Editorial Commentary: Outcome of Hip Arthroscopy Is Determined by Diverse Intrinsic and Extrinsic Factors in Addition to Capsular Closure.

There are contrasting findings between randomized controlled trials and systematic reviews that investigate capsular closure during arthroscopic treatment of femoroacetabular impingement syndrome. Some surgeons advocate that capsular closure is beneficial, as it reduces risks of instability and degeneration, while others argue that capsular closure could lead to joint stiffness and/or fibrosis, in addition to increased surgical time. Although unrepaired periportal or interportal capsulotomies may (or may not) compromise outcomes, it is beneficial to close larger incisions and extensions of T-type capsulotomies, especially in patients with a high risk of instability (concomitant borderline dysplasia, hyperlaxity, young age, etc.). Most studies focused on the effect of capsular closure do not identify other intrinsic and extrinsic factors-factors that could influence outcomes. Intrinsic factors include patient age, sex, type of femoroacetabular impingement syndrome (cam, pincer, or mixed), Tönnis grade, and presence of concomitant hypermobility or dysplasia. Extrinsic factors include surgeon experience, surgical technique, adjuvant procedures (such as labral repair), and type of capsulotomy (periportal, interportal, T-type).