Capsular repair and knotless labral work, and where the athletes went

Design

Retrospective cohort with 1:1 propensity matching; level of evidence 3

Population

98 hips in 92 competitive athletes undergoing primary hip arthroscopy for FAIS and labral tears, minimum 2-year follow-up

Primary outcome

Patient-reported outcomes and return-to-sport rate

Effect

Return to sport 97.6% contemporary vs 81.0% early technique (P=.03), with higher mHHS, NAHS, iHOT-12 and HOS-SSS

Ninety-eight hips in competitive athletes were compared after primary arthroscopy for femoroacetabular impingement: a contemporary cohort having capsular repair with knotless labral repair or reconstruction, matched one-to-one for age, sex, body mass index and competition level against an early-technique cohort who had knotted repair or debridement and no capsular closure.

Both groups improved. The contemporary group improved more on every patient-reported score, met clinically important thresholds more often, and returned to sport at 97.6 per cent against 81.0 per cent.

The caution is structural rather than statistical. The two cohorts are separated by time as well as by technique — different rehabilitation, different indications, different thresholds for operating on an athlete, and a surgical team further along its learning curve. Propensity matching cannot balance the calendar.

• Capsular management should be a documented decision in every hip arthroscopy, not an omission by default.
• Record return to sport at the same level, not just return to any sport; the two diverge.
• Set the rehabilitation protocol before surgery; it differs between the eras being compared here.
• Level 3 evidence with 98 hips supports a direction, not a magnitude.
• Athlete expectation management matters as much as technique — 97.6 per cent is from a high-volume specialist centre.

Why it matters

It gives a number to the shift in technique most hip arthroscopists have already made.

Don't overread it

The cohorts differ by era as well as by technique, so the gain cannot be attributed to capsular repair alone.

The statistics, in plain English

This is a matched retrospective comparison, level 3 evidence, so the P values describe differences between two groups that were never randomised. Matching on age, sex, body mass index and competition level leaves the biggest confounder untouched — the era, and everything that changed with it. The return-to-sport gap of 16.6 percentage points is large enough to be interesting and fragile enough that it rests on a handful of athletes in a 98-hip series.

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