Capsular Repair Improves 12‐Month Healing and Favorable Healing Correlates With Better Early Patient‐Reported Outcome Measures in Femoroacetabular Impingement Syndrome Patients Undergoing Hip Arthroscopy

PURPOSE: To evaluate the effect of capsular repair on capsular healing and the healing status on early clinical outcomes in femoroacetabular impingement syndrome patients undergoing hip arthroscopy. METHODS: Data collected between July 2022 and December 2024 were reviewed. Patients with femoroacetabular impingement syndrome who underwent hip arthroscopy with interportal capsulotomies were included. Patients with a lateral center-edge angle of less than 25, Tönnis grade greater than 1, Perthes disease, slipped upper femoral epiphysis, avascular necrosis, and prior ipsilateral hip injury or surgery were excluded. Patients were divided into the Repair Group and the Nonrepair Group based on whether intraoperative capsular repair was performed. All patients underwent 2 postoperative follow-up evaluations at 6 and 12 months postoperatively, which included magnetic resonance imaging scans and completion of patient-reported outcome measures (PROMs). Based on the assessment of capsular healing status on magnetic resonance imaging, patients were divided into the Healed Group and the Unhealed Group. PROMs included the modified Harris Hip Score; Hip Outcome Score-Activities of Daily Living subscale; Hip Outcome Score-Sport-Specific subscale (HOS-SSS); University of California, Los Angeles score; and visual analog scale pain score. All the PROMs were collected prospectively. RESULTS: The cohort comprised 69 patients (73 hips), with 26 patients (27 hips) in the Nonrepair Group and 44 patients (46 hips) in the Repair Group. The cohort comprised 41 male and 28 female patients, and the mean age of the patients was 43.09 years. At 6 months postoperatively, the Repair Group exhibited a higher capsular healing rate, but the difference between the 2 groups was not statistically significant (60.87% vs 44.44%, P = .179). For PROMs, the Healed Group exhibited significantly higher improvements on Hip Outcome Score-Activities of Daily Living (12.91 ± 17.25 vs 3.16 ± 19.91, P = .025) and HOS-SSS (19.09 ± 23.64 vs 4.45 ± 28.97, P = .016) and higher minimal clinically important difference achieving the rate of HOS-SSS (62.50% vs 33.33%, P = .014). At 12 months postoperatively, the Repair Group showed a significantly higher capsule healing rate compared with the Nonrepair Group (76.09% vs 51.85%, P = .038). For PROMs, the Healed Group exhibited significantly higher improvements in HOS-SSS (22.66 ± 22.74 vs 8.64 ± 29.59, P = .035) and a higher rate of achieving the minimal clinically important difference for HOS-SSS (63.27% vs 37.50%, P = .035). CONCLUSIONS: Arthroscopic capsular repair significantly improves the 12-month capsular healing rate in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome. Successful capsular healing is associated with better preoperative-to-postoperative improvements in PROMs and higher rates of achieving the minimal clinically important difference, particularly in sports-specific function, and these beneficial effects are more pronounced in female patients. LEVEL OF EVIDENCE: Level III, retrospective case-control study.