Top

Current Reviews in Musculoskeletal Medicine

Published in:

01-06-2020 | Hip Arthroscopy | Outcomes Research in Orthopedics (O Ayeni, Section Editor)

Return to Sport After Femoroacetabular Impingement Surgery and Sport-Specific Considerations: a Comprehensive Review

Authors: Kevin C. Parvaresh, Daniel Wichman, Jonathan Rasio, Shane J. Nho

Published in: Current Reviews in Musculoskeletal Medicine | Issue 3/2020

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.

Summary

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.

•• 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 on femoroacetabular impingement syndrome (FAI). This statement is an international agreement regarding the key terminology, diagnosis, and treatment related to FAI. CrossRefPubMed

Frank JM, Harris JD, Erickson BJ, et al. Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: a systematic review. Arthrosc J Arthrosc Relat Surg. 2015;31(6):1199–204. https://doi.org/10.1016/j.arthro.2014.11.042.CrossRef

Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H. Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthop. 2009;467(3):638–44. https://doi.org/10.1007/s11999-008-0680-y.CrossRefPubMedPubMedCentral

Reiman MP, Goode AP, Cook CE, Hölmich P, Thorborg K. Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis. Br J Sports Med. 2015;49(12):811. https://doi.org/10.1136/bjsports-2014-094302.CrossRefPubMed

Clohisy JC, Carlisle JC, Beaulé PE, Kim YJ, Trousdale RT, Sierra RJ, et al. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am. 2008;90(Suppl 4):47–66. https://doi.org/10.2106/JBJS.H.00756.CrossRefPubMedPubMedCentral

Albers CE, Wambeek N, Hanke MS, Schmaranzer F, Prosser GH, Yates PJ. Imaging of femoroacetabular impingement-current concepts. J Hip Preserv Surg. 2016;3(4):245–61. https://doi.org/10.1093/jhps/hnw035.CrossRefPubMedPubMedCentral

Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock K. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop. 2003;417:112–20. https://doi.org/10.1097/01.blo.0000096804.78689.c2.CrossRef

Pfirrmann CWA, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology. 2006;240(3):778–85. https://doi.org/10.1148/radiol.2403050767.CrossRefPubMed

Kuhns BD, Weber AE, Levy DM, Wuerz TH. The natural history of femoroacetabular impingement. Front Surg. 2015;2. https://doi.org/10.3389/fsurg.2015.00058.

10.

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

11.

•• 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 on return to sport after injury. This statement is an international agreement regarding the decision making for return to sport and cognization of return to sport as a continuum, paralleled with recovery and rehabilitation. CrossRefPubMed

12.

Nawabi DH, Bedi A, Tibor LM, Magennis E, Kelly BT. The demographic characteristics of high-level and recreational athletes undergoing hip arthroscopy for femoroacetabular impingement: a sports-specific analysis. Arthrosc J Arthrosc Relat Surg. 2014;30(3):398–405. https://doi.org/10.1016/j.arthro.2013.12.010.CrossRef

13.

Naal FD, Miozzari HH, Kelly BT, Magennis EM, Leunig M, Noetzli HP. The Hip Sports Activity Scale (HSAS) for patients with femoroacetabular impingement. Hip Int J Clin Exp Res Hip Pathol Ther. 2013;23(2):204–11. https://doi.org/10.5301/hipint.5000006.CrossRef

14.

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 Sports Med. 2015;3(9):2325967115601030. https://doi.org/10.1177/2325967115601030.CrossRefPubMedPubMedCentral

15.

Wall PDH, Fernandez M, Griffin DR, Foster NE. Nonoperative treatment for femoroacetabular impingement: a systematic review of the literature. PM R. 2013;5(5):418–26. https://doi.org/10.1016/j.pmrj.2013.02.005.CrossRefPubMed

16.

Griffin DR, Dickenson EJ, Wall PDH, Achana F, Donovan JL, Griffin J, et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet Lond Engl. 2018;391(10136):2225–35. https://doi.org/10.1016/S0140-6736(18)31202-9.CrossRef

17.

Mansell NS, Rhon DI, Meyer J, Slevin JM, Marchant BG. Arthroscopic surgery or physical therapy for patients with femoroacetabular impingement syndrome: a randomized controlled trial with 2-year follow-up. Am J Sports Med. 2018;46(6):1306–14. https://doi.org/10.1177/0363546517751912.CrossRefPubMed

18.

• 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/10.1177/0363546518804805Prospective study evaluating the effect of nonoperative management for the treatment of FAI in a young athletic cohort. A majority of patients, 82%, could be managed nonoperatively with similar outcomes at 2 years. This demonstrated that nonoperative management should be first-line therapy in young athletic patients with symptomatic FAI. CrossRefPubMed

19.

Espinosa N, Beck M, Rothenfluh DA, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. Surgical technique. J Bone Joint Surg Am. 2007;89(Suppl 2 Pt.1):36–53. https://doi.org/10.2106/JBJS.F.01123.CrossRefPubMed

20.

Laude F, Sariali E, Nogier A. Femoroacetabular impingement treatment using arthroscopy and anterior approach. Clin Orthop. 2009;467(3):747–52. https://doi.org/10.1007/s11999-008-0656-y.CrossRefPubMed

21.

Matsuda DK, Carlisle JC, Arthurs SC, Wierks CH, Philippon MJ. Comparative systematic review of the open dislocation, mini-open, and arthroscopic surgeries for femoroacetabular impingement. Arthrosc J Arthrosc Relat Surg. 2011;27(2):252–69. https://doi.org/10.1016/j.arthro.2010.09.011.CrossRef

22.

• Reiman MP, Peters S, Sylvain J, Hagymasi S, Mather RC, Goode AP. Femoroacetabular impingement surgery allows 74% of athletes to return to the same competitive level of sports participation but their level of performance remains unreported: a systematic review with meta-analysis. Br J Sports Med. 2018;52(15):972–81. https://doi.org/10.1136/bjsports-2017-098696Systematic review of 35 studies on return to sport following surgery in patients with FAI. Few studies (37%) clearly distinguished return to sport and return to sport to preinjury level. This makes it impossible to clearly state whether surgery for symptomatic FAI will return patients to pre-injury sport performance. CrossRefPubMed

23.

Memon M, Kay J, Hache P, Simunovic N, Harris JD, O’Donnell J, et al. Athletes experience a high rate of return to sport following hip arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2019;27(10):3066–104. https://doi.org/10.1007/s00167-018-4929-z.CrossRefPubMed

24.

Casartelli NC, Leunig M, Maffiuletti NA, Bizzini M. Return to sport after hip surgery for femoroacetabular impingement: a systematic review. Br J Sports Med. 2015;49(12):819–24. https://doi.org/10.1136/bjsports-2014-094414.CrossRefPubMed

25.

Kuhns BD, Weber AE, Batko B, Nho SJ, Stegemann C. A four-phase physical therapy regimen for returning athletes to sport following hip arthroscopy for femoroacetabular impingement with routine capsular closure. Int J Sports Phys Ther. 2017;12(4):683–96.PubMedPubMedCentral

26.

Hallberg S, Sansone M, Augustsson J. Full recovery of hip muscle strength is not achieved at return to sports in patients with femoroacetabular impingement surgery. Knee Surg Sports Traumatol Arthrosc. 2018:1–7. https://doi.org/10.1007/s00167-018-5337-0.CrossRefPubMedPubMedCentral

27.

Weber AE, Kuhns BD, Cvetanovich GL, Grzybowski JS, Salata MJ, Nho SJ. Amateur and recreational athletes return to sport at a high rate following hip arthroscopy for femoroacetabular impingement. Arthrosc J Arthrosc Relat Surg. 2017;33(4):748–55. https://doi.org/10.1016/j.arthro.2016.10.015.CrossRef

28.

Levy DM, Kuhns BD, Frank RM, Grzybowski JS, Campbell KA, Brown S, et al. High rate of return to running for athletes after hip arthroscopy for the treatment of femoroacetabular impingement and capsular plication. Am J Sports Med. 2017;45(1):127–34. https://doi.org/10.1177/0363546516664883.CrossRefPubMed

29.

Siebenrock KA, Ferner F, Noble PC, Santore RF, Werlen S, Mamisch TC. The cam-type deformity of the proximal femur arises in childhood in response to vigorous sporting activity. Clin Orthop. 2011;469(11):3229–40. https://doi.org/10.1007/s11999-011-1945-4.CrossRefPubMedPubMedCentral

30.

Harris JD, Gerrie BJ, Varner KE, Lintner DM, McCulloch PC. Radiographic prevalence of dysplasia, cam, and pincer deformities in elite ballet. Am J Sports Med. 2016;44(1):20–7. https://doi.org/10.1177/0363546515601996.CrossRefPubMed

31.

Gerhardt MB, Romero AA, Silvers HJ, Harris DJ, Watanabe D, Mandelbaum BR. The prevalence of radiographic hip abnormalities in elite soccer players. Am J Sports Med. 2012;40(3):584–8. https://doi.org/10.1177/0363546511432711.CrossRefPubMed

32.

Kapron AL, Peters CL, Aoki SK, Beckmann JT, Erickson JA, Anderson MB, et al. The prevalence of radiographic findings of structural hip deformities in female collegiate athletes. Am J Sports Med. 2015;43(6):1324–30. https://doi.org/10.1177/0363546515576908.CrossRefPubMed

33.

Locks R, Utsunomiya H, Briggs KK, McNamara S, Chahla J, Philippon MJ. Return to play after hip arthroscopic surgery for femoroacetabular impingement in professional soccer players. Am J Sports Med. 2018;46(2):273–9. https://doi.org/10.1177/0363546517738741.CrossRefPubMed

34.

Chahla J, Sherman B, Philippon MJ, Gerhardt M. Hip injuries in kicking athletes. Oper Tech Sports Med. 2019;27(3):138–44. https://doi.org/10.1053/j.otsm.2019.04.006.CrossRef

35.

Begly JP, Buckley PS, Utsunomiya H, Briggs KK, Philippon MJ. Femoroacetabular impingement in professional basketball players: return to play, career length, and performance after hip arthroscopy. Am J Sports Med. 2018;46(13):3090–6. https://doi.org/10.1177/0363546518801320.CrossRefPubMed

36.

Klingenstein GG, Martin R, Kivlan B, Kelly BT. Hip injuries in the overhead athlete. Clin Orthop. 2012;470(6):1579–85. https://doi.org/10.1007/s11999-012-2245-3.CrossRefPubMedPubMedCentral

37.

Frank RM, Ukwuani G, Allison B, Clapp I, Nho SJ. High rate of return to yoga for athletes after hip arthroscopy for femoroacetabular impingement syndrome. Sports Health. 2018;10(5):434–40. https://doi.org/10.1177/1941738118757406.CrossRefPubMedPubMedCentral

38.

Nwachukwu BU, Bedi A, Premkumar A, Draovitch P, Kelly BT. Characteristics and outcomes of arthroscopic femoroacetabular impingement surgery in the National Football League. Am J Sports Med. 2018;46(1):144–8. https://doi.org/10.1177/0363546517729163.CrossRefPubMed

39.

Menge TJ, Bhatia S, McNamara SC, Briggs KK, Philippon MJ. Femoroacetabular impingement in professional football players: return to play and predictors of career length after hip arthroscopy. Am J Sports Med. 2017;45(8):1740–4. https://doi.org/10.1177/0363546517700118.CrossRefPubMed

40.

Schallmo MS, Fitzpatrick TH, Yancey HB, Marquez-Lara A, Luo TD, Stubbs AJ. Return-to-play and performance outcomes of professional athletes in North America after hip arthroscopy from 1999 to 2016. Am J Sports Med. 2018;46(8):1959–69. https://doi.org/10.1177/0363546518773080.CrossRefPubMed

41.

Boykin RE, McFeely ED, Ackerman KE, Yen Y-M, Nasreddine A, Kocher MS. Labral injuries of the hip in rowers. Clin Orthop. 2013;471(8):2517–22. https://doi.org/10.1007/s11999-013-3109-1.CrossRefPubMedPubMedCentral

42.

Byrd JWT, Jones KS. Hip arthroscopy in high-level baseball players. Arthrosc J Arthrosc Relat Surg. 2015;31(8):1507–10. https://doi.org/10.1016/j.arthro.2015.03.002.CrossRef

43.

Jack RA, Sochacki KR, Hirase T, Vickery J, McCulloch P, Lintner DM, et al. Performance and return to sport after hip arthroscopic surgery in Major League Baseball players. Orthop J Sports Med. 2019;7(2):2325967119825835. https://doi.org/10.1177/2325967119825835.CrossRefPubMedPubMedCentral

44.

Newman JT, Saroki AJ, Briggs KK, Philippon MJ. Return to elite level of play and performance in professional golfers after arthroscopic hip surgery. Orthop J Sports Med. 2016;4(4):2325967116643532. https://doi.org/10.1177/2325967116643532.CrossRefPubMedPubMedCentral

45.

Stone AV, Beck EC, Nho SJ. Hip injuries in endurance athletes: the runner and cyclist. Oper Tech Sports Med. 2019;27(3):119–22. https://doi.org/10.1053/j.otsm.2019.04.003.CrossRef

46.

Chen AW, Craig MJ, Yuen LC, Ortiz-Declet V, Maldonado DR, Domb BG. Five-year outcomes and return to sport of runners undergoing hip arthroscopy for labral tears with or without femoroacetabular impingement. Am J Sports Med. 2019;47(6):1459–66. https://doi.org/10.1177/0363546519836429.CrossRefPubMed

47.

Frank RM, Ukwuani G, Clapp I, Chahla J, Nho SJ. High rate of return to cycling after hip arthroscopy for femoroacetabular impingement syndrome. Sports Health. 2018;10(3):259–65. https://doi.org/10.1177/1941738117747851.CrossRefPubMed

48.

Frank RM, Ukwuani G, Chahla J, Batko B, Bush-Joseph CA, Nho SJ. High rate of return to swimming after hip arthroscopy for femoroacetabular impingement. Arthrosc J Arthrosc Relat Surg. 2018;34(5):1471–7. https://doi.org/10.1016/j.arthro.2017.11.030.CrossRef

49.

Riff AJ, Ukwuani G, Clapp I, Movassaghi K, Kelly DM, Nho SJ. High rate of return to high-intensity interval training after arthroscopic management of femoroacetabular impingement syndrome. Am J Sports Med. 2018;46(11):2594–600. https://doi.org/10.1177/0363546518776638.CrossRefPubMed

50.

• Litrenta J, Mu B, Ortiz-Declet V, et al. Hip arthroscopy successfully treats femoroacetabular impingement in adolescent athletes. J Pediatr Orthop. 2019. https://doi.org/10.1097/BPO.0000000000001411Retrospective review of young athletic patients treated arthroscopically for symptomatic FAI with high rate of follow-up at 2 years. Most patients (84%) returned to sport by 2 years post-operatively with 76.5% reported a similar level of competitive ability as one year before surgery. CrossRefPubMed

51.

Gwathmey FW, Lewis D. Femoroacetabular impingement in the adolescent athlete. Oper Tech Sports Med. 2019;27(3):152–8. https://doi.org/10.1053/j.otsm.2019.04.008.CrossRef

52.

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(2):124–33. https://doi.org/10.1093/jhps/hnz017.CrossRefPubMedPubMedCentral

53.

• Lovett-Carter D, Jawanda AS, Hannigan A. Meta-analysis of the surgical and rehabilitative outcomes of hip arthroscopy in athletes with femoroacetabular impingement. Clin J Sport Med. 2018. https://doi.org/10.1097/JSM.0000000000000623Meta-analysis of 15 studies and 823 patients on return to sport after hip arthroscopy for symptomatic FAI. 88.3% returned to sport and 85.3% returned to pre-injury level. The severity of intra-articular damage affected the return to sport ability of patients included in the meta-analysis.

54.

Frangiamore SJ, Mannava S, Briggs KK, McNamara S, Philippon MJ. Career length and performance among professional baseball players returning to play after hip arthroscopy. Am J Sports Med. 2018;46(11):2588–93. https://doi.org/10.1177/0363546518775420.CrossRefPubMed

55.

McDonald JE, Herzog MM, Philippon MJ. Performance outcomes in professional hockey players following arthroscopic treatment of FAI and microfracture of the hip. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):915–9. https://doi.org/10.1007/s00167-013-2691-9.CrossRefPubMed

56.

Thomas Byrd JW, 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.CrossRef

57.

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

58.

Degen RM, Pan TJ, Chang B, Mehta N, Chamberlin PD, Ranawat AS, et al. Risk of failure of primary hip arthroscopy-a population-based study. J Hip Preserv Surg. 2017;4(3):214–23. https://doi.org/10.1093/jhps/hnx018.CrossRefPubMedPubMedCentral

59.

Malviya A, Raza A, Jameson S, James P, Reed MR, Partington PF. Complications and survival analyses of hip arthroscopies performed in the National Health Service in England: a review of 6,395 cases. Arthrosc J Arthrosc Relat Surg. 2015;31(5):836–42. https://doi.org/10.1016/j.arthro.2014.12.013.CrossRef

Title: Return to Sport After Femoroacetabular Impingement Surgery and Sport-Specific Considerations: a Comprehensive Review
Authors: Kevin C. Parvaresh
Daniel Wichman
Jonathan Rasio
Shane J. Nho
Publication date: 01-06-2020
Publisher: Springer US
Keywords: Hip Arthroscopy
Femuroacetabular Impingement
Impingement Syndromes
Published in: Current Reviews in Musculoskeletal Medicine / Issue 3/2020
Electronic ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-020-09617-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Return to Sport After Femoroacetabular Impingement Surgery and Sport-Specific Considerations: a Comprehensive Review

Abstract

Purpose of Review

Recent Findings

Summary

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 3/2020

Hamstring Autograft for Lateral Ligament Stabilization

Approach to a Failed Hip Arthroscopy

Anterior Cruciate Ligament Re-tear and Revision Reconstruction in the Skeletally Immature Athlete

Sagittal Pelvic Kinematics in Hip Arthroplasty

Revision Medial Ulnar Collateral Ligament Reconstruction in Baseball Pitchers: Review of Epidemiology, Surgical Techniques, and Outcomes

Robots in the Operating Room During Hip and Knee Arthroplasty