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Current Reviews in Musculoskeletal Medicine

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01-08-2020 | Hip Arthroscopy | Outcomes Research in Orthopedics (O Ayeni, Section Editor)

Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: a Comprehensive Review of Qualitative Considerations

Authors: Sebastian J. Ko, Michael A. Terry, Vehniah K. Tjong

Published in: Current Reviews in Musculoskeletal Medicine | Issue 4/2020

Abstract

Purpose of Review

Arthroscopic hip surgery for femoroacetabular impingement syndrome has evolved over time and has resulted in significantly improved clinical outcomes. These outcomes can be measured by clinical and radiographic metrics. Return to sport is commonly used as an outcome measure, not only in terms of overall rate but also type of sport, level of competition, and timing of return, as its quantitative definition continues to develop. Qualitative research methods can highlight the patient-derived themes that affect an athlete’s individual return to sport pathway, and can augment the existing methods of outcome reporting. We will specifically review the qualitative research that has been performed on evaluating return to sport after arthroscopic hip surgery for femoroacetabular impingement syndrome.

Recent Findings

Current evidence finds a high overall rate of return to sport at 87–93% after arthroscopic hip surgery for femoroacetabular impingement syndrome. The available qualitative research in this body of literature, which is limited, has found three main overarching themes behind athletes’ decision and ability, or inability, to return to sport: self-efficacy, social support, and resetting expectations.

Summary

Athletes experience high rates of return to sport and athletic performance after arthroscopic hip surgery for femoroacetabular impingement syndrome. This review highlights the qualitative considerations for these athletes in their overall readiness to return to sport, and its utility for treating physicians as we interact with these athletes both pre- and post-operatively. Further research is required to elucidate any further overarching themes that may be prevalent in different levels of competition.

•• Griffin DR, Dickenson EJ, O’Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016;50(19):1169–76. https://doi.org/10.1136/bjsports-2016-096743Consensus statement from an international panel of 22 expert clinicians and academics regarding the key terminology, diagnosis, and treatment related to FAIS. CrossRefPubMed

Byrd JWT. Femoroacetabular impingement in athletes, part 1. Sport Heal A Multidiscip Approach. 2010;2(4):321–33. https://doi.org/10.1177/1941738110368392.CrossRef

Zadpoor AA. Etiology of femoroacetabular impingement in athletes: a review of recent findings. Sport Med. 2015;45(8):1097–106. https://doi.org/10.1007/s40279-015-0339-2.CrossRef

Philippon MJ, Schenker ML. Arthroscopy for the treatment of femoroacetabular impingement in the athlete. Clin Sports Med. 2006;25(2):299–308. https://doi.org/10.1016/j.csm.2005.12.006.CrossRefPubMed

Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H. Clinical presentation of patients with symptomatic anterior hip impingement. In: Clinical Orthopaedics and Related Research. Vol 467. Springer New York. 2009, pp 638–644. https://doi.org/10.1007/s11999-008-0680-y

Pennock AT, Bomar JD, Johnson KP, Randich K, Upasani VV. Nonoperative management of femoroacetabular impingement: a prospective study. Am J Sports Med. 2018;46(14):3415–22. https://doi.org/10.1177/0363546518804805.CrossRefPubMed

Sogbein OA, Shah A, Kay J, Memon M, Simunovic N, Belzile EL, et al. Predictors of outcomes after hip arthroscopic surgery for femoroacetabular impingement: a systematic review. Orthop J Sport Med. 2019;7(6):2325967119848982. https://doi.org/10.1177/2325967119848982.CrossRef

Khan W, Khan M, Alradwan H, Williams R, Simunovic N, Ayeni OR. Utility of intra-articular hip injections for Femoroacetabular impingement: a systematic review. Orthop J Sport Med. 2015;3(9):2325967115601030. https://doi.org/10.1177/2325967115601030.CrossRef

Nwachukwu BU, Rebolledo BJ, McCormick F, Rosas S, Harris JD, Kelly BT. Arthroscopic versus open treatment of femoroacetabular impingement: a systematic review of medium- to long-term outcomes. Am J Sports Med. 2016;44(4):1062–8. https://doi.org/10.1177/0363546515587719.CrossRefPubMed

10.

McCarthy JC, Jarrett BT, Ojeifo O, Lee JA, Bragdon CR. What factors influence long-term survivorship after hip arthroscopy? Clin Orthop Relat Res. 2011;469(2):362–71. https://doi.org/10.1007/s11999-010-1559-2.CrossRefPubMed

11.

Gohal C, Shamshoon S, Memon M, Kay J, Simunovic N, Randelli F, et al. Health-related quality of life after hip arthroscopy for femoroacetabular impingement: a systematic review and meta-analysis. Sports Health. 2019;11(3):209–17. https://doi.org/10.1177/1941738119838799.CrossRefPubMedPubMedCentral

12.

de Sa D, Lian J, Sheean AJ, et al. A systematic summary of systematic reviews on the topic of hip arthroscopic surgery. Orthop J Sport Med. 2018;6(9):1–12. https://doi.org/10.1177/2325967118796222.CrossRef

13.

Tjong VK, Gombera MM, Kahlenberg CA, Patel RM, Han B, Deshmane P, et al. Isolated acetabuloplasty and Labral repair for combined-type femoroacetabular impingement: are we doing too much? Arthrosc - J Arthrosc Relat Surg. 2017;33(4):773–9. https://doi.org/10.1016/j.arthro.2016.10.022.CrossRef

14.

Nho SJ, Magennis EM, Singh CK, Kelly BT. Outcomes after the arthroscopic treatment of femoroacetabular impingement in a mixed group of high-level athletes. Am J Sports Med. 2011;39(1_suppl):14–9. https://doi.org/10.1177/0363546511401900.CrossRef

15.

Philippon MJ, Weiss DR, Kuppersmith DA, Briggs KK, Hay CJ. Arthroscopic labral repair and treatment of femoroacetabular impingement in professional hockey players. Am J Sports Med. 2010;38(1):99–104. https://doi.org/10.1177/0363546509346393.CrossRefPubMed

16.

Byrd JWT, Jones KS. Hip arthroscopy in athletes: 10-year follow-up. Am J Sports Med. 2009;37(11):2140–3. https://doi.org/10.1177/0363546509337705.CrossRefPubMed

17.

Amenabar T, O’Donnell J. Return to sport in Australian football league footballers after hip arthroscopy and midterm outcome. Arthrosc - J Arthrosc Relat Surg. 2013;29(7):1188–94. https://doi.org/10.1016/j.arthro.2013.05.001.CrossRef

18.

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(1):159–66. https://doi.org/10.1177/0363546519885359.CrossRefPubMed

19.

Bedi A, Chen N, Robertson W, Kelly BT. The management of labral tears and femoroacetabular impingement of the hip in the young, active patient. Arthrosc - J Arthrosc Relat Surg. 2008;24(10):1135–45. https://doi.org/10.1016/j.arthro.2008.06.001.CrossRef

20.

Horner NS, Ekhtiari S, Simunovic N, Safran MR, Philippon MJ, Ayeni OR. Hip arthroscopy in patients age 40 or older: a systematic review. Arthrosc - J Arthrosc Relat Surg. 2017;33(2):464–475.e3. https://doi.org/10.1016/j.arthro.2016.06.044.CrossRef

21.

Minkara AA, Westermann RW, Rosneck J, Lynch TS. Systematic review and meta-analysis of outcomes after hip arthroscopy in femoroacetabular impingement. Am J Sports Med. 2019;47(2):488–500. https://doi.org/10.1177/0363546517749475.CrossRefPubMed

22.

Bhatia S, Briggs K, Philippon M, Soares E. Post-operative alpha angle not associated with outcomes 5 years following hip arthroscopy for FAI. Arthrosc J Arthrosc Relat Surg. 2016;32(6):e12–3. https://doi.org/10.1016/j.arthro.2016.03.060.CrossRef

23.

Domb BG, Gui C, Lodhia P. How much arthritis is too much for hip arthroscopy: a systematic review. Arthroscopy. 2015;31(3):520–9. https://doi.org/10.1016/j.arthro.2014.11.008.CrossRefPubMed

24.

Gomberawalla MM, Kelly BT, Bedi A. Interventions for hip pain in the maturing athlete: the role of hip arthroscopy? Sports Health. 2014;6(1):70–7. https://doi.org/10.1177/1941738113497678.CrossRefPubMedPubMedCentral

25.

Shah A, Kay J, Memon M, et al. Clinical and radiographic predictors of failed hip arthroscopy in the management of dysplasia: a systematic review and proposal for classification. Knee Surg Sport Traumatol Arthrosc. 2019;0(0):0. https://doi.org/10.1007/s00167-019-05416-3

26.

Byrd JWT, Jones KS, Bardowski EA. Influence of Tönnis grade on outcomes of arthroscopy for FAI in athletes: a comparative analysis. J Hip Preserv Surg. 2018;5(2):162–5. https://doi.org/10.1093/JHPS/HNY011.CrossRefPubMedPubMedCentral

27.

Ishøi L, Thorborg K, Kraemer O, Hölmich P. Return to sport and performance after hip arthroscopy for femoroacetabular impingement in 18- to 30-year-old athletes: a cross-sectional cohort study of 189 athletes. Am J Sports Med. 2018;46(11):2578–87. https://doi.org/10.1177/0363546518789070.CrossRefPubMed

28.

Wörner T, Thorborg K, Stålman A, Webster KE, Momatz Olsson H, Eek F. High or low return to sport rates following hip arthroscopy is a matter of definition? Br J Sports Med. 2018;52(22):1475–6. https://doi.org/10.1136/bjsports-2018-099154.CrossRefPubMed

29.

•• Ardern CL, Glasgow P, Schneiders A, et al. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy. Bern. Br J Sports Med. 2016;50(14):853–64. https://doi.org/10.1136/bjsports-2016-096278Consensus statement from an international panel of 17 expert clinicians and academics regarding the decision-making for return to sport and how it is currently seen as a continuum, as opposed to a binary outcome. CrossRefPubMed

30.

Malterud K. Qualitative research: standards, challenges, and guidelines. Lancet. 2001;358(9280):483–8. https://doi.org/10.1016/S0140-6736(01)05627-6.CrossRefPubMed

31.

Marshall MN. Sampling for qualitative research. Fam Pract. 1996;13(6):522–5. https://doi.org/10.1093/fampra/13.6.522.CrossRefPubMed

32.

Clement D, Arvinen-Barrow M, Fetty T. Psychosocial responses during different phases of sport-injury rehabilitation: a qualitative study. J Athl Train. 2015;50(1):95–104. https://doi.org/10.4085/1062-6050-49.3.52.CrossRefPubMedPubMedCentral

33.

Ardern CL, Österberg A, Tagesson S, Gauffin H, Webster KE, Kvist J. The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction. Br J Sports Med. 2014;48(22):1613–9. https://doi.org/10.1136/bjsports-2014-093842.CrossRefPubMed

34.

Tjong VK, Murnaghan ML, Nyhof-Young JM, Ogilvie-Harris DJ. A qualitative investigation of the decision to return to sport after anterior cruciate ligament reconstruction: to play or not to play. Am J Sports Med. 2014;42(2):336–42. https://doi.org/10.1177/0363546513508762.CrossRefPubMed

35.

Tjong VK, Devitt BM, Murnaghan ML, Ogilvie-Harris DJ, Theodoropoulos JS. A qualitative investigation of return to sport after arthroscopic Bankart repair: beyond stability. Am J Sports Med. 2015;43(8):2005–11. https://doi.org/10.1177/0363546515590222.CrossRefPubMed

36.

Christino MA, Fantry AJ, Vopat BG. Psychological aspects of recovery following anterior cruciate ligament reconstruction. J Am Acad Orthop Surg. 2015;23(8):501–9. https://doi.org/10.5435/JAAOS-D-14-00173.CrossRefPubMed

37.

•• Tjong VK, Cogan CJ, Riederman BD, Terry MA. A qualitative assessment of return to sport after hip arthroscopy for femoroacetabular impingement. Orthop J Sport Med. 2016;4(11):1–7. https://doi.org/10.1177/2325967116671940First salient article using qualitative methods to assess return to sport in athletes after arthroscopic hip surgery for FAIS. This research found three overarching themes directly correlating with return to sport: self efficacy, social support, and resetting expectations. CrossRef

38.

Mitchell I, Evans L, Rees T, Hardy L. Stressors, social support, and tests of the buffering hypothesis: effects on psychological responses of injured athletes. Br J Health Psychol. 2014;19(3):486–508. https://doi.org/10.1111/bjhp.12046.CrossRefPubMed

39.

Chmielewski TL, Hurd WJ, Snyder-Mackler L. Elucidation of a potentially destabilizing control strategy in ACL deficient non-copers. J Electromyogr Kinesiol. 2005;15(1):83–92. https://doi.org/10.1016/j.jelekin.2004.07.003XY.CrossRefPubMed

40.

Kaplan Y. Identifying individuals with an anterior cruciate ligament-deficient knee as copers and noncopers: a narrative literature review. J Orthop Sports Phys Ther. 2011;41(10):758–66. https://doi.org/10.2519/jospt.2011.3384.CrossRefPubMed

41.

Schilaty ND, Nagelli C, Hewett TE. Use of objective neurocognitive measures to assess the psychological states that influence return to sport following injury. Sport Med. 2016;46(3):299–303. https://doi.org/10.1007/s40279-015-0435-3.CrossRef

42.

Podlog L, Eklund RC. Returning to competition after a serious injury: the role of self-determination. J Sports Sci. 2010;28(8):819–31. https://doi.org/10.1080/02640411003792729.CrossRefPubMed

43.

Stone AV, Malloy P, Beck EC, Neal WH, Waterman BR, Bush-Joseph CA, et al. Predictors of persistent postoperative pain at minimum 2 years after arthroscopic treatment of femoroacetabular impingement. Am J Sports Med. 2019;47(3):552–9. https://doi.org/10.1177/0363546518817538.CrossRefPubMed

44.

O’Connor M, Minkara AA, Westermann RW, Rosneck J, Lynch TS. Return to play after hip arthroscopy: a systematic review and meta-analysis. Am J Sports Med. 2018;46(11):2780–8. https://doi.org/10.1177/0363546518759731.CrossRefPubMed

Title: Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: a Comprehensive Review of Qualitative Considerations
Authors: Sebastian J. Ko
Michael A. Terry
Vehniah K. Tjong
Publication date: 01-08-2020
Publisher: Springer US
Keywords: Hip Arthroscopy
Impingement Syndromes
Published in: Current Reviews in Musculoskeletal Medicine / Issue 4/2020
Electronic ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-020-09634-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: a Comprehensive Review of Qualitative Considerations

Abstract

Purpose of Review

Recent Findings

Summary

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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