Capsular Repair During Hip Arthroscopy for Femoroacetabular Impingement Syndrome Improves Revision Rates and Hip Outcome Score Result but Not Overall Patient‐Reported Outcomes: A Systematic Review and Meta‐analysis of Randomized Clinical Trials

Purpose To determine whether capsular repair (CR) after hip arthroscopy for femoroacetabular impingement syndrome provides superior clinical outcomes, functional recovery, and complication profiles compared with nonrepair. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, a search of PubMed, Scopus, Embase, and MEDLINE identified 5 randomized controlled trials comparing CR with no capsular repair in patients with femoroacetabular impingement. Studies published between 2000 and September 2025 with a follow‐up of ≥12 months were included. Data on patient demographics, surgical techniques, postoperative protocols, patient‐reported outcome measures, complications, and revision rates were extracted. Standardized mean differences were calculated using random‐effects models. Heterogeneity was assessed using Cochran's Q statistics and Higgins’ I 2 . Results Five randomized controlled trials (n = 615) met the inclusion criteria: 334 patients in the no capsular repair group and 281 in the CR group. Most patient‐reported outcome measures, including the modified Harris Hip Score, the International Hip Outcome Tool‐12, and all subscales of the Copenhagen Hip and Groin Outcome Score, showed no significant differences between groups. However, the Hip Outcome Score showed a significant advantage for CR (standardized mean difference = 0.59; P < .001). Revision procedures were more frequent in patients who did not undergo CR (15 vs 8 cases). Heterogeneity was generally low across analyses. Conclusions CR after hip arthroscopy for femoroacetabular impingement syndrome did not show significant advantages over nonrepair in most pooled patient‐reported outcome measures, including the modified Harris Hip Score, International Hip Outcome Tool‐12, and Hip and Groin Outcome Score subscales. However, CR was associated with superior Hip Outcome Score outcomes and lower rates of revision procedures and conversion to total hip arthroplasty. These differences were observed predominantly in studies including unrepaired T‐capsulotomy, whereas studies evaluating only interportal capsulotomy generally reported comparable outcomes between repair and nonrepair. Level of Evidence Level II, systematic review and meta‐analysis of Level I and II studies.