Femoroacetabular Impingement in Elite Skiers and Snowboarders: Return to Sports and Outcomes After Hip Arthroscopy

Abstract

Background: Hip arthroscopy has been shown to be an effective treatment for femoroacetabular impingement (FAI) in high–level athletes; however, limited outcome and return–to–play data exist for hip arthroscopy in skiers and snowboarders. Purposes: To determine the return–to–sports rate of elite skiers and snowboarders who have undergone hip arthroscopic surgery for FAI and to assess hip–related outcomes at a minimum 2–year follow–up. Study Design: Case series; Level of evidence, 4. Methods: Elite skiers and snowboarders who underwent hip arthroscopy for the treatment of FAI between 2005 and 2018 were identified via a retrospective review of prospectively collected data. Data were obtained from fis-ski.org , usskiandsnowboard.org , xgames.com , and wikipedia.org , including information on each player's career length, participation on a national team, and time between surgery and first competition after surgery. Patient-reported outcomes (PROs) were prospectively collected preoperatively and at minimum 2 years postoperatively. Results: In total, 26 elite skiers and snowboarders (34 hips) were included. The mean ± standard deviation age at surgery was 24.5 ± 6.7 years (range, 18.7-46.8 years). A total of 85% (22/26) returned to elite–level competition at 8.9 months (range, 2.9-23.7 months) with an average career length of 3.6 ± 2.7 years after surgery. Four athletes (5 hips) required revision arthroscopy, with adhesions being the most frequent indication. At a mean follow–up of 7.7 ± 3.2 years, significant improvement in PROs ( P < .05) was demonstrated for the Hip Outcome Score (HOS)–Activities of Daily Living (from 76 ± 20 to 95 ± 6), HOS–Sport Specific Subscale (from 63 ± 28 to 92 ± 14), modified Harris Hip Score (from 70 ± 19 to 89 ± 12), and 12-Item Short Form Health Survey Physical Component Summary (from 45 ± 11 to 54 ± 8). Patient satisfaction had a mean of 8 ± 2 (range, 1-10) and median of 10. Conclusion: The return–to–competition rate in elite skiers and snowboarders after hip arthroscopy for FAI was 85% at an average of 8.9 months and with a career length of 3.6 years after surgery. Significant improvement in PROs was demonstrated for the HOS–Activities of Daily Living, HOS–Sport Specific Subscale, modified Harris Hip Score, and 12-Item Short Form Health Survey Physical Component Summary, with a median patient satisfaction score of 10. These findings support hip arthroscopy as an effective procedure for the treatment of FAI in elite skiers and snowboarders with symptomatic activity–limiting hip pain, allowing them to return to their previous levels of competition at a high rate.

Self-Reported Level of Sports Compared With Objective Data in Athletes With Femoroacetabular Impingement Syndrome

“…1,10,23 In addition to HSAS, a wide variety of other self-reported questionnaires, along with objective data, have been used to measure and confirm level of sports and RTS. 6,12,19,24 There is a risk of an incorrect estimation when using questionnaires in terms of misapprehension of the questionnaire itself along with an overestimation of the athlete's own level of sports. It is common that the athletes report on their level of sports before onset of symptoms, which might have been years ago, which is further problematized with the risk of recall bias.…”