Characteristics of Soccer Players Undergoing Primary Hip Arthroscopy for Femoroacetabular Impingement: A Sex- and Competitive Level-Specific Analysis

Self-Reported Level of Sports Compared With Objective Data in Athletes With Femoroacetabular Impingement Syndrome

BACKGROUND

Femoroacetabular impingement syndrome (FAIS) is common among ice hockey and soccer players. To evaluate the prevalence of return to sports after hip arthroscopy or level of sports before surgery, self-reported questionnaires such as the Hip Sports Activity Scale (HSAS) are frequently used. There is a risk of self-reporting bias when using these tools.

PURPOSE

To evaluate how self-reported levels of sports using HSAS correspond to objective data.

STUDY DESIGN

Cohort study, Level of evidence: 3.

METHOD

Ice hockey and soccer players undergoing hip arthroscopy for FAIS between 2011 and 2019 and included in the local hip arthroscopy registry in Gothenburg, Sweden, aged ≥18 years at the time of surgery, with a self-reported HSAS level of 7 or 8 before onset of symptoms, were included. Objective data on level of sports were collected through sports-specific sources (https://football.instatscout.com, https://hockey.instatscout.com, https://www.eliteprospects.com, and Swedish Football Association). Objective data were collected for the corresponding season when the athletes reported their symptom onset. Agreement between subjective and objective data was described using descriptive statistics, and comparison between subgroups was made.

RESULTS

A total of 483 athletes met the inclusion criteria: 80 ice hockey and 403 soccer players. The majority were men (90%). The mean age was 26.5 years (SD, 8.3 years). When comparing HSAS level with objective data, 112 athletes (23%) had a correct self-reported HSAS level. Of 251 athletes with a self-reported HSAS level of 8, 76 (30%) had a matching objective HSAS level, and 36 of 232 (16%) athletes with a self-reported HSAS level of 7 had a matching objective HSAS level. Of the erroneous subjective ratings, 98% were higher than the objective data. Athletes reporting a correct HSAS level were younger (24.6 vs 26.4 years; P = .04) and had a shorter symptom duration (18 vs 24 months; P < .001). Ice hockey players scored themselves correctly more often than soccer players (P < .001).

CONCLUSION

Only 23% of athletes undergoing hip arthroscopy for FAIS self-reported an HSAS level before onset of symptoms that was accurate according to the objectively recorded data. The majority self-reported an HSAS level above their correct level of sports. Ice hockey players, younger age, and shorter symptom duration were associated with correct self-assessment.

Sex-Based Differences in Prevalence, Outcomes, and Complications of Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review and Meta-analysis

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.

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

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.

Hip Pain and Movement Dysfunction Associated With Nonarthritic Hip Joint Pain: A Revision

The Academy of Orthopaedic Physical Therapy (AOPT), formerly the Orthopaedic Section of the American Physical Therapy Association (APTA), has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). This is an update to the 2014 Clinical Practice Guideline (CPG) for Hip Pain and Movement Dysfunction Associated with Nonarthritic Hip Joint Pain. The goals of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. This current CPG covers pathoanatomical features, clinical course, prognosis, diagnosis, examination, and physical therapy interventions in the management of nonarthritic hip joint pain. J Orthop Sports Phys Ther 2023;53(7):CPG1-CPG70. doi:10.2519/jospt.2023.0302.

High-level soccer players have a low rate of return to performance after hip arthroscopy for femoroacetabular impingement syndrome

PURPOSE

Femoroacetabular impingement syndrome (FAIS) is a known cause of impaired sports performance in athletes and the relationship between FAIS and soccer players has previously been described. Hip arthroscopy is a viable treatment option that can facilitate athletes' return to sport (RTS). The aim of this study was to evaluate the RTS and return to performance (RTP) with objective measurements in high-level soccer players after hip arthroscopy for FAIS.

METHOD

Soccer players, with a hip sports activity scale (HSAS) level of 7 or 8 before symptom onset and undergoing hip arthroscopy for FAIS between 2011 and 2019 were identified in the Gothenburg hip arthroscopic registry. A total of 83 high-level soccer players, with a mean age of 23.9 (SD 4.4) years at surgery, were included. To verify the activity level and further stratify players as elite or sub-elite, player statistics were collected from soccer-specific scout webpages and the Swedish national soccer association. The return to sport was defined as return to one game of soccer. Return to performance was defined as playing at the same level, or higher, and participating in at least 80% of the number of games played the season before symptom onset or the season before surgery either the first or second season after hip arthroscopy.

RESULTS

In total, 71 (85.5%, 95% confidence interval (CI) 76.1-92.3%) of the players returned to sport the first or second season after surgery. Compared to the season before symptom onset, 31 (37.3%, 95% CI 27.0-48.7%) players returned to performance the first or second season after surgery, and 32 (38.6%, 95% CI 28.1-49.9%) players returned to performance the first or second season after surgery compared to the season before surgery.

CONCLUSION

A high rate of elite and sub-elite soccer players return to soccer after hip arthroscopy for FAIS. However, less than half of the players RTP when evaluating performance through level of play and number of games played.

LEVEL OF EVIDENCE

Level IV.

Arthroscopic resection as a rapid recovery treatment for Os acetabuli in soccer players who had undergone hip arthroscopy: a case series with 1-year follow-up

INTRODUCTION

Os acetabuli (OSA) is defined as a radiopaque structure located around the acetabular rim highly related to Femoroacetabular Impingement (FAI). Its treatment depends on the perspective of post-surgical joint instability. Ossicle resection is recommended if the femoral head is covered enough by the labrum. Previous research has described the results of this technique in general population. The aim of this study is to describe the outcomes and the time and rate of return to play (RTP) after hip arthroscopy and OSA removal in soccer players.

METHODS

This study is a retrospective analysis of a prospective database containing all the consecutive soccer players who had undergone hip arthroscopy between 2018 and 2019. The subjects diagnosed with OSA and a center-edge angle (CEA) > 25 ° were included in the analysis. All the patients were treated with arthroscopic removal of the OSA and femoral osteoplasty. Hip function was assessed using the Modified Harris Hip Score (MHHS) before and at 3 and 12 months after surgery. Rate of RTP and competitive level at RTP were assessed at a 1-year follow-up.

RESULTS

Between 2018 and 2019, 90 soccer players were treated with hip arthroscopy in our facilities. Six of them (6.6%) were diagnosed with OSA. Mean (SD) MHHS values were 69.7 (12.1) before the surgery, 89.7 (6.7) at 3 months post-surgery and 95.7 (5.1) at 12 months post-surgery. All the subjects reported significant improvements in their MHHS scores at 3 and 12 months post-surgery compared with pre-surgery levels (p < 0.01). Non-significant differences were found between 3 and 12 months post-surgery (p > 0.05). All the subjects (100%) returned to previous competitive levels.

CONCLUSIONS

After surgery, all the soccer players returned to previous competitive level. Preoperative MHHS improved significantly at 3 months maintained for up to 12 months.