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Pasurka M, Szlufcik M, Theodoropoulos J, Betsch M. Return-to-sports criteria used by professional team physicians in elite athletes after hip arthroscopy - a qualitative study. PHYSICIAN SPORTSMED 2024:1-8. [PMID: 39328014 DOI: 10.1080/00913847.2024.2410148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 09/06/2024] [Accepted: 09/25/2024] [Indexed: 09/28/2024]
Abstract
OBJECTIVES The purpose of this study was to explore currently utilized readiness to Return to Sport (RTS) criteria after Hip Arthroscopy (HA) used in elite athletes to gain novel insights into the RTS decision-making process of professional team physicians. The authors hypothesized that even among this group of highly specialized physicians, there exists variability of measures and criteria used to determine RTS after HA. METHODS A total of 15 qualitative semi-structured interviews with professional team physicians were conducted by a single trained interviewer. The interviews were used to identify team physician concepts and themes regarding the criteria used to determine RTS after HA. Themes and sub-themes were identified using a general inductive analysis and a coding process. A hierarchical approach in coding helped to link themes. RESULTS Four key themes and several subordinate themes were identified from the interviews that seem to influence the return to sports decision. The most important RTS criteria were muscle strength (especially symmetric hip strength and muscle bulk with low side-to-side variance compared to the contralateral side) followed by pain-free sport-specific activity (pain-free drill skills and play at a lower level), physical examination (with major emphasis on the absence of hip pain with a painless hip range of motion compared to the contralateral side), and functional testing (including full squats, Ober test, FABER test, and pain-free FADIR position). CONCLUSION Besides objective findings, including muscle strength, we identified time after surgery as well as subjective findings, including absence of pain and feedback of clinical team members that influence RTS decision after HA. We showed that even among specialized professional team physicians, the main criteria to RTS in these categories were not consistent necessitating the further development of specific RTS guidelines.
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Affiliation(s)
- Mario Pasurka
- Department of Orthopaedics and Trauma Surgery, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Mike Szlufcik
- Department of Orthopaedics and Trauma Surgery, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - John Theodoropoulos
- Women's College Hospital, University of Toronto Orthopaedic Sports Medicine Program (UTOSM), Toronto, ON, Canada
| | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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Lamba A, Wang AS, Okoroha KR, Levy BA, Krych AJ, Hevesi M. Satisfactory Clinical Outcomes and Continuance of Sports After Hip Arthroscopic Labral Repair in Young Competitive Athletes at Minimum 8.5-Year Follow-Up. Arthroscopy 2024; 40:1126-1132. [PMID: 37716632 DOI: 10.1016/j.arthro.2023.08.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE To evaluate long-term patient-reported outcomes and achievement rates of patient acceptable symptomatic state (PASS) in young athletes undergoing hip arthroscopy, and to report long-term sports continuance and reoperation. METHODS Inclusion criteria consisted of age <24 years at surgery, femoroacetabular impingement undergoing primary hip arthroscopy with labral repair, and participation in sport with intent to return to sport after surgery. The enrollment period was from April 2009 to June 2014. Modified Harris Hip Scores (mHHS), Hip Outcome Score (HOS), HOS Activities of Daily Living (HOS-ADL), and HOS Sport (HOS-Sport) were collected preoperatively, 2 years' postoperatively, and final follow-up. Patients were evaluated for PASS achievement, reoperation, and sports participation. RESULTS Forty-two hips in 37 patients (11 male, 26 female, age: 17.7 ± 2.1 years, range 13.6-23.0, body mass index 22.8 ± 2.9, range 17.6-33.7) met inclusion criteria and were followed for 10.0 ± 1.3 years (range 8.5-13.0) postoperatively. Mean mHHS, HOS-ADL and HOS-Sports outcome scores at minimum 8.5 years were 82.2 ± 12.9, 89.6 ± 10.9, and 81.8 ± 16.4, respectively, with significant (P < .001) postoperative improvements. Thirty survey respondents (83%) met PASS for mHHS, 27 (75%) for HOS-ADL, and 24 (67%) for HOS-Sports. At minimum 8.5-year follow-up, only 9 of 37 (24%) cited their hip as the reason for stopping sport. Of the remaining patients, 17 of 28 (61%), continued playing their initial sport. There was no difference in patient-reported outcomes between patients who endorsed sports continuance and patients who did not report sports continuance and did not cite their hip as a reason (P ≥ .229). At final follow-up, 4 hips (10%) had undergone subsequent surgical intervention at a mean of 4.8 ± 3.3 years (range 1.0-8.4) postoperatively. CONCLUSIONS Durable mid-term outcomes and satisfactory PASS achievement rates are observed in young amateur athletes undergoing primary hip arthroscopy. At minimum 8.5-year follow up, approximately 1 in 4 patients discontinue their sports due to hip related reasons. LEVEL OF EVIDENCE Level IV, case-series.
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Affiliation(s)
- Abhinav Lamba
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Allen S Wang
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A..
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Hugenberg G, Stallons J, Smith C, Brockhoff K, Gingras M, Yardley D, Ayeni O, Almasri M. Clinical Commentary: A Criteria-Based Testing Protocol for Return to Sport Post Hip Arthroscopy for Impingement. Int J Sports Phys Ther 2023; 18:1218-1229. [PMID: 37795325 PMCID: PMC10547071 DOI: 10.26603/001c.87629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/09/2023] [Indexed: 10/06/2023] Open
Abstract
Overall, 84%-87% of athletes will return to sport following hip arthroscopy; however, some literature suggests that only 57% of athletes return to their preinjury level, and only 16.9% report optimal performance. This discrepancy may be due to a lack of consistency within the definition of return to sport as well as a lack of consistency within rehabilitation programs when determining return to sport readiness. Athletes who are returning to sport must demonstrate adequate range of motion, strength, and the ability to perform multi-directional movements without the risk of reinjury. There has yet to be a comprehensive, criteria-based, return to sport testing protocol that utilizes objective measures to ensure athletes are ready for return to sport. The goal of the authors was to create a criteria-based testing protocol for return to sport following hip arthroscopy utilizing components best supported in the literature. The following parameters were identified as key areas to assess for within a return to sport testing protocol: range of motion, strength, functional testing, self-reported outcomes including psychological readiness and time. The purpose of this clinical commentary is to propose a criteria-based testing protocol to be used following hip arthroscopy for impingement from early rehabilitation through return to previous level of sport. Criteria are presented clearly to promote objective progression through rehabilitation while still being mindful of the biological healing time required for safe and efficient progression. It is the authors' hope that in identifying and establishing a criteria-based testing protocol a higher percentage of athletes will be able to return to sport. Level of Evidence 5.
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Affiliation(s)
| | | | | | | | | | | | | | - Mahmoud Almasri
- Orthopedic Surgery Mercy Health
- Cincinnati SportsMedicine Research & Educational Foundation
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4
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Sjövall Anari S, Olsson A, Öhlin A, Desai N, Senorski EH, Sansone M, Lindman I. High-level soccer players have a low rate of return to performance after hip arthroscopy for femoroacetabular impingement syndrome. Knee Surg Sports Traumatol Arthrosc 2023; 31:2071-2078. [PMID: 36947232 PMCID: PMC10183425 DOI: 10.1007/s00167-023-07336-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/30/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Femoroacetabular impingement syndrome (FAIS) is a known cause of impaired sports performance in athletes and the relationship between FAIS and soccer players has previously been described. Hip arthroscopy is a viable treatment option that can facilitate athletes' return to sport (RTS). The aim of this study was to evaluate the RTS and return to performance (RTP) with objective measurements in high-level soccer players after hip arthroscopy for FAIS. METHOD Soccer players, with a hip sports activity scale (HSAS) level of 7 or 8 before symptom onset and undergoing hip arthroscopy for FAIS between 2011 and 2019 were identified in the Gothenburg hip arthroscopic registry. A total of 83 high-level soccer players, with a mean age of 23.9 (SD 4.4) years at surgery, were included. To verify the activity level and further stratify players as elite or sub-elite, player statistics were collected from soccer-specific scout webpages and the Swedish national soccer association. The return to sport was defined as return to one game of soccer. Return to performance was defined as playing at the same level, or higher, and participating in at least 80% of the number of games played the season before symptom onset or the season before surgery either the first or second season after hip arthroscopy. RESULTS In total, 71 (85.5%, 95% confidence interval (CI) 76.1-92.3%) of the players returned to sport the first or second season after surgery. Compared to the season before symptom onset, 31 (37.3%, 95% CI 27.0-48.7%) players returned to performance the first or second season after surgery, and 32 (38.6%, 95% CI 28.1-49.9%) players returned to performance the first or second season after surgery compared to the season before surgery. CONCLUSION A high rate of elite and sub-elite soccer players return to soccer after hip arthroscopy for FAIS. However, less than half of the players RTP when evaluating performance through level of play and number of games played. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Sofie Sjövall Anari
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alexander Olsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Axel Öhlin
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Neel Desai
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Sansone
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ida Lindman
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Betsch M, Darwich A, Chang J, Whelan D, Ogilvie-Harris D, Chahal J, Theodoropoulos J. Wide Variability in Return-to-Sport Criteria used by Team Physicians After Anterior Cruciate Ligament Reconstruction in Elite Athletes—A Qualitative Study. Arthrosc Sports Med Rehabil 2022; 4:e1759-e1766. [DOI: 10.1016/j.asmr.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 11/24/2022] Open
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Snaebjörnsson T, Anari SS, Lindman I, Desai N, Stålman A, Ayeni OR, Öhlin A. Most Elite Athletes Who Underwent Hip Arthroscopy for Femoroacetabular Impingement Syndrome Did Not Return to the Same Level of Sport, but the Majority Were Satisfied With the Outcome of Surgery. Arthrosc Sports Med Rehabil 2022; 4:e899-e906. [PMID: 35747664 PMCID: PMC9210366 DOI: 10.1016/j.asmr.2021.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/30/2021] [Indexed: 11/25/2022] Open
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Lindman I, Löfskog M, Öhlin A, Abrahamsson J, Hamrin Senorski E, Karlsson J, Ayeni OR, Sansone M. Return to Sport for Professional and Subelite Ice Hockey Players After Arthroscopic Surgery for Femoroacetabular Impingement Syndrome. Orthop J Sports Med 2022; 10:23259671221089984. [PMID: 35571973 PMCID: PMC9092588 DOI: 10.1177/23259671221089984] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain,
which can prevent ice hockey players from sports participation. Hip
arthroscopy is often performed to relieve pain and enable the player to
return to sport (RTS) and return to performance (RTP). Purpose: To determine the RTS and RTP rates for ice hockey players at the professional
and subelite levels after hip arthroscopy for FAIS. Study Design: Case series; Level of evidence, 4. Methods: High-level ice hockey players who underwent hip arthroscopy for FAIS between
2011 and 2019 were identified using a local hip arthroscopy registry. The
player’s level was confirmed with ice hockey–specific web pages and was
stratified as subelite or professional. Data on the players’ careers were
extracted from these web pages. Player position was divided into
goalkeepers, defensemen, and forwards. Data on participation in games
included the season before onset of symptoms, the season before surgery, and
the first and second seasons after surgery. RTS was defined as returning to
ice hockey after surgery, and RTP was considered as returning to the same
league at a comparable level to before symptoms. Results: A total of 80 ice hockey players were included. Comparing presymptom
performance with the first season after surgery, the RTS rate was 72%, of
which 94% of the players returned to the same or higher level of play.
Comparing the presurgery season with the first season after surgery, the RTS
rate was 78%. At the second season after surgery, 64% of players still
played ice hockey, with a significantly higher return rate among
professional players compared with subelite players (96% vs 69%;
P = .014). Overall, 85% goalkeepers, 74% forwards, and
60% defensemen returned to sport. Only 28% played at least the same number
of games during the first season after surgery as they did during the
presymptom season. Conclusion: High-level ice hockey players who underwent hip arthroscopy for FAIS had a
high RTS rate, in which the majority returned to the same league. However,
only 28% played the same number of games the first season after surgery as
they did at the presymptom level. Professional ice hockey players returned
more frequently than players on the subelite level.
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Affiliation(s)
- Ida Lindman
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin Löfskog
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Axel Öhlin
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Josefin Abrahamsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olufemi R. Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mikael Sansone
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Riedl M, Fickert S. Bedeutung des femoroazetabulären Impingements im Sport. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00522-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Almasri M, Simunovic N, Heels-Ansdell D, Ayeni OR. Femoroacetabular impingement surgery leads to early pain relief but minimal functional gains past 6 months: experience from the FIRST trial. Knee Surg Sports Traumatol Arthrosc 2021; 29:1362-1369. [PMID: 33386426 DOI: 10.1007/s00167-020-06401-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To understand the early outcomes after hip arthroscopy and better define the trajectory of improvement in a prospective cohort of patients who have undergone hip arthroscopic osteochondroplasty for femoroacetabular impingement (FAI) syndrome. METHODS Data were analyzed from the Femoroacetabular Impingement RandomiSed controlled Trial (FIRST) on the 108 study patients who underwent osteochondroplasty, with or without labral repair. Study outcomes included patient-reported pain (using a 100-point Visual Analogue Scale (VAS)), hip function (using the Hip Outcome Score (HOS) and International Hip Outcome Tool (iHOT-12)), and health-related quality of life (using the EuroQol 5 Dimensions (EQ-5D)) measured at baseline, 2 weeks, 3 months, 6 months, and 12 months post-operatively. RESULTS There was a decrease in mean post-operative pain VAS scores from baseline. The first 2 weeks post-operative yielded the greatest reduction in pain with a mean (SD) VAS score of 37.8 (23.4), with score stabilization between 6 months (26.9 (26.9)) and 12 months (25.3 (27.6)). Mean HOS (activities of daily living) scores improved from baseline (59.7 (16.2)) starting at 6 weeks post-operative (64.1 (19.1)). The HOS (Sports) showed no improvement from baseline (41.2 (20.4)) until 3 months (49.1 (27.9)), and continued to improve at 6 months (64.1 (28.7)) and 12 months (68.6 (30.5)). The iHOT-12 scores showed functional improvement from baseline (31.3 (18.8)), as early as 6 weeks (44.9 (22.4)) up to and including 12 months (67.1 (29.7)). EQ-5D index scores showed modest steady improvement from 6 weeks to 12 months post-operative, while the EQ-5D VAS component similarly showed modest and steady improvements from 3 months onward. CONCLUSION Results from this study highlight that hip arthroscopic osteochondroplasty with or without labral repair for FAI leads to early pain relief. While all scores improved from baseline, functional gains appear to plateau from 6 months onwards. These data can be used to inform decision-making about timelines for rehabilitation and return to sport, a knowledge gap in the current FAI literature. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Mahmoud Almasri
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St. W. 4E15, HamiltonHamilton, ON, L8N 3Z5, Canada.,Mercy Health - Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, OH, USA
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St. W. 4E15, HamiltonHamilton, ON, L8N 3Z5, Canada
| | - Diane Heels-Ansdell
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St. W. 4E15, HamiltonHamilton, ON, L8N 3Z5, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
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