Arthroscopic Correction of Sports-Related Femoroacetabular Impingement in Competitive Athletes: 2-Year Clinical Outcome and Predictors for Achieving Minimal Clinically Important Difference

Abstract

Background: A growing body of literature supports surgical intervention for femoroacetabular impingement (FAI) in young, active athletes. However, factors likely to influence results in this cohort are less clearly defined. Purpose: To quantify changes in validated patient-reported outcome measures (PROMs) and determine whether differences in baseline athlete demographic characteristics, intraoperative findings, and surgical techniques are associated with achieving improved outcomes and minimal clinically important difference (MCID) after arthroscopic management of sports-related FAI. Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected from competitive athletes who underwent hip arthroscopy between January 2009 and February 2017. Athletes who underwent primary arthroscopic correction of sports-related FAI with labral repair were included providing they had a Tönnis grade ≤1 and a lateral center-edge angle ≥20°, excluding significant articular cartilage injury and lateral rim dysplasia. The modified Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, University of California Los Angeles activity scale, and 36-Item Short Form Health Survey were used to measure outcomes at the 2-year follow-up. MCID was measured using 3 methods: a mean change method, a distribution-based method, and the percentage of possible improvement (POPI) method. Multivariate regression models were used to assess a number of diagnostic and surgical variables associated with good outcome and achieving MCID at follow-up. Results: At 2-year follow-up, statistically significant improvements were observed for all PROMs ( P < .001 for all), and 84% of athletes continued to play sport. Higher preoperative PROM scores reduced the likelihood of achieving MCID; however, returning to play was the strongest predictor of reaching MCID in this athletic cohort. Using absolute score change (mean change or distribution method) to calculate MCID was less accurate owing to ceiling effects and dependence on preoperative PROM scores. Conclusion: Athletes undergoing arthroscopy for sports-related FAI can expect a successful outcome and continued sports participation at 2 years postoperatively. The majority of athletes will achieve MCID. The POPI method of MCID calculation was more applicable to higher functioning athletic cohorts. Reduced preoperative PROM scores and the ability to return to sport increased the likelihood of achieving MCID in this population.

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

“…In addition, an MCID based on a previously reported anchor-based reference scorespecifically, the percentage of possible improvement (POPI)-was included for the mHHS and SF-36, 6 as well as the UCLA and WOMAC. 23 The MCID, represented as a percentage change from baseline, has been shown to negate ceiling effects of PROMs and is independent of the baseline score. 6 For each case, the POPI achieved was calculated as follows: [PROM change / (maximum possible achievable score -preoperative score)] 3 100.…”

Quantifying Surgeon Intuition Using a Judgment Analysis Model: Surgeon Accuracy of Predicting Patient-Reported Outcomes in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement Is Moderate at Best

“… 6 , 7 , 8 , 9 Predictors of positive outcomes include younger age, male sex, body mass index less than 25, Tönnis grade 0, pain relief from preoperative intra-articular hip injections, and lower preoperative baseline patient-reported outcomes (PRO) scores. 9 , 10 …”

“…Similarly, studies have identified predictors of negative outcomes, including symptom duration greater than 8 months, age greater than 45 years, chondral defects, decreased joint space greater than 2 mm, and increased lateral center edge angle. 8 , 9 , 10 While individual risk factors provide good information, these types of studies are limited by the fact that actual patient outcomes are not predicated on a singular risk factor but rather are complex and multifactorial in nature. 2 …”

Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Chinese Patients: A Minimum 2-Year Follow-up Study

“…Favorable outcomes have been reported regarding the surgical treatment of FAIS, 12 , 25 , 27 , 39 , 43 not only regarding pain and function scores, but also regarding the rate of return to sport, including professional athletes. 8 , 28 , 32 , 42 The majority of these studies concern populations in Western countries, and outcomes in the Asian population have been limited to small sample sizes. 13 , 16 , 27 Moon et al 27 reported good outcomes in 73 patients with concomitant labral tears in Korea.…”