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

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.