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Owen MM, Gohal C, Angileri HS, Hartwell MJ, Plantz MA, Tjong VK, Terry MA. Sex-Based Differences in Prevalence, Outcomes, and Complications of Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671231188332. [PMID: 37547081 PMCID: PMC10403993 DOI: 10.1177/23259671231188332] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/11/2023] [Indexed: 08/08/2023] Open
Abstract
Background Trends between the sexes have been reported regarding prevalence, patient-reported outcomes (PROs), and complications of hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS), yet current results lack consensus. Purpose To evaluate sex-based differences after HA for FAIS in (1) prevalence of cam and pincer morphology in FAIS and (2) PROs, pain scores, and postoperative complication rates. Study Design Systematic review; Level of evidence, 4. Methods The EMBASE, PubMed, and Ovid (MEDLINE) databases were searched from establishment to February 28, 2022, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies had sex-based data on prevalence, outcomes, and complications of HA for FAIS. Reviews and commentaries were excluded. Data were combined, and between-sex differences were analyzed. Meta-analyses using random-effects models were performed when possible. Pooled risk ratios (RRs) and standardized mean differences were calculated. Results A total of 74 studies were included (213,059 patients; 132,973 female hips [62.4%] and 80,086 male hips [37.6%]). The mean age was 30.7 ± 7.7 years among male patients and 31.1 ± 7.8 years among female patients. Male patients experienced mixed-type impingement significantly more often (39.4% vs 27.2% for female patients; RR = 0.69 [95% confidence interval [CI], 0.58-0.81]; P < .001), whereas female patients experienced pincer-type impingement more often (50.6% vs 30.8% for male patients; RR = 2.35 [95% CI, 1.14-4.86]; P = .02). Male patients had higher likelihoods of undergoing femoroplasty (89.8% vs 77.4% for female patients; RR = 0.90 [95% CI, 0.83-0.97]; P = .006), acetabuloplasty (67.1% vs 59.3% for female patients; RR = 0.87 [95% CI, 0.79-0.97]; P = .01), or combined femoroplasty/acetabuloplasty (29.2% vs 14.5% for female patients; RR = 0.63 [95% CI, 0.44-0.90]; P = .01). Although female patients showed greater improvements in Hip Outcome Score-Sport-Specific subscale (P = .005), modified Harris Hip Score (P = .006), and visual analog scale pain (P < .001), both sexes surpassed the minimal clinically important difference at 1, 2, and 5 years postoperatively. Female patients had higher complication rates (P = .003), although no sex-based differences were found in total hip arthroplasty conversion rates (P = .21). Conclusion Male patients undergoing HA for FAIS had a higher prevalence of mixed-type FAIS while female patients had more pincer-type FAIS. Female patients gained greater improvements in PROs, although both sexes exceeded the minimal clinically important difference, suggesting that both male and female patients can benefit from HA.
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Affiliation(s)
- Madeline M. Owen
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Chetan Gohal
- Division of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
| | - Hunter S. Angileri
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew J. Hartwell
- Division of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
| | - Mark A. Plantz
- Division of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
| | - Vehniah K. Tjong
- Division of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
| | - Michael A. Terry
- Division of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
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Marom N, Olsen R, Burger JA, Dooley MS, Coleman SH, Ranawat AS, Kelly BT, Nawabi DH. Majority of competitive soccer players return to soccer following hip arthroscopy for femoroacetabular impingement: female and older aged players are less likely to return to soccer. Knee Surg Sports Traumatol Arthrosc 2023; 31:2721-2729. [PMID: 36809515 PMCID: PMC10523359 DOI: 10.1007/s00167-023-07349-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 02/10/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE To determine return to soccer rates and soccer performance in a large cohort of competitive soccer players after hip arthroscopic surgery for the treatment of femoroacetabular impingement (FAI) and to identify possible risk factors associated with not returning to soccer. METHODS An institutional hip preservation registry was retrospectively reviewed for patients identified as competitive soccer players who underwent primary hip arthroscopy for FAI performed between 2010 and 2017. Patient demographics and injury characteristics as well as clinical and radiographic findings were recorded. All patients were contacted for return to soccer information using a soccer-specific return to play questionnaire. Multivariable logistic regression analysis was used to identify potential risk factors for not returning to soccer. RESULTS Eighty-seven competitive soccer players (119 hips) were included. 32 players (37%) underwent simultaneous or staged bilateral hip arthroscopy. The mean age at surgery was 21.6 ± 7.0 years. Overall, 65 players (74.7%) returned to soccer, of which 43 players (49% of all included players) returned to pre-injury level of play or better. Most common reasons for not returning to soccer were pain or discomfort (50%) followed by fear of re-injury (31.8%). The mean time to return to soccer was 33.1 ± 26.3 weeks. Among 22 players who did not return to soccer, 14 (63.6%) reported satisfaction from surgery. Multivariable logistic regression analysis revealed female players (odds ratio [OR] = 0.27; confidence interval [CI] = 0.083 to 0.872; p = 0.029) and older aged players (OR = 0.895; 95% CI = 0.832 to 0.963; p = 0.003) were less likely to return to soccer. Bilateral surgery was not found to be a risk factor. CONCLUSION Hip arthroscopic treatment for FAI in symptomatic competitive soccer players allowed three-quarters of them to return to soccer. Despite not returning to soccer, two-thirds of players who did not return to soccer were satisfied with their outcome. Female and older aged players were less likely to return to soccer. These data can better guide clinicians and soccer players with realistic expectations related to the arthroscopic management of symptomatic FAI. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Niv Marom
- Department of Orthopaedic Surgery, Meir Medical Center, 59 Tcharnihovsky St, 4428164, Kfar Saba, Israel.
- The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Reena Olsen
- Sports Medicine Institute and Hip Preservation Service, Hospital for Special Surgery, New York, NY, USA
| | - Joost A Burger
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Matthew S Dooley
- Sports Medicine Institute and Hip Preservation Service, Hospital for Special Surgery, New York, NY, USA
| | - Struan H Coleman
- Sports Medicine Institute and Hip Preservation Service, Hospital for Special Surgery, New York, NY, USA
| | - Anil S Ranawat
- Sports Medicine Institute and Hip Preservation Service, Hospital for Special Surgery, New York, NY, USA
| | - Bryan T Kelly
- Sports Medicine Institute and Hip Preservation Service, Hospital for Special Surgery, New York, NY, USA
| | - Danyal H Nawabi
- Sports Medicine Institute and Hip Preservation Service, Hospital for Special Surgery, New York, NY, USA
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Tramer JS, Castle JP, Gaudiani MA, Lizzio VA, McGee A, Freehill MT, Lynch TS. Upper-Extremity Injuries Have the Poorest Return to Play and Most Time Lost in Professional Baseball: A Systematic Review of Injuries in Major League Baseball. Arthroscopy 2022:S0749-8063(22)00863-5. [PMID: 36587750 DOI: 10.1016/j.arthro.2022.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 12/02/2022] [Accepted: 12/13/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To summarize the incidence of injuries occurring in professional baseball and compare player outcomes reported in the literature. METHODS We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across 3 databases (PubMed, MEDLINE, Embase). Inclusion criteria were studies of injury incidences and/or injury outcomes on active Major League Baseball (MLB) athletes and studies published in the English language. Exclusion criteria were non-MLB players, case series and case report studies with a cohort of ≤3 players, and/or review articles. RESULTS A total of 477 articles were identified from the initial search of 3 databases, with 105 studies meeting inclusion criteria. Among these articles, the most common injuries studied were elbow (38%), shoulder (14%), hip/groin (11%), hand/wrist (7%), head/face (7%), knee (7%), spine (5%), and foot/ankle (3%). Injuries with the greatest incidence included hand/wrist (150.3 per year), hamstring (7.8-73.5 per year), ulnar collateral ligament (UCL) tears (0.23-26.8 per year), gastrocnemius strains (24.2 per year), and concussions (3.6-20.5 per year). Lowest rates of return to play were seen following shoulder labral tears (40%-72.5%), rotator cuff tears (33.3%-87%), and UCL tears (51%-87.9%). The injuries leading to most time away from sport included elbow UCL tears (average 90.3 days treated nonoperatively to 622.8 days following revision reconstruction), shoulder labral tears (average 315-492 days), and anterior cruciate ligament (ACL) tears (average 156.2-417.5 days). Following ACL tears, rotator cuff tears, shoulder labral tears, and hip femoroacetabular impingement requiring arthroscopy, athletes had a significantly lower workloads compared with before injury upon return to play. CONCLUSIONS Most published investigations focus on elbow injuries of the UCL, with variable return to play and mixed performance following surgery. UCL tears, shoulder labral tears, and ACL tears result in the most missed time. Upper-extremity injury such as shoulder labral tears, rotator cuff tears, and UCL tears had the poorest return to play rates. Workload was most affected following ACL reconstruction, rotator cuff repair, shoulder labral repair, and hip arthroscopy for femoroacetabular impingement. LEVEL OF EVIDENCE IV, systematic review of level II-IV studies.
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Affiliation(s)
- Joseph S Tramer
- Department of Orthopedic Surgery, Stanford University, Redwood City, California.
| | - Joshua P Castle
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Michael A Gaudiani
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Vincent A Lizzio
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Anna McGee
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Michael T Freehill
- Department of Orthopedic Surgery, Stanford University, Redwood City, California
| | - T Sean Lynch
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
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Shrier I, Stokes T, Wang C, Trejovargas J, Impellizzeri FM, Steele RJ. Investigating the Effect of Return-to-Play Timing After Injury on Performance: Does the Analysis Answer the Research Objective? Sports Med 2022; 53:949-958. [PMID: 36378413 DOI: 10.1007/s40279-022-01792-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/16/2022]
Abstract
Return-to-play decision making should be based on all the advantages and disadvantages of return to play for athletes, not just the risk of injury. For competitive athletes, this includes the effect of early versus delayed return to sport on performance. In this paper, we address the questions "How can I estimate the effect of injury on the individual's performance at return to play?" and "What is the effect of delaying return to sport on the individual's performance?". To address these questions, we describe (1) some foundational concepts, design and analytical challenges related to estimating the causal effect of return to play timing on performance in the athlete, (2) additional challenges if one is interested in the effects of delaying return to play and (3) differences when the questions relate to the team's performance. Although the analytical strategies described appear complicated, coaches and athletes make these judgements informally every day without explicitly stating their assumptions. Using a formal approach should help analysts provide the most valid answers to the questions asked by athletes and coaches. In brief, the choice of a comparison group depends on the research question and requires that one consider the hypothetical performance trajectory of the athlete had they never been injured. Thus, the optimal comparison group depends on the shape of the expected trajectory and the specific research question being asked.
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Affiliation(s)
- Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, 3755 Cote Ste-Catherine Road, Montreal, QC, H3T 1E2, Canada.
| | - Tyrel Stokes
- Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada
| | - Chinchin Wang
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Jorge Trejovargas
- Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada
| | | | - Russell J Steele
- Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada
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Egger AC, Minkara A, Parker R, Rosneck J. Intra-articular Hip Injuries in National Basketball Association Players: A Descriptive Epidemiological Study. Orthop J Sports Med 2022; 10:23259671221122744. [PMID: 36157088 PMCID: PMC9490462 DOI: 10.1177/23259671221122744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 07/06/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Since the most recent epidemiologic study of injuries in National Basketball Association (NBA) players was completed in 2012, the understanding and diagnosis of intra-articular hip injury has advanced. Purpose: To report the epidemiology of intra- versus extra-articular hip injuries in NBA players with regard to missed games, risk factors for injury, and treatment types. Study Design: Cohort study; Level of evidence, 3. Methods: The NBA injury database was queried for all reported hip and groin injuries from 2013 to 2017. The injuries were then divided into intra-articular and extra-articular types. Variables compared between injury types included player age, NBA tenure, season schedule (preseason or offseason), onset type, injury mechanism, roster position, games missed, time to return to play, and need for surgery. Results: A total of 224 athletes sustaining 353 total hip pathologies were identified. Of these injuries, 216 (61.2%) were sustained during game competition and affected 156 (69.6%) of the athletes. Intra-articular injuries represented 39 (11.0%) cases and involved 36 (16.1%) players. The time to return to play was significantly longer after intra-articular versus extra-articular injury (44.6 ± 96.0 vs 11.8 ± 32.0 days; P = .03), and the number of games missed was significantly greater after intra-articular versus extra-articular injury (8.0 ± 18.7 vs 1.54 ± 4.9 games; P = .03). Patients with intra-articular hip injuries were more likely to undergo surgery (odds ratio, 5.5 [95% CI, 1.8-16.7]; P = .005). There was no statistically significant difference in the number of games missed due to surgery (35.2 ± 8.3 [intra-articular] vs 35.4 ± 11.6 [extra-articular]; P = .42) or nonoperative treatment (4.2 ± 3.4 [intra-articular] vs 1.3 ± 0.5 [extra-articular]; P = .11). Years of NBA tenure were not significantly different between intra-articular and extra-articular injuries (7.1 ± 3.7 vs 6.3 ± 4.0 years). For both types of hip injury, there was no correlation between player age and either days to return to play or number of games missed (R2 = 0.014). Conclusion: NBA players with intra-articular hip injuries underwent surgery more frequently and had a longer return-to-play time compared with those with extra-articular hip injuries. NBA tenure and player age were not correlated with the risk of developing hip injury or the need for surgery.
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Affiliation(s)
| | - Anas Minkara
- Cleveland Clinic Foundation, Garfield Heights, Ohio, USA
| | - Richard Parker
- Cleveland Clinic Foundation, Garfield Heights, Ohio, USA
| | - James Rosneck
- Cleveland Clinic Foundation, Garfield Heights, Ohio, USA
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6
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Lu Y, Pareek A, Lavoie-Gagne OZ, Forlenza EM, Patel BH, Reinholz AK, Forsythe B, Camp CL. Machine Learning for Predicting Lower Extremity Muscle Strain in National Basketball Association Athletes. Orthop J Sports Med 2022; 10:23259671221111742. [PMID: 35923866 PMCID: PMC9340342 DOI: 10.1177/23259671221111742] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/11/2022] [Indexed: 12/23/2022] Open
Abstract
Background In professional sports, injuries resulting in loss of playing time have serious implications for both the athlete and the organization. Efforts to quantify injury probability utilizing machine learning have been met with renewed interest, and the development of effective models has the potential to supplement the decision-making process of team physicians. Purpose/Hypothesis The purpose of this study was to (1) characterize the epidemiology of time-loss lower extremity muscle strains (LEMSs) in the National Basketball Association (NBA) from 1999 to 2019 and (2) determine the validity of a machine-learning model in predicting injury risk. It was hypothesized that time-loss LEMSs would be infrequent in this cohort and that a machine-learning model would outperform conventional methods in the prediction of injury risk. Study Design Case-control study; Level of evidence, 3. Methods Performance data and rates of the 4 major muscle strain injury types (hamstring, quadriceps, calf, and groin) were compiled from the 1999 to 2019 NBA seasons. Injuries included all publicly reported injuries that resulted in lost playing time. Models to predict the occurrence of a LEMS were generated using random forest, extreme gradient boosting (XGBoost), neural network, support vector machines, elastic net penalized logistic regression, and generalized logistic regression. Performance was compared utilizing discrimination, calibration, decision curve analysis, and the Brier score. Results A total of 736 LEMSs resulting in lost playing time occurred among 2103 athletes. Important variables for predicting LEMS included previous number of lower extremity injuries; age; recent history of injuries to the ankle, hamstring, or groin; and recent history of concussion as well as 3-point attempt rate and free throw attempt rate. The XGBoost machine achieved the best performance based on discrimination assessed via internal validation (area under the receiver operating characteristic curve, 0.840), calibration, and decision curve analysis. Conclusion Machine learning algorithms such as XGBoost outperformed logistic regression in the prediction of a LEMS that will result in lost time. Several variables increased the risk of LEMS, including a history of various lower extremity injuries, recent concussion, and total number of previous injuries.
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Affiliation(s)
- Yining Lu
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota,
USA
| | - Ayoosh Pareek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota,
USA
| | - Ophelie Z. Lavoie-Gagne
- Harvard Combined Orthopaedic Surgery Program, Harvard Medical
School, Boston, Massachusetts, USA
| | - Enrico M. Forlenza
- Department of Orthopaedic Surgery, Rush University Medical Center,
Chicago, Illinois, USA
| | - Bhavik H. Patel
- Department of Orthopedic Surgery, University of Illinois at Chicago,
Chicago, Illinois, USA
| | - Anna K. Reinholz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota,
USA
| | - Brian Forsythe
- Department of Orthopaedic Surgery, Rush University Medical Center,
Chicago, Illinois, USA
| | - Christopher L. Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota,
USA.,∥Christopher L. Camp, MD, Mayo Clinic, 200
First Street SW, Rochester, MN 55905, USA (
)
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Editorial Commentary: Earlier Hip Arthroscopy May Result in Improved Outcomes for Femoroacetabular Impingement Syndrome in Symptomatic Athletes: No Time Like the Present Could Mean Better Luck Next Year. Arthroscopy 2022; 38:2192-2194. [PMID: 35809978 DOI: 10.1016/j.arthro.2022.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/19/2022] [Indexed: 02/02/2023]
Abstract
Hip arthroscopy is an effective tool to address hip pain and dysfunction related to femoroacetabular impingement syndrome (FAIS), and an increasing volume of evidence suggests improved outcomes of these procedures if they are done closer to the onset of symptoms. Although this same relationship is observed in competitive athletes, these patients often have competing priorities when deciding if and when to proceed with surgical management of FAIS, including the desire to complete a competitive season, scouting and scholarship considerations, and financial incentives. Despite these incentives, consideration may be given to earlier surgical management, given the improved outcome potential and high rates of return to play. However, caution should be taken, particularly in the elite athlete population, as return to play data may not paint the whole picture, and there remains a paucity of data on sport performance after hip arthroscopy for FAIS.
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8
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LaPrade CM, Cinque ME, Safran MR, Freehill MT, Wulf CA, LaPrade RF. Using Advanced Data to Analyze the Impact of Injury on Performance of Major League Baseball Pitchers: A Narrative Review. Orthop J Sports Med 2022; 10:23259671221111169. [PMID: 35898207 PMCID: PMC9310227 DOI: 10.1177/23259671221111169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/12/2022] [Indexed: 12/05/2022] Open
Abstract
Major league baseball (MLB) pitchers are at risk of numerous injuries during
play, and there is an increasing focus on evaluating their performance in the
context of injury. Historically, performance after return to play (RTP) from
injury has focused on general descriptive statistics, such as innings or games
played, or rate statistics with inherent variability (eg, earned run average,
walks and hits per inning pitched, strikeouts per 9 innings, or walks per 9
innings). However, in recent years, MLB has incorporated advanced technology and
tracking systems in every stadium, allowing for more in-depth analysis of
pitcher-specific data that are captured with every pitch of every game. This
technology allows for the ability to delve into the pitching performance on a
basis that is more specific to each pitcher and allows for more in-depth
analysis of different aspects of pitching performance. The purpose of this
narrative review was to illustrate the current state of injury recording for
professional baseball pitchers, highlight recent technological advances in MLB,
and describe the advanced data available for analysis. We used advanced data in
the literature to review the current state of performance analysis after RTP in
MLB pitchers after injury. Finally, we strived to provide a framework for future
studies to more meticulously assess RTP performance given the current available
resources for analysis.
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Affiliation(s)
- Christopher M LaPrade
- Department of Orthopaedic Surgery and Department of Sports Medicine, Stanford University, Redwood City, California, USA
| | - Mark E Cinque
- Department of Orthopaedic Surgery and Department of Sports Medicine, Stanford University, Redwood City, California, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery and Department of Sports Medicine, Stanford University, Redwood City, California, USA
| | - Michael T Freehill
- Department of Orthopaedic Surgery and Department of Sports Medicine, Stanford University, Redwood City, California, USA
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9
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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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10
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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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Inclan PM, Chang PS, Mack CD, Solomon GS, Brophy RH, Hinton RY, Spindler KP, Sills AK, Matava MJ. Validity of Research Based on Public Data in Sports Medicine: A Quantitative Assessment of Anterior Cruciate Ligament Injuries in the National Football League. Am J Sports Med 2022; 50:1717-1726. [PMID: 34166138 DOI: 10.1177/03635465211015435] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Numerous researchers have leveraged publicly available Internet sources to publish publicly obtained data (POD) studies concerning various orthopaedic injuries in National Football League (NFL) players. PURPOSE To provide a comprehensive systematic review of all POD studies regarding musculoskeletal injuries in NFL athletes and to use anterior cruciate ligament (ACL) injuries in NFL players to quantify the percentage of injuries identified by these studies. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review was conducted to identify all published studies utilizing POD regarding ACL injury in NFL athletes from 2000 to 2019. Data regarding player demographics were extracted from each publication. These results were compared with prospectively collected data reported by the teams' medical staff to the NFL Injury Surveillance System database linked to the League's electronic health record. An ACL "capture rate" for each article was calculated by dividing the number of ACL injuries in the POD study by the total number of ACL injuries in the NFL injury database occurring in the study period of interest. RESULTS A total of 42 studies were extracted that met the definition of a POD study: 28 evaluated a variety of injuries and 14 dealt specifically with ACL injuries, with 35 (83%) of the 42 studies published during or since 2015. POD studies captured a mean of 66% (range, 31%-90%) of ACL injuries reported by the teams' medical staff. This inability to capture all injury rates varied by position, with 86% capture of ACL injuries in skill athletes, 72% in midskill athletes, and 61% in linemen. POD studies captured 35% of injuries occurring during special teams play. CONCLUSION The frequency of studies leveraging publicly obtained injury data in NFL players has rapidly increased since 2000. There is significant heterogeneity in the degree to which POD studies correctly identify ACL injuries from public reports. Sports medicine research relying solely on publicly obtained sources should be interpreted with an understanding of their inherent limitations and biases. These studies underreport the true incidence of injuries, with a bias toward capturing injuries in more popular players.
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Affiliation(s)
- Paul M Inclan
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Peter S Chang
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | | | - Gary S Solomon
- National Football League, New York, New York, USA.,Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Robert H Brophy
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | | | | | - Allen K Sills
- National Football League, New York, New York, USA.,Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Matthew J Matava
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
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12
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Lian J, Sewani F, Dayan I, Voleti PB, Gonzalez D, Levy IM, Musahl V, Allen A. Systematic Review of Injuries in the Men's and Women's National Basketball Association. Am J Sports Med 2022; 50:1416-1429. [PMID: 34213367 DOI: 10.1177/03635465211014506] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Numerous studies have reported the incidence and outcomes of injuries in the men's and women's National Basketball Association (NBA and WNBA, respectively). PURPOSE To synthesize published data regarding the incidence and outcomes of all injuries in the NBA and WNBA in a comprehensive review. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched 3 electronic databases (PubMed, MEDLINE, Embase) for studies of all levels of evidence since 1990 pertaining to injuries sustained by active players in the NBA and WNBA. Studies were excluded if the cohort of interest included ≤3 active players. RESULTS The initial search of the 3 databases yielded 1253 unique studies, of which 49 met final inclusion criteria for this review. Only 4 studies included athletes in the WNBA. Based on the mean annual incidence, the 5 most common orthopaedic sports injuries sustained in the NBA were concussions (9.5-14.9 per year), fractures of the hand (3.5-5.5 per year), lower extremity stress fractures (4.8 per year), meniscal tears (2.3-3.3 per year), and anterior cruciate ligament tears (1.5-2.6 per year). Cartilage defects treated using microfracture, Achilles tendon ruptures, and anterior cruciate ligament injuries were 3 injuries that led to significant reductions in performance measurements after injury. CONCLUSION With advances in sports technology and statistical analysis, there is rapidly growing interest in injuries among professional basketball athletes. High-quality prospective studies are needed to understand the prevalence and effect of injuries on player performance and career length. This information can inform preventative and treatment measures taken by health care providers to protect players and guide safe return to play at a high level.
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Affiliation(s)
- Jayson Lian
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Faraz Sewani
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Isaac Dayan
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Pramod B Voleti
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - David Gonzalez
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - I Martin Levy
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Answorth Allen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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13
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Zhou ML, Haley CC. The Team Physician: Return to Play Considerations and Outcomes. Sports Med Arthrosc Rev 2021; 29:e65-e70. [PMID: 34730118 DOI: 10.1097/jsa.0000000000000323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Successful rehabilitation of sports-related orthopedic injuries remains a challenge for both orthopedic surgeons and their patients. Team physicians are tasked with the complex problem of minimizing time away from competition, while simultaneously mitigating the risk of reinjury. Varying levels of expectation and demand between recreational and competitive athletes coupled with the already complex nature of sports-related injuries present a multifactorial challenge for the even the most experienced physicians. In the realm of sports medicine, timing of return to sport has become a controversial yet ubiquitous criterion by which treatment outcomes are measured. While accelerated rehabilitation may be desired in many cases, surgeons must also recognize the identifiable risk factors for potential reinjury. With these principles in mind, we present a summary of the available literature on data pertaining to return to sport, with coverage of injuries commonly seen within an orthopedic sports medicine practice.
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Affiliation(s)
- Maj Liang Zhou
- Keller Army Hospital, United States Military Academy, West Point, NY
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14
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Ishøi L, Nielsen MF, Krommes K, Husted RS, Hölmich P, Pedersen LL, Thorborg K. Femoroacetabular impingement syndrome and labral injuries: grading the evidence on diagnosis and non-operative treatment-a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). Br J Sports Med 2021; 55:1301-1310. [PMID: 34531185 DOI: 10.1136/bjsports-2021-104060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 11/03/2022]
Abstract
This statement summarises and appraises the evidence on diagnostic tests and clinical information, and non-operative treatment of femoroacetabular impingement (FAI) syndrome and labral injuries. We included studies based on the highest available level of evidence as judged by study design. We evaluated the certainty of evidence using the Grading of Recommendations Assessment Development and Evaluation framework. We found 29 studies reporting 23 clinical tests and 14 different forms of clinical information, respectively. Restricted internal hip rotation in 0° hip flexion with or without pain was best to rule in FAI syndrome (low diagnostic effectiveness; low quality of evidence; interpretation of evidence: may increase post-test probability slightly), whereas no pain in Flexion Adduction Internal Rotation test or no restricted range of motion in Flexion Abduction External Rotation test compared with the unaffected side were best to rule out (very low to high diagnostic effectiveness; very low to moderate quality of evidence; interpretation of evidence: very uncertain, but may reduce post-test probability slightly). No forms of clinical information were found useful for diagnosis. For treatment of FAI syndrome, 14 randomised controlled trials were found. Prescribed physiotherapy, consisting of hip strengthening, hip joint manual therapy techniques, functional activity-specific retraining and education showed a small to medium effect size compared with a combination of passive modalities, stretching and advice (very low to low quality of evidence; interpretation of evidence: very uncertain, but may slightly improve outcomes). Prescribed physiotherapy was, however, inferior to hip arthroscopy (small effect size; moderate quality of evidence; interpretation of evidence: hip arthroscopy probably increases outcome slightly). For both domains, the overall quality of evidence ranged from very low to moderate indicating that future research on diagnosis and treatment may alter the conclusions from this review.
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Affiliation(s)
- Lasse Ishøi
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Mathias Fabricius Nielsen
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Kasper Krommes
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Rasmus Skov Husted
- Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Orthopedic Surgery and Physical Therapy, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Per Hölmich
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | | | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
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15
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A Systematic Review of the Orthopaedic Literature on Truncal and Lower Extremity Injuries in Major League Baseball Players. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202108000-00002. [PMID: 34343147 PMCID: PMC8337061 DOI: 10.5435/jaaosglobal-d-21-00030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/12/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Orthopaedic injuries in Major League Baseball (MLB) players can have a tremendous impact on player health, longevity, salaries, and time lost from play. PURPOSE To summarize all data published between January 1980 and August 2019 on truncal and lower extremity orthopaedic injuries sustained by MLB players. METHODS A literature review of studies examining injuries in MLB was performed using the PubMed and Embase databases. Included studies focused on truncal and lower extremity injuries in professional baseball players. Studies pertaining to nonorthopaedic injuries, and case reports, were excluded. RESULTS A total of 41 articles met the inclusion criteria and were selected for the final analysis. Articles were divided based on anatomic region of injury: hip and pelvis (16%), thigh (15%), truncal (14%), knee (13%), and ankle (11%). Most studies (83.7%) were level 3 evidence. Most studies obtained data using publicly available internet resources (29.8%) compared with the MLB Health and Injury Tracking System (22.1%). CONCLUSION This review provides physicians with a single source of the most current literature regarding truncal and lower extremity orthopaedic injuries in MLB players. Most research was published on hip and pelvic, truncal, and thigh injuries and consisted of level III evidence.
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16
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Outcomes and rate of return to play in elite athletes following arthroscopic surgery of the hip. INTERNATIONAL ORTHOPAEDICS 2021; 45:2507-2517. [PMID: 34148120 PMCID: PMC8514359 DOI: 10.1007/s00264-021-05077-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/10/2021] [Indexed: 11/18/2022]
Abstract
Background The tremendous physical demands of elite performance increase the risk of elite athletes sustaining various orthopaedic injuries. Hip pain is common in high-level athletes representing up to 6% of all athletic injuries. Expedient diagnosis and effective treatment are paramount for their future sporting careers and to prevent subsequent joint degeneration. Purpose This systematic review aimed to evaluate the outcome and the rate of return to play (RTP) following arthroscopic procedures in the hip (osteoplasty, chondroplasty, labral repair and/or debridement, capsulotomy, capsulorrhaphy or any soft tissue procedure) in elite athletes. Elite athletes were defined as those who represented their country in international contests or were competing professionally for the purpose of this study. Methods A computer-based systematic search, following the PRISMA Guidelines, was performed on CENTRAL, PUBMED, EMBASE, SCOPUS, EBSCO, Google Scholar and Web of Science from inception until January 1, 2020, identifying studies that looked at return to sports post-hip arthroscopy in elite athletes. Weighted means were calculated for the RTP rate and duration and for patient-reported outcome measures (PROMs). Results After eligibility screening, 22 articles were included with a total of 999 male and seven female patients, 1146 hips and a mean age of 28.4 ± 3.2 years. The mean follow-up period was 35.8 ± 13.4 months and 15.9 ± 9.6% of athletes had undergone bilateral procedures. Overall, 93.9% (95% CI: 90.5, 96.6, P < 0.0001) of patients demonstrated RTP after 6.8 ± 2.1 months post-surgery and all PROMs improved post-operatively. During follow-up, 9.6% (95% CI: 5.2, 15.2, P = 0.025) patients needed further intervention. Conclusion A high percentage of elite athletes return to the same level of competition after hip arthroscopy, with a low rate of further interventions. Hip arthroscopy appears to be an efficacious treatment for hip and/or groin pain, caused by pathologies such as FAI or labral tears, in elite athletes in the shorter term. Long term outcomes need further evaluation.
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17
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Blond BN, Blond JB, Loscalzo PJ. Game Spacing and Density in Relation to the Risk of Injuries in the National Hockey League. Orthop J Sports Med 2021; 9:2325967121999401. [PMID: 33954221 PMCID: PMC8058808 DOI: 10.1177/2325967121999401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/30/2020] [Indexed: 11/15/2022] Open
Abstract
Background Ice hockey has significant workload demands. Research of other sports has suggested that decreased rest between games as well as an increased workload may increase the risk of injuries. Purpose To evaluate whether condensed game schedules increase the frequency and severity of injuries in the National Hockey League (NHL). Study Design Descriptive epidemiology study. Methods Data were obtained from publicly available online sources on game schedules and injuries for all NHL teams for the 2005-2006 through 2018-2019 seasons. Injury rates (per team per game) and the proportion of severe and nonsevere injuries were determined. The game-spacing analysis assessed the risk of injuries in relation to the number of days between games played (range, 0-≥6 days). The game-density analysis assessed the risk of injuries in relation to the number of games played within 7 days (range, 1-5 games). Results were assessed by analysis of variance, the post hoc Tukey test, and the chi-square test of distribution. Results The game-spacing analysis included 33,170 games and 7224 injuries, and a significant group difference was found (P = 1.44×10-5), with the post hoc test demonstrating an increased risk of injuries when games were spaced with <1 day of rest. There was no significant difference in the ratio of severe to nonsevere injuries. The game-density analysis included 33,592 games and 10,752 injuries, and a significant group difference was found (P = 8.22×10-48), demonstrating an increased risk of injuries with an increased number of games in all conditions except for the comparison between 4 versus 5 games in 7 days. There was also a significant difference in injury severity (P = .008), indicating that the least dense condition had a higher ratio of severe to nonsevere injuries compared with the other game-density conditions. Finally, the game-density analysis was repeated after excluding games played with <1 day of rest, and the finding of increased injury rates with increasingly condensed schedules remained significant (P = 9.52×10-46), with significant differences between all groups except for the comparison between 1 versus 2 games in 7 days. Conclusion We found that a condensed schedule and <1 day of rest between games were associated with an increased rate of injuries in the NHL. These findings may help in the design of future game schedules.
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Affiliation(s)
- Benjamin N Blond
- Department of Neurology, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, New York, USA
| | - Joshua B Blond
- Department of Neurology, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, New York, USA
| | - Paul J Loscalzo
- Department of Neurology, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, New York, USA
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18
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Lindman I, Abrahamsson J, Öhlin A, Wörner T, Eek F, Ayeni OR, Senorski EH, Sansone M. Improvements After Arthroscopic Treatment for Femoroacetabular Impingement Syndrome in High-Level Ice Hockey Players: 2-Year Outcomes by Player Position. Orthop J Sports Med 2021; 9:2325967120981687. [PMID: 33796583 PMCID: PMC7983446 DOI: 10.1177/2325967120981687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Ice hockey players often undergo arthroscopic treatment for femoroacetabular impingement syndrome (FAIS); however, only a few studies have reported postoperative patient-reported outcomes. It has been debated whether player position is related to FAIS. Purpose: To evaluate the change in patient-reported outcome measures (PROMs) in high-level ice hockey players from presurgery to 2 years after arthroscopic treatment for FAIS. The secondary aim was to evaluate differences in outcomes among player positions and whether stick handedness is related to the side of the symptomatic hip. Study Design: Case series; Level of evidence, 4. Methods: Ice hockey players undergoing treatment for FAIS between 2011 and 2019 were prospectively included. Preoperative and 2-year follow-up scores were collected for the following PROMs: HAGOS (Copenhagen Hip and Groin Outcome Score), iHOT-12 (12-item International Hip Outcome Tool), EQ-5D (EuroQol–5 Dimensions) and EQ-VAS (EuroQol–Visual Analog Scale), Hip Sports Activity Scale, and visual analog scale for overall hip function. Player position and stick handedness were collected from public sources. Preoperative and follow-up outcomes were compared for the entire cohort and among player positions. Results: The cohort included 172 ice hockey players with a mean age of 28 years, a mean body mass index of 25.6, and a mean symptom duration of 46.3 months. In the 120 players with 2-year follow-up data, there was significant improvement in all PROMs as compared with presurgery: HAGOS subscales (symptoms, 47.5 vs 68.0; pain, 57.0 vs 75.8; activities of daily living, 62.5 vs 81.0; sports, 40.0 vs 64.7; physical activity, 30.9 vs 57.2; quality of life, 32.5 vs 57.8), iHOT-12 (45.2 vs 66.7), EQ-5D (0.59 vs 0.75), EQ-VAS (68.3 vs 73.2), and visual analog scale for overall hip function (49.6 vs 69.2) (P < .0001 for all). At 2-year follow-up, 83% reported satisfaction with the procedure. There was no difference in the improvement in PROMs among player positions. Further, there was no significant relationship between stick handedness and side of symptomatic hip; however, because of the number of bilateral procedures and large number of left-handed shooters, no conclusions could be drawn. Conclusion: High-level ice hockey players undergoing arthroscopic treatment for FAIS reported improvements in PROMs 2 years after surgery, regardless of player position.
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Affiliation(s)
- Ida Lindman
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Josefin Abrahamsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Axel Öhlin
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Tobias Wörner
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Frida Eek
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Eric Hamrin Senorski
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Mikael Sansone
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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19
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Allahabadi S, Su F, Lansdown DA. Systematic Review of Orthopaedic and Sports Medicine Injuries and Treatment Outcomes in Women's National Basketball Association and National Basketball Association Players. Orthop J Sports Med 2021; 9:2325967120982076. [PMID: 33623799 PMCID: PMC7878958 DOI: 10.1177/2325967120982076] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/31/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Athletes in the Women’s National Basketball Association (WNBA) and National Basketball Association (NBA) are subject to high injury rates given the physical demands of the sport. Comprehensive data regarding injury patterns and rates in these athletes are limited. Purpose: To summarize available data on orthopaedic and sports medicine–related injuries through 2020 in professional female and male basketball players. Study Design: Systematic review; Level of evidence, 4. Methods: A search was conducted using PubMed and Embase through April 5, 2020, to identify injury studies regarding WNBA and NBA players. Studies were included if the injury or surgery was considered a direct consequence of game play including musculoskeletal/orthopaedic, concussion, ophthalmologic, and craniomaxillofacial injuries. Systematic reviews, screening studies, or studies without sufficient WNBA or NBA player subgroup analysis were excluded. Results: A total of 49 studies met inclusion criteria, 43 (87.8%) of which detailed musculoskeletal injuries. The lower extremity represented 63.3% of studies. A majority (59.2%) of studies were level 4 evidence. The source of data was primarily comprehensive online search (n = 33; 67.3%), followed by official databases (n = 11; 22.4%). Only 3 studies concerned WNBA athletes compared with 47 that concerned NBA athletes. The lowest return-to-play rates were cited for Achilles tendon repairs (61.0%-79.5%). Variability in return-to-play rates existed among studies even with similar seasons studied. Conclusion: The majority of literature available on orthopaedic and sports medicine–related injuries of NBA and WNBA athletes is on the lower extremity. The injuries that had the greatest effect on return to play and performance were Achilles tendon ruptures and knee cartilage injuries treated using microfracture. The reported outcomes are limited by heterogeneity and overlapping injury studies. There are limited available data on WNBA injuries specifically.
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Affiliation(s)
- Sachin Allahabadi
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Favian Su
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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20
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Dekker TJ, Goldenberg B, Lacheta L, P Horan M, Millett PJ. Anterior Shoulder Instability in the Professional Athlete: Return to Competition, Time to Return, and Career Length. Orthop J Sports Med 2020; 8:2325967120959728. [PMID: 33209943 PMCID: PMC7645762 DOI: 10.1177/2325967120959728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/16/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Anterior shoulder instability is a common condition in professional athletes,
yet little is known about the success of surgery. Return to competition
(RTC) is a metric indicative of a successful outcome for professional
athletes who undergo anterior shoulder stabilization surgery. Purpose: To determine the rate of RTC, time to RTC, recurrence rate, and length of
career after surgery in professional athletes who had undergone surgical
treatment for anterior shoulder instability. Study Design: Case series; Level of evidence, 4. Methods: We evaluated professional athletes who underwent surgical treatment for
anterior shoulder instability by a single surgeon between 2007 and 2018.
Data from patients’ medical records, a patient data registry, basic search
engines, sports websites, and individual team websites were used to
determine length of professional play before injury, duration of career
after surgery, and RTC level. Results: Overall, 23 professional athletes (25 shoulders from 12 contact and 13
noncontact athletes) were identified. The mean age at the time of surgery
was 24.3 ± 4.9 years (range, 16-35 years). Primary procedures included
arthroscopic Bankart repair (76%; 19/25), open Latarjet (20%; 5/25), and
bony Bankart repair (4%; 1/25). Of the 23 athletes, 22 returned to their
previous level of competition (96%; 95% CI, 78%-100%). The mean time between
surgery and RTC was 4.5 months (range, 3-8 months). There was no difference
in time to RTC between contact and noncontact athletes (4.1 vs 4.4 months).
There was no difference in RTC rates and time to return for players who
received a Bankart repair versus a Latarjet procedure (4.6 vs 4.2 months). A
total of 12 participants were still actively engaged in their respective
sport at an average of 4.3 years since surgery, while 11 athletes went on to
retire at an average of 4.8 years. Duration of play after surgery was 3.8
years for contact athletes and 5.8 years for noncontact athletes
(P > .05). Conclusion: In this series, professional athletes who underwent surgical shoulder
stabilization for the treatment of anterior glenohumeral instability
returned to their presurgical levels of competition at a high rate. No
differences in RTC rate or time to RTC were observed for contact versus
noncontact athletes or for those who received arthroscopic Bankart repair
versus open Latarjet. However, contact athletes had shorter careers after
surgery than did noncontact athletes.
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Affiliation(s)
| | | | - Lucca Lacheta
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Peter J Millett
- United States Air Force, Eglin Air Force Base, Florida, USA.,Steadman Philippon Research Institute, Vail, Colorado, USA
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21
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Berube ER, Lopez CD, Trofa DP, Popkin CA. A Systematic Review of the Orthopedic Literature Involving National Hockey League Players. Open Access J Sports Med 2020; 11:145-160. [PMID: 33116968 PMCID: PMC7569065 DOI: 10.2147/oajsm.s263260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/28/2020] [Indexed: 01/10/2023] Open
Abstract
Background Orthopedic injuries of National Hockey League (NHL) players are common and may significantly affect players’ health and careers. Evidence-based injury management is important in guiding players’ timely return to sport and their ability to play at their pre-injury levels of competition. Purpose To summarize all data published between January 1980 and March 2020 on orthopedic injuries experienced by professional ice hockey players competing in the NHL. Study Design Systematic review. Methods A literature review of studies examining orthopedic injuries in the NHL was performed using the Embase, PubMed, and CINAHL databases. The review included studies focusing on NHL players and players attending the NHL Combine and preseason NHL team camps. Studies pertaining to non-orthopedic injuries and case reports were excluded. Results A total of 39 articles met the inclusion criteria and were analyzed. The articles were divided by anatomic site of injury for further analysis: hip and pelvis (24%), general/other (14%), ankle (10%), knee (10%), foot (7%), shoulder (7%), thigh (7%), trunk (7%), spine (6%), elbow (4%), and hand and wrist (4%). The majority of articles were Level IV Evidence (51.3%), followed by Level III Evidence (38.5%). Most studies obtained data from publicly available internet resources (24.7%), player medical records (19.5%) or surveys of team physicians and athletic trainers (15.5%). A much smaller number of studies utilized the NHL Injury Surveillance System (NHLISS) (6.5%) or the Athlete Health Management System (AHMS) (2.6%). Conclusion This systematic review provides NHL team physicians with a single source of the current literature regarding orthopedic injuries in NHL players. Most research was published on hip and pelvis (24%) injuries, did not utilize the NHLISS and consisted of Level IV Evidence.
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Affiliation(s)
- Emma R Berube
- Center for Shoulder, Elbow and Sports Medicine, Department of Orthopedics, Columbia University Medical Center, New York, NY, USA
| | - Cesar D Lopez
- Center for Shoulder, Elbow and Sports Medicine, Department of Orthopedics, Columbia University Medical Center, New York, NY, USA
| | - David P Trofa
- Center for Shoulder, Elbow and Sports Medicine, Department of Orthopedics, Columbia University Medical Center, New York, NY, USA
| | - Charles A Popkin
- Center for Shoulder, Elbow and Sports Medicine, Department of Orthopedics, Columbia University Medical Center, New York, NY, USA
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22
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Chona DV, Bonano JC, Ayeni OR, Safran MR. Definitions of Return to Sport After Hip Arthroscopy: Are We Speaking the Same Language and Are We Measuring the Right Outcome? Orthop J Sports Med 2020; 8:2325967120952990. [PMID: 33015214 PMCID: PMC7509720 DOI: 10.1177/2325967120952990] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/09/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Return to sport is a commonly studied outcome of hip arthroscopy that is relevant to both patients and providers. There exists substantial variability in criteria used to define successful return to sport. Purpose: To review and evaluate the definitions used in the literature so as to establish a single standard to enable comparison of outcomes in future studies. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed, MEDLINE, and Embase databases were searched from inception to June 1, 2019, for studies relating to hip arthroscopy and return to sport. Articles included were those that met the following criteria: (1) contained 2 or more patients, (2) studied patients 18 years of age and older, (3) reported postoperative outcomes after hip arthroscopy, (4) clearly defined return to play, and (5) were written in English. Excluded articles (1) reported outcomes for nonoperative or open treatments, (2) did not clearly define return to play, or (3) were review articles, meta-analyses, or survey-based studies. Return-to-play definitions and additional metrics of postoperative performance and outcome were recorded. Results: A total of 185 articles were identified, and 28 articles were included in the final review, of which 18 involved elite athletes and 10 involved recreational athletes. Of articles studying elite athletes, 6 (33%) defined return to play as participation in regular or postseason competition, 3 (17%) extended the criteria to the preseason, and 2 (11%) used participation in sport-related activities and training. The remaining 7 (39%) reported rates of return to the preoperative level of competition but did not specify preseason versus regular season. All 10 articles evaluating recreational athletes defined return to play based on patient-reported outcomes. Four (40%) did so qualitatively, while 6 (60%) did so quantitatively. Conclusion: There exists significant variability in criteria used to define successful return to sport after hip arthroscopy, and these criteria differ among elite and recreational athletes. For elite athletes, return to the preoperative level of competition is most commonly used, but there exists no consensus on what type of competition—regular season, preseason, or training—is most appropriate. For recreational athletes, patient-reported data are most commonly employed, although there are clear differences between authors on the ways in which these are being used as well.
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Affiliation(s)
- Deepak V Chona
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - John C Bonano
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
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23
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Mullins K, Hanlon M, Carton P. Arthroscopic correction of femoroacetabular impingement improves athletic performance in male athletes. Knee Surg Sports Traumatol Arthrosc 2020; 28:2285-2294. [PMID: 31463551 DOI: 10.1007/s00167-019-05683-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 08/19/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE To measure the changes in athletic performance in athletes treated arthroscopically for femoroacetabular impingement and compare results to a matched controlled athletic cohort, over a 1-year period. METHODS Male athletes scheduled for arthroscopic correction of symptomatic FAI were recruited and tested (pre-operatively and 1-year postsurgery) for measures of athletic performance which included acceleration (10-m sprint), change of direction speed (CODS), squatting depth, and reactive strength index (RSI). The FAI group was compared to a matched, healthy, control group who were tested at baseline and 1 year later with no disruption to their regular training or competition status; the prevalence of anterior groin pain during testing in either group was recorded. Hip range of motion (ROM) was also measured for both groups at baseline and at 1 year in the FAI group to look for change following intervention. RESULTS Prior to surgery, the FAI group were slower than the control group (p < 0.001) for acceleration (3% slower) and CODS (10% slower). At 1 year, 91% of the FAI group returned to full competition at an average time of 17 weeks, while substantial reductions in pain were also noted during acceleration (51-6%, p = 0.004), CODS (62-8%, p = 0.001), and squat test (38-8%, p = 0.003). Significant improvements were seen in the FAI group for CODS (7%, p < 0.001) and squat depth measures (6%, p = 0.004) from baseline to 1 year (significant time × group interaction effects were noted for these also). The changes in performance in the control group over time were non-significant across all of the measures (n.s.). At 1-year postsurgery, there were no statistically significant differences between the groups for any of the athletic measures. There was a significant and clinically important improvement in range of hip motion in the FAI group at 1-year postsurgery (p < 0.05). CONCLUSION Symptomatic FAI causes substantial reductions in athletic performance compared to healthy competitors placing these athletes at a distinct performance disadvantage. The results from the current study demonstrate that arthroscopic correction (including labral repair) in athletes with symptomatic FAI, reduces pain and restores athletic performance to a level which is comparable to healthy athletes, at 1 year. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Karen Mullins
- Department of Sports Leisure and Tourism, Limerick Institute of Technology, Moylish Park, Limerick, Ireland.
| | - Michael Hanlon
- Department of Health Sport and Exercise Science, Waterford Institute of Technology, Co Waterford, Ireland
| | - Patrick Carton
- Department of Health Sport and Exercise Science, Waterford Institute of Technology, Co Waterford, Ireland.,The Hip and Groin Clinic, UPMC Whitfield, Co Waterford, Ireland
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24
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Parvaresh KC, Wichman D, Rasio J, Nho SJ. Return to Sport After Femoroacetabular Impingement Surgery and Sport-Specific Considerations: a Comprehensive Review. Curr Rev Musculoskelet Med 2020; 13:213-219. [PMID: 32147778 PMCID: PMC7251016 DOI: 10.1007/s12178-020-09617-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Recent advancements in surgical technology and techniques have improved functional results for operative treatment of femoroacetabular impingement syndrome (FAIS). Few studies have comprehensively evaluated the literature regarding return to sport criteria, timing, level, and rates. The purpose of this study was to review recent studies regarding return to play after surgical correction of FAIS. We will specifically evaluate the level of return to play and look to compare pre- and postoperative competition levels when available. We will also analyze timing of return to play from injury to surgery. Additionally, we will elucidate any sport-specific criteria that may determine readiness for return. RECENT FINDINGS Athletes with FAIS treated non-operatively have a low rate of return to sport and are often functionally limited in their level of performance. Surgical management of FAIS includes hip arthroscopy as well as open techniques. Current literature suggests a high rate of return to sport after contemporary surgery for FAIS at 87-93% overall. Rate of return to the same level of competition following surgery for FAIS is 55-83% in pooled studies. Limited evidence is available comparing postoperative rehabilitation protocols and timing of return among different sports. Operative treatment of FAIS results in high rates of return to sport and functional performance. The results of this study may help educate patients preoperatively in regard to the likelihood of functional return to sport and sport-specific considerations. Further research evaluating rehabilitation protocols and return criteria may better elucidate timing intervals for patients to maximize function while limiting complications.
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Affiliation(s)
- Kevin C Parvaresh
- Department of Orthopedic Surgery, Section of Young Adult Hip Surgery, Division of Sports Medicine, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL, USA
| | - Daniel Wichman
- Department of Orthopedic Surgery, Section of Young Adult Hip Surgery, Division of Sports Medicine, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL, USA
| | - Jonathan Rasio
- Department of Orthopedic Surgery, Section of Young Adult Hip Surgery, Division of Sports Medicine, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL, USA
| | - Shane J Nho
- Department of Orthopedic Surgery, Section of Young Adult Hip Surgery, Division of Sports Medicine, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL, USA.
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25
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Weber AE, Nakata H, Mayer EN, Bolia IK, Philippon MJ, Snibbe J, Romano R, Tibone JE, Gamradt SC. Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement Syndrome in NCAA Division I Athletes: Experience at a Single Institution. Orthop J Sports Med 2020; 8:2325967120918383. [PMID: 32548179 PMCID: PMC7249579 DOI: 10.1177/2325967120918383] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/29/2020] [Indexed: 11/24/2022] Open
Abstract
Background: The rate of return to sport after surgical treatment of femoroacetabular
impingement (FAI) syndrome (FAIS) has been studied in high-level athletes.
However, few studies examining this rate have focused exclusively on
National Collegiate Athletic Association (NCAA) Division I athletes. Purpose: To evaluate the return-to-sport rate after hip arthroscopy for FAIS and to
examine the influence of sport type on the clinical presentation of FAIS in
collegiate athletes. Study Design: Case series; Level of evidence, 4. Methods: Included in this study were NCAA Division I student-athletes who underwent
hip arthroscopy for FAIS at our institution between 2010 and 2017. Exclusion
criteria were history of previous hip pathology, pediatric hip disease,
radiographic evidence of osteoarthritis (Tönnis grade >0), prior lower
extremity procedure, history of chronic pain, osteoporosis, or history of
systemic inflammatory disease. Athletes were categorized into 6 subgroups
based on the type of sport (cutting, contact, endurance, impingement,
asymmetric/overhead, and flexibility) by using a previously reported
classification system. Patient characteristics and preoperative,
intraoperative, and return-to-sport variables were compared among sport
types. Results: A total of 49 hip arthroscopies for FAIS were performed in 39 collegiate
athletes (10 females, 29 males; mean age, 19.5 ± 1.3 years). A total of 1
(2.6%) cutting athlete, 15 (38.5%) contact athletes, 8 (20.5%) impingement
athletes, 6 (15.4%) asymmetric/overhead athletes, and 9 (23.1%) endurance
athletes were included in the study. There were no differences among sports
groups with respect to the FAI type. Endurance athletes had lower rates of
femoral osteochondroplasty (45.5%) and labral debridement (0.0%)
(P < .0001). Contact sport athletes had higher rates
of labral debridement (50.0%; P < .0001). Patients were
evaluated for return to sport at an average of 1.96 ± 0.94 years. Overall,
the return-to-sport rate was 89.7%. There were no differences in
return-to-sport rates based on the sport type except for endurance athletes,
who returned at a lower rate (66.6%; P < .001). No
differences in return-to-sport rate (P = .411), duration
after return (P = .265), or highest attempted level of
sport resumed (P = .625) were found between patients who
underwent labral repair versus debridement. Conclusion: Collegiate-level athletes who underwent hip arthroscopy for FAIS returned to
sport at high and predictable rates, with endurance athletes possibly
returning to sport at lower rates than all other sport types. Surgical
procedures may be influenced by sport type, but the rate of return to sport
between athletes who underwent labral debridement versus labral repair was
similar.
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Affiliation(s)
- Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Haley Nakata
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Eric N Mayer
- Department of Orthopedic Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Marc J Philippon
- The Steadman Clinic and Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Jason Snibbe
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Russ Romano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - James E Tibone
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Seth C Gamradt
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
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26
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Lindman I, Öhlin A, Desai N, Samuelsson K, Ayeni OR, Hamrin Senorski E, Sansone M. Five-Year Outcomes After Arthroscopic Surgery for Femoroacetabular Impingement Syndrome in Elite Athletes. Am J Sports Med 2020; 48:1416-1422. [PMID: 32195598 PMCID: PMC7227125 DOI: 10.1177/0363546520908840] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain and disability in athletes. Arthroscopic treatment for FAIS is well-established; however, the long-term results in elite athletes are limited. PURPOSE To evaluate outcomes 5 years after arthroscopic treatment for FAIS in elite athletes. STUDY DESIGN Case series; Level of evidence, 4. METHODS Elite athletes undergoing arthroscopic treatment for FAIS with a minimum 5-year follow-up were included. They were prospectively followed up with patient-reported outcome measures. An elite athlete was defined as having a Hip Sports Activity Scale (HSAS) level of 7 or 8 before the onset of symptoms. Preoperatively and 5 years after surgery, all athletes completed a web-based questionnaire, including the Copenhagen Hip and Groin Outcome Score (comprising 6 subscales), the EQ-5D and EQ-VAS (European Quality of Life-5 Dimensions Questionnaire and European Quality of Life-Visual Analog Scale), iHOT-12 (International Hip Outcome Tool), a visual analog scale for hip function, and the HSAS. Moreover, patients reported their overall satisfaction with their hip function. Preoperative measurements were compared with the 5-year follow-up. RESULTS A total of 64 elite athletes (52 men, 12 women) with a mean ± SD age of 24 ± 6 years were included. On average, patients reported a statistically significant and clinically relevant improvement from preoperative patient-reported outcome measures to the 5-year follow-up (P < .0003), Copenhagen Hip and Groin Outcome Score subscales (symptoms, 51.7 vs 71.9; pain, 61.0 vs 81.1; function of daily living, 67.1 vs 83.6; function in sports and recreation, 40.0 vs 71.5; participation in physical activity, 25.0 vs 67.4; hip and groin-related quality of life, 34.4 vs 68.0), EQ-5D (0.60 vs 0.83), EQ-VAS (66.1 vs 76.7), and iHOT-12 (40.0 vs 68.8). At the 5-year follow-up, 90.5% reported satisfaction with their overall hip function. In total, 54% still participated in competitive sports (HSAS, 5-8) at follow-up, while 77% had decreased their level. Older patients and patients with longer duration of symptoms reported a significantly lower level of sports activity (HSAS, 0-4; P < .009). CONCLUSION Arthroscopic treatment for FAIS in elite athletes results in a statistically significant and clinically relevant improvement regarding symptoms, hip function, quality of life, and pain 5 years after surgery. Approximately half of the cohort was still in competitive sports at follow-up, yet 77% had decreased their level of sports. Nine of 10 patients were satisfied with their surgery.
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Affiliation(s)
- Ida Lindman
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden,Ida Lindman, MD, Department of Orthopaedics, University of Gothenburg, Hedasg 12B, Gothenburg 413 45, Sweden ()
| | - Axel Öhlin
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Neel Desai
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Olufemi R. Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - Eric Hamrin Senorski
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Mikael Sansone
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden,Orthocenter/IFK-Kliniken, Gothenburg, Sweden
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27
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Salehi PP, Heiser A, Torabi SJ, Azizzadeh B, Lee J, Lee YH. Facial Fractures and the National Basketball Association: Epidemiology and Outcomes. Laryngoscope 2020; 130:E824-E832. [DOI: 10.1002/lary.28690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/09/2020] [Accepted: 03/25/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Parsa P. Salehi
- Department of Surgery, Otolaryngology–Head and Neck Surgery Yale University School of Medicine New Haven Connecticut U.S.A
| | - Alyssa Heiser
- Department of Otolaryngology–Head and Neck Surgery The University of Vermont Medical Center Burlington Vermont U.S.A
| | - Sina J. Torabi
- Department of Surgery, Otolaryngology–Head and Neck Surgery Yale University School of Medicine New Haven Connecticut U.S.A
| | - Babak Azizzadeh
- Center for Advanced Facial Plastic Surgery Beverly Hills California U.S.A
- Division of Head and Neck Surgery, Department of Otolaryngology–Head and Neck Surgery David Geffen School of Medicine at the University of California Los Angeles California Los Angeles U.S.A
| | - Jonathan Lee
- Department of Surgery, Division of Plastic Surgery Baystate Medical Center Springfield Massachusetts U.S.A
| | - Yan H. Lee
- Department of Surgery, Otolaryngology–Head and Neck Surgery Yale University School of Medicine New Haven Connecticut U.S.A
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28
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Editorial Commentary: Hip Arthroscopy Wins the National Basketball Association Slam Dunk Contest! Arthroscopy 2020; 36:479-480. [PMID: 32014178 DOI: 10.1016/j.arthro.2019.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 02/02/2023]
Abstract
Hip arthroscopy has proved its efficacy and value in the management of femoroacetabular impingement syndrome in recreational and professional athletes. However, needs, expectations, and economic burden are remarkable and astonishingly different within the elite sport world. When considering hip arthroscopy to address a femoroacetabular impingement condition, 3 big questions are asked by every athlete and must be answered: (1) Can I play again? (2) Will I play at the same level? (3) When can I return to sport? Regarding the National Basketball Association, approximately 88% of athletes return to play at the same level in about 6 months.
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29
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Clapp IM, Nwachukwu BU, Beck EC, Jan K, Gowd AK, Nho SJ. Comparing Outcomes of Competitive Athletes Versus Nonathletes Undergoing Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome. Am J Sports Med 2020; 48:159-166. [PMID: 31743036 DOI: 10.1177/0363546519885359] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A growing number of studies have examined return to sport in competitive athletes after undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS); however, few have evaluated the rate of achieving meaningful clinical outcomes in this group. PURPOSE To determine if competitive athletes (professional, semiprofessional, or collegiate) have better 2-year patient-reported outcomes and achieve the minimal clinically important difference (MCID) and substantial clinical benefit at higher rates when compared with nonathletes undergoing hip arthroscopy for the treatment of FAIS. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The study was a retrospective analysis of all consecutive patients who identified as either a competitive athlete or a nonathlete and had undergone hip arthroscopy for FAIS by a single fellowship-trained surgeon between January 2012 and April 2017. Patients in the 2 groups were matched 1:2 by age, sex, and body mass index. Baseline and clinical outcomes, including the Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Subscale (HOS-SS), modified Harris Hip Score, and international Hip Outcome Tool-12, were collected preoperatively and at 2 years postoperatively and compared between the groups. The MCID and substantial clinical benefit were calculated for each group separately and compared using chi-square analysis. RESULTS A total of 59 competitive athletes and 118 nonathletes were included in the final analysis. Most of the competitive athletes were soccer players (23.7%), followed by softball players (10.2%) and runners (10.2%). Postoperative score comparison between competitive athletes and nonathletes demonstrated a statistically significant difference in the HOS-SS (mean ± SD, 84.5 ± 19.0 vs 76.1 ± 23.8; P = .02). Meaningful outcome analysis demonstrated that competitive athletes had a higher rate of achieving the HOS-SS threshold for the MCID (97.4% vs 82.5%; P = .021). There was no other difference in frequency of achieving the threshold for any other meaningful clinical outcome between the groups. CONCLUSION Hip arthroscopy for the treatment of FAIS in competitive athletes and nonathletes produced clinically meaningful outcomes in both patient groups. However, competitive athletes achieved the MCID on the HOS-SS at higher rates than nonathletes and had significantly higher scores at 2 years postoperatively on the HOS-SS.
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Affiliation(s)
- Ian M Clapp
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Benedict U Nwachukwu
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Edward C Beck
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Kyleen Jan
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Anirudh K Gowd
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Shane J Nho
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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30
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Wilson KW, Kannan AS, Kopacko M, Vyas D. Rehabilitation and Return to Sport After Hip Arthroscopy. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.oto.2019.100739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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O'Brien LK, Schallmo MS, Stubbs AJ. Return to Sport Following Femoroacetabular Impingement Syndrome. OPER TECHN SPORT MED 2019. [DOI: 10.1053/j.otsm.2019.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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32
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Haeberle HS, Bartschat NI, Navarro SM, Rooney PW, Rosneck J, Westermann RW, Ramkumar PN. Hip Arthroscopy: A Social Media Analysis of Patient Perception. Orthop J Sports Med 2019; 7:2325967119854188. [PMID: 31245432 PMCID: PMC6582302 DOI: 10.1177/2325967119854188] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The rate of hip arthroscopy has increased significantly in recent years, although understanding of patient perception remains limited. Purpose To analyze posts shared on Instagram and Twitter referencing hip arthroscopy to evaluate perspective, tone, timing, content, visibility, and location. Study Design Cross-sectional study; Level of evidence, 3. Methods A search of public posts on Instagram and Twitter was performed over a 1-year period, selected through use of the following hashtags: #hiparthroscopy, #hipscope, and #labralrepair. A total of 1850 Instagram posts and 163 Twitter posts were included in the analysis. A categorical classification system was used for media format (picture or video), perspective (patient, family or friend, physician, hospital or physical therapy group, professional organization, news media, or industry), timing (preoperative, postoperative, nonoperative), perioperative period (within 1 week before or after surgery), tone (positive, negative, or neutral), and content (surgical site, hospital or surgeon, imaging, rehabilitation, activities of daily living (ADLs), return to work, surgical instruments, or education). Post popularity (number of likes) and geographic location were also recorded. Results Of the 1850 Instagram posts analyzed, 91.2% were made by patients, and 52.9% were positive. The most common content included in Instagram posts was rehabilitation, ADLs, and hospital or surgeon. A total of 163 Twitter posts were analyzed, with 59.0% of posts made by physicians. A majority of posts had a positive tone, and the most frequently referenced themes included education, hospital or surgeon, and rehabilitation. Overall, posts originated from 24 different countries. Conclusion The majority of patients who undergo hip arthroscopy have a positive tone when discussing their procedure. Posts commonly focused on rehabilitation, ADLs, hospital or surgeon, and education. This analysis provides insight into patient perspectives toward hip arthroscopy.
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Affiliation(s)
- Heather S Haeberle
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | | | | | - Patrick W Rooney
- Department of Orthopedic Surgery, University of Iowa, Iowa City, Iowa, USA
| | - James Rosneck
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Prem N Ramkumar
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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33
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Ishøi L, Thorborg K, Kraemer O, Hölmich P. The association between specific sports activities and sport performance following hip arthroscopy for femoroacetabular impingement syndrome: A secondary analysis of a cross-sectional cohort study including 184 athletes. J Hip Preserv Surg 2019; 6:124-133. [PMID: 31660197 PMCID: PMC6662959 DOI: 10.1093/jhps/hnz017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 05/05/2019] [Indexed: 12/14/2022] Open
Abstract
The main purpose of this secondary analysis was to compare the proportion of athletes with moderate-to-extreme difficulties in eight specific sport activities in athletes with optimal versus impaired sport performance after a hip arthroscopy for femoroacetabular impingement syndrome. Subjects were identified in a nationwide registry and invited to answer a return to sport and performance questionnaire, and the Copenhagen Hip and Groin Outcome Score Sport subscale investigating difficulties in eight specific sports activities (HAGOS sport items) as; none, mild, moderate, severe or extreme. Subjects were divided into two groups based on sport performance (optimal or impaired). The proportion of athletes with none-to-mild versus moderate-to-extreme difficulties in the eight specific sport activities was compared between groups. The association between difficulties in sport activities and sport performance were investigated using logistic regression analysis. One hundred and eighty-four athletes (31 athletes with optimal and 153 athletes with impaired sport performance) were included at a mean follow-up of 33.1 ± 16.3 months. Up to six athletes (<20%) with optimal sport performance had moderate-to-extreme difficulties in sport activities. Contrary, 43–108 athletes (28.1–70.6%) with impaired performance had moderate-to-extreme difficulties in sport activities. Furthermore, moderate-to-extreme difficulties in HAGOS sport items: ‘running as fast as you can’ and ‘kicking, skating etc.’ increased the odds (14.7 and 6.1 times, respectively) of having impaired sport performance. Many athletes with impaired sport performance reported moderate-to-extreme difficulties in sport activities, specifically moderate-to-extreme difficulties in ‘running as fast as you can’ and ‘kicking, skating etc.’ were associated with patients having impaired sport performance.
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Affiliation(s)
- Lasse Ishøi
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Allé 30, Hvidovre, Denmark and
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Allé 30, Hvidovre, Denmark and.,Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Department of Orthopaedic Surgery and Physical Therapy, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Allé 30, Hvidovre, Denmark
| | - Otto Kraemer
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Allé 30, Hvidovre, Denmark and
| | - Per Hölmich
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Allé 30, Hvidovre, Denmark and
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Rosinsky PJ, Chen SL, Domb BG. Editorial Commentary: Returning to High-Impact Sports After Hip Arthroscopy: Are We Shooting Ourselves in the Hip? Arthroscopy 2019; 35:1429-1431. [PMID: 31054722 DOI: 10.1016/j.arthro.2019.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/07/2019] [Indexed: 02/02/2023]
Abstract
There is a clear consensus in the literature that professional athletes exhibit high rates of return to sport following hip arthroscopy. As orthopaedic surgeons, we are well equipped to guide athletes back to the field after intra-articular hip injuries. However, returning to high-impact sports and playing through the pain can have implications on long-term health. Literature suggests that former elite athletes are at greater risk for reinjury and developing hip osteoarthritis compared with non-athletes. While it is incumbent upon us as orthopaedic surgeons to inform and advise our patients regarding the long-term consequences of return to sport after a hip injury, we recognize and enthusiastically support the passion that many athletes feel for the game and the vast benefits that they can derive from returning to the sport they love.
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Sahota S, Kelly B. Editorial Commentary: Hip Arthroscopy in the Professional Athlete…Back in the Game. Arthroscopy 2019; 35:843-844. [PMID: 30827437 DOI: 10.1016/j.arthro.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 12/19/2018] [Accepted: 01/02/2019] [Indexed: 02/02/2023]
Abstract
With improved outcomes and expanding indications, the rate of hip arthroscopy for treatment of numerous pathologies has increased. There is significant interest from patients and providers alike regarding return to meaningful play after surgical intervention, particularly for the professional athlete. Although each athlete and each sport have unique obstacles, the literature suggests hip arthroscopy has a high success rate and allows for elite athletes to return to play without significant differences in postoperative performance scores.
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