the femoral head size and neck length, and only repair when or as necessary without altering capsular tensions. ä It is not fully understood what the role of capsular tightness is in patients who have cam femoroacetabular impingement and if partial capsular release could be beneficial and/or therapeutic. ä During arthroplasty surgery, a femoral head implant that is nearly equivalent to the native head size with an optimal neck-length offset can optimize capsular tension and decrease dislocation risk where an intact posterior hip capsule plays a critical role in maintaining hip stability. Characteristics Anatomy Human ligaments consist of predominantly type-I collagen (85%) and combinations of type III, V, VI, XI, and XIV (15%) 21,22. Within the hip joint, higher ratios of type-III collagen in the ligamentous capsule are associated with hip instability 23,24 , whereas elevated levels in the cartilage are associated with Disclosure: The authors indicated grant support from the Engineering and Physical Sciences Research Council (EPSRC) (EP/K027549/1 and EP/ N006267/1) and the Wellcome Trust (088844/Z/09/Z), during the conduct of the study. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJS/F511).

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“…3,[6][7][8] More recently, the debate over the importance of capsular repair 9,10 and various repair strategies [11][12][13] has culminated with several outcome studies that leave no question as to the evidence in support of superior surgical outcomes with capsular repair. 14,15 Yes, folks, it is quite clear that the capsule must be addressed during routine arthroscopy. In fact, if you have not yet done so, I would encourage you to visit the ISHA website at https://ishasoc.net and view the realtime polling results for capsular management among its society members.…”

Section: See Related Article On Page 116mentioning

confidence: 99%

Editorial Commentary: #Capsule-ophilesRejoice! The Evidence in Support of Diligent Capsular Management During Hip Arthroscopy Can No Longer Be Ignored

Walters

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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From its infancy until now, the enthusiasm and growth of the field of hip arthroscopy have been exciting to watch. Perhaps, it could be argued that there has not been a more hotly debated topic in recent years than what to do with the hip capsule. Once merely an afterthought in the context of hip arthroscopy, the oft overlooked and underappreciated intricacies of hip capsular anatomy and its role in hip stability have now taken center stage. As surgical indications continue to expand, our surgical techniques have rapidly evolved. Despite the rapid growth and advent of industry, the leaders in this field have remained steadfast in their relentless quest to improve their scientific knowledge and understanding of the native hip joint. If we have learned nothing else from watching the capsular debate evolve, it is that without an advanced understanding of the critical and complex marriage of anatomy and function that exists in a healthy hip joint, we cannot begin to master the surgical treatment of its pathologic states.

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Patient-Reported Outcomes of Capsular Repair Versus Capsulotomy in Patients Undergoing Hip Arthroscopy: Minimum 5-Year Follow-up—A Matched Comparison Study

Cited by 110 publications

References 35 publications

Effect of Capsular Closure on Outcomes of Hip Arthroscopy for Femoracetabular Impingement: A Systematic Review and Meta‐analysis

Effect of Capsular Closure on Outcomes of Hip Arthroscopy for Femoracetabular Impingement: A Systematic Review and Meta‐analysis

Hip Joint Capsular Anatomy, Mechanics, and Surgical Management

Editorial Commentary: #Capsule-ophilesRejoice! The Evidence in Support of Diligent Capsular Management During Hip Arthroscopy Can No Longer Be Ignored

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