OBJECTIVE: To summarize the effects of surgical treatment compared to conservative treatment in femoroacetabular impingement syndrome in the short, medium, and long term. STUDY DESIGN: Systematic review. METHODS: The following databases were searched on 14/09/2020: Medline, Embase, CENTRAL, Web of Science, and PEDro. There were no date or language limits. The methodological quality assessment was performed using the PEDro scale and the quality of the evidence followed the GRADE recommendation. The outcomes pain, disability, and adverse effects were extracted. RESULTS: Of 6,264 initial studies, three met the full-text inclusion criteria. All studies were of good methodological quality. Follow up ranged from six months to two years, with 650 participants in total. The meta-analyses found no difference in disability between surgical versus conservative treatment, with a mean difference (MD) between groups of 3.91 points (95% CI -2.19 to 10.01) at six weeks, MD of 5.53 points (95% CI -3.11 to 14.16) at 12 weeks, and 3.8 points (95% CI -6.0 to 13.6) at 24 months. The quality of the evidence (GRADE) varied from moderate to low across all comparisons. CONCLUSION: There is moderate-quality evidence that surgical treatment is not superior to conservative treatment for femoroacetabular impingement syndrome in the short term, and there is low-quality evidence that it is not superior in the medium term. LEVEL OF EVIDENCE: Therapy, level 1a. REGISTRATION NUMBER: PROSPERO CRD42019134118.

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