Majority of competitive soccer players return to soccer following hip arthroscopy for femoroacetabular impingement: female and older aged players are less likely to return to soccer

Abstract

Purpose To determine return to soccer rates and soccer performance in a large cohort of competitive soccer players after hip arthroscopic surgery for the treatment of femoroacetabular impingement (FAI) and to identify possible risk factors associated with not returning to soccer. Methods An institutional hip preservation registry was retrospectively reviewed for patients identiied as competitive soccer players who underwent primary hip arthroscopy for FAI performed between 2010 and 2017. Patient demographics and injury characteristics as well as clinical and radiographic indings were recorded. All patients were contacted for return to soccer information using a soccer-speciic return to play questionnaire. Multivariable logistic regression analysis was used to identify potential risk factors for not returning to soccer. Results Eighty-seven competitive soccer players (119 hips) were included. 32 players (37%) underwent simultaneous or staged bilateral hip arthroscopy. The mean age at surgery was 21.6 ± 7.0 years. Overall, 65 players (74.7%) returned to soccer, of which 43 players (49% of all included players) returned to pre-injury level of play or better. Most common reasons for not returning to soccer were pain or discomfort (50%) followed by fear of re-injury (31.8%). The mean time to return to soccer was 33.1 ± 26.3 weeks. Among 22 players who did not return to soccer, 14 (63.6%) reported satisfaction from surgery. Multivariable logistic regression analysis revealed female players (odds ratio [OR] = 0.27; conidence interval [CI] = 0.083 to 0.872; p = 0.029) and older aged players (OR = 0.895; 95% CI = 0.832 to 0.963; p = 0.003) were less likely to return to soccer. Bilateral surgery was not found to be a risk factor. Conclusion Hip arthroscopic treatment for FAI in symptomatic competitive soccer players allowed three-quarters of them to return to soccer. Despite not returning to soccer, two-thirds of players who did not return to soccer were satisied with their outcome. Female and older aged players were less likely to return to soccer. These data can better guide clinicians and soccer players with realistic expectations related to the arthroscopic management of symptomatic FAI. Level of evidence III.

Femoroacetabular Impingement and Groin Injuries Among Soccer Players

“…Marom et al 50 2023 87 competitive soccer players (119 hips)-75% of players returned to soccer, 49% of whom returned at the same level Bilateral hip surgery was not a risk factor for RTP; however, female players and older patients returned at lower rates than male and younger patients Anari et al 53 2023 83 high-level soccer athletes-85% of whom returned to the sport in the first or second season after surgery Only 37% of the athletes returned to performing in 80% of the games 1 y after surgery compared with the last asymptomatic season Saito et al 54 2019 28 soccer players undergoing hip arthroscopy-92% of players returned to soccer at the same or higher level at a median of 5.5 mo 51 Prevalence of tenderness at the pubic symphysis decreased from 32% preoperatively to 3% postoperatively RTP indicates return to play.…”

Lost in research translation: Female athletes are not male athletes, especially at the hip

“…Females (i.e., individuals identified as female sex at birth) comprise two‐thirds of the individuals diagnosed with or treated for FAI syndrome (pain in the presence of cam or pincer morphology and clinical signs) 1,20–22 . Compared to males, females with FAI syndrome report worse pain and functional deficits, 23,24 have poorer surgical outcomes, 25–27 and are less likely to return to sport following treatment 27,28 . The high prevalence combined with poorer outcomes expose a critical need for female‐focused studies to determine if and when cam morphology develops in the female athlete.…”

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

“…Femoroacetabular impingement syndrome (FAIS) is a common cause of hip and groin pain in athletes. It is even more common in sports with high demands on the hip joint, such as ice hockey and soccer, 8,9,12,16 and studies have shown a higher prevalence of radiological cam morphology in athletes performing these types of sports. 7,13 In both ice hockey and soccer, athletes put high loads on their hip joints and perform repetitive movements such as rapid change of direction, internal rotation, adduction, and deep hip flexion that potentially provoke symptoms that are associated with FAIS.…”

“…8,11 Hip arthroscopy is a treatment option for athletes with FAIS that has shown favorable outcomes in terms of pain relief and patient satisfaction. 9,12 Studies have further shown high rates of return to sports (RTS) (87%-93%). 14,18 However, there is a large discrepancy between reported rates of RTS to preinjury performance level (21%-83%) depending on the definition used.…”

“…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.…”