Arthroscopic correction of femoroacetabular impingement improves athletic performance in male athletes

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.

How Many Patients Achieve an Acceptable Symptom State After Hip Arthroscopy for Femoroacetabular Impingement Syndrome? A Cross-sectional Study Including PASS Cutoff Values for the HAGOS and iHOT-33

“…12,22,32 Additionally, many cohort studies suggest that hip arthroscopy for FAIS is associated with large and clinically relevant improvements in pain and function pre-to postoperatively. 17,23,24,30,39 Many patients, however, still present with persistent hip and groin pain and functional limitations after surgery, 17,18,21,39 indicating that discrepancies may exist between "getting better" and "feeling good." 25 To better understand if patients consider their current state of health (eg, pain and function) to be at an acceptable level after hip arthroscopy for FAIS, the Patient Acceptable Symptom State (PASS) can be used.…”

Hip Range of Motion Is Increased After Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review

“…Eight of 23 (35%) of the included studies described the use of a goniometer as the primary ROM measurement technique, with 5 of these studies specifying the use of a manual/handheld goniometer. Of those that used goniometric evaluation, 2 studies 27 , 28 reported dual-operator evaluation, 1 study 29 evaluated with a single operator, and the remaining 5 30 , 31 , 32 , 33 , 34 did not distinguish. In 1 additional study, 35 although not the primary purpose of the study, the authors did also report single-operator goniometric evaluation of ROM at 3-month clinical follow-up.…”

“…Postoperative changes in ER from each study's baseline were statistically significant in 20% (3/15), not statistically significant in 46.7% (7/15), and statistical significance was not reported in 33.3% (5/15). For those studies reporting statistically significant improvements in ER, effect size was weak in 33.3% (1/ 3) 27 of studies and large in 66.7% (2/3), 28,30 of studies. Pre-to postoperative measured changes in external rotation are presented in Figure 2C, whereas those studies evaluating a mix of unilateral and bilateral patients are presented in Figure 3C.…”

“…Only 2 studies included in this review evaluated the impact of bony resection on ROM: Kelly et al 32 reported a change in alpha angle correlated with the magnitude of increase in IR (r ¼ 0.35) whereas Stähelin et al 47 reported that neither postoperative alpha value or difference in alpha value achieved by correction correlated with any of the ascertained clinical parameters. Eight (32%) of the included studies reported preand postoperative LCEA measurements, quantifying the degree of acetabuloplasty [27][28][29]34,38,44,45 (Table 3). The mean extent of LCEA correction ranged from 1.2 to 6.8 .…”

Arthroscopic Correction of Femoroacetabular Impingement for Concomitant Inguinal Disruption in Athletes With Dual Pathology

“…Although HA is a well-established and effective treatment intervention for the management and alleviation of symptoms in athletes with diagnosed FAI, 24 to date the effect of surgical outcomes among patients with concomitant inguinal-related pathology is limited despite a high proportion of symptomatic FAI surgical cases citing groin pain as a major symptom. 8,20,30 Larson et al 19 reported on sports-related cases of athletic pubalgia and FAI and found 50% effectiveness of HA alone in terms of athletes returning to unrestricted sports, as compared with 25% effectiveness when surgical management of sports pubalgia was performed in isolation.…”