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Which Athletes Have Highest Rate of Return to Sport After FAI? Anyone?

by Elizabeth Hofheinz, M.P.H., M.Ed.

Citing the increased prevalence of mixed and cam-based femoroacetabular Impingement (FAI) in high-level athletes, a team of researchers from the Keck Medicine of USC, the Steadman Philippon Research Institute, the University of Michigan Medical School, and Midwest Orthopaedics at Rush took a deep dive into “return to sport.” They asked, “Does the rate of return to sport vary by type of athlete—cutting, impingement, contact, endurance, flexibility, and asymmetric/overhead—who undergo hip arthroscopy for femoroacetabular Impingement Syndrome (FAIS?)”

Their study, “Cutting, Impingement, Contact, Endurance, Flexibility, and Asymmetric/Overhead Sports: Is There a Difference in Return-to-Sport Rate After Arthroscopic Femoroacetabular Impingement Surgery?” was published in The American Journal of Sports Medicine.

First-of-a-kind systematic review

Using a previously designed classification system1 that categorized sports based on the biomechanical stress placed on the hip, this multicenter group also set out to determine if there were differences in demographics, type of surgery, and time to return to play among the six subgroups of sports.

Co-author Alexander Weber, M.D. is an Assistant Professor of Orthopaedic Surgery at the USC Keck School of Medicine. Dr. Weber, also Team Physician USC Athletics and LA Kings, told OSN, “One of the most common questions we get as orthopaedic surgeons and team physicians is, ‘Doc, when can I return to my sport?’ There have been some prior studies looking to answer this question; however, most of the prior studies focus on a specific sport. As we all know there are different demands on the hip of a football athlete compared to a cross country running athlete.”

“Nawabi and the HSS [Hospital for Special Surgery] group published a sports classification based on the demands on the hip [for example, flexibility sports (such as ballet, gymnastics etc.), contact sports (such as football) etc.). And to date, there has not been a return to sport study comparing the rates of return to sport across the different sports classifications.”

The researchers looked at 29 articles and 1,426 hip arthroscopy cases (185 cutting, 265 impingement, 304 contact, 207 endurance, 116 flexibility, and 356 asymmetric/overhead athletes).

And the “winner” is?

They wrote, “Flexibility athletes had the highest rate of return to sport after hip arthroscopy for FAIS (94.1%), whereas contact athletes had the lowest rate (87%). The longest mean 6 SD time (8.5 6 1.9 months) to return to sport was reported in cutting sports, while endurance athletes returned faster than the rest (5.4 6 2.6 months). The difference in rate and time to return to sport, as well as the intraoperative procedure performed, did not reach statistical significance among the 6 subgroups.”

Dr. Weber: “Flexibility athletes have a high demand on their hips in terms of a combination of range of motion and strength. It was great to see that they have the highest rate of return to sport.”

“The results of this study are useful for preoperative counseling of athletes with symptomatic FAIS who are considering hip arthroscopy and wanting to return to sport afterward.”

“Overall this study helps with establishing more realistic patient and surgeon expectations when an athlete is undergoing hip arthroscopy for symptomatic FAIS. The findings from this study help both surgeon and patient understand the timeline for recovery and likelihood of a full return to sport based on sport-type. Additionally, it should be reassuring to both surgeon and patient that on the whole, athletes return to sport at high rates following hip arthroscopy for symptomatic FAIS.”



Josh Sandberg

Josh Sandberg is the President and CEO of Ortho Spine Partners and sits on several company and industry related Boards. He also is the Creator and Editor of OrthoSpineNews.

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