EP3.31 Capsular Insufficiency and the Instability Pathway After Hip Arthroscopy: An Umbrella Review Beyond Closure Versus Non-Closure

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ID: 331164
2026
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Abstract
Abstract Background Capsular management in hip arthroscopy has moved beyond the simple question of whether the capsule should be closed. There is growing concern that capsular insufficiency may play a role in microinstability and, ultimately, failure after surgery. At the same time, most available systematic reviews tend to focus on individual aspects of this problem, which makes it difficult to see the full picture. Purpose To perform an umbrella review bringing together existing systematic reviews and meta-analyses on capsular management, with a focus on instability and failure after hip arthroscopy. Methods An umbrella review was performed to synthesize existing systematic reviews and meta-analyses on capsular management after hip arthroscopy. A focused search of PubMed, Embase, and the Cochrane Library identified relevant studies addressing capsulotomy technique, capsular repair, microinstability, and instability-related outcomes. Data was extracted at the review level, allowing comparison and integration of findings across studies to provide a broader, more unified clinical perspective. Results Nine systematic reviews were included. Across technique-focused reviews, interportal capsulotomy was most commonly described, followed by T-capsulotomy, and there has been a noticeable shift over time toward routine capsular repair. Even so, many studies did not clearly report how the capsule was repaired. Details such as suture type, number of sutures, and specific repair techniques were often missing or inconsistently described. Reviews focusing on instability pointed in a similar direction, with capsular insufficiency repeatedly identified as an important contributor to persistent symptoms. This seemed particularly relevant in patients with underlying laxity or other risk factors. While instability events overall were reported as uncommon, more severe cases, such as dislocation or subluxation, carried real clinical consequences and often required additional procedures. When looking across reviews, capsular repair generally showed more favorable trends in terms of survivorship and the need for further surgery. At the same time, short-term patient-reported outcomes were often similar between groups, which makes interpretation a bit tricky and suggests that these scores may not fully capture failure. Bringing these findings together, a consistent pattern starts to emerge capsular violation, followed by insufficiency, may lead to microinstability, ongoing symptoms, and eventually revision surgery. This relationship is not always obvious within individual reviews but becomes clearer when the data are considered collectively. Conclusion Capsular insufficiency appears to be an important part of the instability pathway after hip arthroscopy. While patient-reported outcomes may look similar across different strategies, failure-related outcomes suggest that loss of capsular integrity still matters. The question is probably no longer just whether to close the capsule, but how to preserve or restore its function. More consistent reporting and clearer technical standards will be important moving forward.
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Authors Ali Parsa, Jonathan Westlake, Patrick Waldron, Maryam Mirzaie, Cameron Foreman, Arturo Corces
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.316
URL
https://doi.org/10.1093/jhps/hnag043.316
Keywords Keywords not found

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