Arthroscopy - 2026-07-01 - Journal Article; Systematic Review; Meta-Analysis; Review
Periportal and Puncture Capsulotomy Techniques Have Similar Outcomes to Traditional Capsulotomies With Closure in Hip Arthroscopy: A Systematic Review and Meta-analysis of 2-Year Outcomes.
Allen BJ, Mun JS, Chenna SS, Poutre RL, Dowley KS, Gillinov SM, Siddiq BS, Cherian NJ, Eberlin CT, Martin SD
Topics
Key Takeaway
Periportal and puncture capsulotomy techniques produced statistically equivalent mHHS improvements (mean difference range 21.30–32.56) to interportal or T-capsulotomy with closure at 2-year follow-up across 1,961 hips.
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Summary
This systematic review and meta-analysis compared periportal/puncture capsulotomy techniques against interportal and T-capsulotomy with closure in primary hip arthroscopy for FAI using mHHS, revision rates, and THA conversion rates at minimum 2-year follow-up. All capsulotomy groups achieved similar mHHS improvements (mean difference ranges 18.33–32.56 across groups, P=.274) with comparable revision arthroscopy (0–5%) and THA conversion (0–1%) rates. Metaregression identified baseline mHHS as a significant confounder (adjusted mean difference -0.53, P=.0006) and MCID threshold selection as a significant influence on achievement rates (coefficient -0.46, P<.0001).
Key Limitation
The systematic review is limited to Level II–IV source studies with heterogeneous MCID thresholds and baseline mHHS values, precluding definitive conclusions about capsulotomy equivalence in higher-risk subgroups such as hypermobile or dysplastic patients.
Original Abstract
PURPOSE
To systematically evaluate capsulotomy techniques through patient-reported outcome measures, rates of revision arthroscopy, conversion to total hip arthroplasty, and achievement of clinically meaningful outcomes.
METHODS
PubMed, Scopus, and Embase databases were queried in June 2024 for studies that could be used to compare capsular management strategies primarily via patient-reported outcome measures at a minimum 2-year follow-up. Inclusion criteria consisted of patients who underwent primary hip arthroscopy for the treatment of femoroacetabular impingement, minimum 2-year follow-up, and reported capsulotomy type. Based on the capsular management technique performed, groups were defined as interportal capsulotomy with closure, T-capsulotomy with complete closure, periportal capsulotomy, or puncture capsulotomy. Heterogeneity was adjusted for using metaregression models.
RESULTS
Of the 1322 unique studies identified in our search, 8 studies (1961 hips) were included. The combined puncture capsulotomy and periportal capsulotomy group (mean difference range, 21.30-32.56) performed similarly to interportal capsulotomy with closure (mean difference range, 18.33-32.00) and T-capsulotomy with complete closure (mean difference range, 20.70-23.30) groups in modified Harris Hip Score (P = .274). This continued when evaluating revision and total hip arthroplasty rates (proportion range, 0.0-0.05 and 0.0-0.01, respectively). Metaregression adjustments found baseline modified Harris Hip Score significantly influences mean differences (adjusted mean difference, -0.53 [-0.83, -0.23], P = .0006). When considering the achievement rates of minimal clinically important difference, all capsulotomy methods were similar for modified Harris Hip Score; however, minimal clinically important difference thresholds had a significant influence of -0.46 (95% confidence interval, [-0.54, -0.39], P < .0001) based on a metaregression model.
CONCLUSIONS
Periportal and puncture capsulotomy techniques did not yield statistically different outcomes compared with traditional capsulotomy techniques that use capsular closure at 2-year follow-up.
LEVEL OF EVIDENCE
Level IV, systematic review of Level II to IV studies.