The Incidence and Outcomes Following Treatment of Capsulolabral Adhesions in Hip Arthroscopy: A Systematic Review.

Background: To perform a systematic review to evaluate the incidence of capsulolabral adhesions following hip arthroscopy (HA) for femoroacetabular impingement (FAI); including risk factors and post-treatment outcomes.

Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we queried PubMed, EMBASE, and Cochrane Central Register of Controlled Trials for English-language studies with minimum 6-month follow-up after primary or revision HA for FAI, which reported the incidence of capsulolabral adhesions. Potential adhesion risk factors, such as anchor type used and protocol for capsule closure, were assessed. Pre-operative and post-operative modified Harris Hip Score (mHHS) values were compared in studies that reported them.

Results: Thirty-seven articles were included (24 primary HA; 13 revision HA). There were 6747 patients who underwent primary HA (6874 hips; 3005 female, 44%). The incidence of capsulolabral adhesions, confirmed surgically during revision HA, was low. Patients undergoing surgical treatment reported postoperative improvement per modified Harris Hip Scores. Data for 746 patients undergoing second revision HA (761 hips; 449 female, 60%), showed an incidence of adhesions greater than that of primary HA patients.

Conclusion: While the incidence of symptomatic capsulolabral adhesions after primary hip arthroscopy is low; revision hip arthroscopy is strongly associated with adhesion development. Lysis of adhesions in primary hip arthroscopy patients reliably improved patient-reported outcomes. Level of Evidence: IV.