Perspective

High percentage of elite athletes returned to competitive sports after hip arthroscopy

Chondral damage did not appear to impact return to play in these high-level athletes.

Male and female elite athletes had a similar high return to competitive sports after hip arthroscopy, according to research findings.

“Interestingly, we looked at the ability to return to same level; the longer symptoms preoperatively tended to be in athletes that were not able to get back to the same level,” Marc R. Safran, MD, said when he presented the results at a meeting. “Those who returned to the same level had a shorter duration of symptoms preoperatively compared with those who returned to sports, but not at the same level, and compared to those who were unable to return to sports.”

Marc R. Safran, MD
Marc R. Safran

Return to play

Safran and his colleagues retrospectively reviewed prospectively obtained data on high-level athletes, including professional, collegiate or Olympic athletes, treated with primary hip arthroscopy between 2007 and 2014. Among the 484 consecutive patients and 547 hips treated, investigators identified 96 elite athletes to evaluate who had a Hip Sports Activity Scale score greater than 6. Investigators categorized the athletes by sport, which included cutting sports, flexibility sports, contact impingement sports, asymmetric sports, overhead sports or endurance sports.

Patients completed a questionnaire preoperatively about their medical and sports activity history, and competition level. Their modified Harris Hip Score (mHHS) and International Hip Outcome Tool-33 (iHOT-33) was obtained at baseline and at the most recent follow-up. Surgical outcomes and return to competitive sports activity was also recorded.

Among the elite athletes who were studied, 80 athletes (38 women, 42 men; average age 21 years) planned to return to play at the same level they were at previously. The average follow-up was more than 1.5 years. Athletes returned to sports on average 8.5 months after hip arthroscopy. Men tended to be more involved in contact and asymmetric sports than the women, who were more involved in flexibility sports and endurance sports, Safran noted.

“When you look at return to play, 84% of the females and 83% of the males returned to play at the same level; 13% of females and 9.5% of males returned to sports, but not at the same level; and 2.5% of women and 5% of men did not go back to sports [like] they had been planning,” Safran said.

Men and women both had statistically significant improvements from mean preoperative to mean postoperative mHHS and iHOT-33 scores.

Effect of chondral damage

The surgeon should not delay the diagnosis and surgery for elite athletes because early treatment after the initial conservative treatment fails increases the likelihood a patient will return to play at the same level as pre-injury, according to Safran.

“Research is showing cam lesions are more likely associated with chondral damage and [osteoarthritis] OA, particularly those with larger alpha angles,” Safran told Orthopedics Today. “Consistent with that information was that we found the men were more likely to have some arthritic changes on plain radiographs, the increased prevalence of cam anatomy being the likely cause.”

He added, “However, mild arthritic changes (Tönnis 1) and chondral damage extent did not seem to affect the ability to return to play in these athletes. Interestingly, delay in treatment and, potentially delay in diagnosis, is associated with more advanced chondral damage and, separately, it is also associated with lower likelihood to return to sports at the same level, although those two facts are not associated.”– by Monica Jaramillo

Disclosure: Safran reports no relevant financial disclosures.

Male and female elite athletes had a similar high return to competitive sports after hip arthroscopy, according to research findings.

“Interestingly, we looked at the ability to return to same level; the longer symptoms preoperatively tended to be in athletes that were not able to get back to the same level,” Marc R. Safran, MD, said when he presented the results at a meeting. “Those who returned to the same level had a shorter duration of symptoms preoperatively compared with those who returned to sports, but not at the same level, and compared to those who were unable to return to sports.”

Marc R. Safran, MD
Marc R. Safran

Return to play

Safran and his colleagues retrospectively reviewed prospectively obtained data on high-level athletes, including professional, collegiate or Olympic athletes, treated with primary hip arthroscopy between 2007 and 2014. Among the 484 consecutive patients and 547 hips treated, investigators identified 96 elite athletes to evaluate who had a Hip Sports Activity Scale score greater than 6. Investigators categorized the athletes by sport, which included cutting sports, flexibility sports, contact impingement sports, asymmetric sports, overhead sports or endurance sports.

Patients completed a questionnaire preoperatively about their medical and sports activity history, and competition level. Their modified Harris Hip Score (mHHS) and International Hip Outcome Tool-33 (iHOT-33) was obtained at baseline and at the most recent follow-up. Surgical outcomes and return to competitive sports activity was also recorded.

Among the elite athletes who were studied, 80 athletes (38 women, 42 men; average age 21 years) planned to return to play at the same level they were at previously. The average follow-up was more than 1.5 years. Athletes returned to sports on average 8.5 months after hip arthroscopy. Men tended to be more involved in contact and asymmetric sports than the women, who were more involved in flexibility sports and endurance sports, Safran noted.

“When you look at return to play, 84% of the females and 83% of the males returned to play at the same level; 13% of females and 9.5% of males returned to sports, but not at the same level; and 2.5% of women and 5% of men did not go back to sports [like] they had been planning,” Safran said.

Men and women both had statistically significant improvements from mean preoperative to mean postoperative mHHS and iHOT-33 scores.

Effect of chondral damage

The surgeon should not delay the diagnosis and surgery for elite athletes because early treatment after the initial conservative treatment fails increases the likelihood a patient will return to play at the same level as pre-injury, according to Safran.

PAGE BREAK

“Research is showing cam lesions are more likely associated with chondral damage and [osteoarthritis] OA, particularly those with larger alpha angles,” Safran told Orthopedics Today. “Consistent with that information was that we found the men were more likely to have some arthritic changes on plain radiographs, the increased prevalence of cam anatomy being the likely cause.”

He added, “However, mild arthritic changes (Tönnis 1) and chondral damage extent did not seem to affect the ability to return to play in these athletes. Interestingly, delay in treatment and, potentially delay in diagnosis, is associated with more advanced chondral damage and, separately, it is also associated with lower likelihood to return to sports at the same level, although those two facts are not associated.”– by Monica Jaramillo

Disclosure: Safran reports no relevant financial disclosures.

    Perspective
    Dean K. Matsuda

    Dean K. Matsuda

    This study adds support that hip arthroscopy can benefit the elite athlete in return to pre-symptom level of play regardless of gender. That symptom duration had a negative correlation with outcome suggests that delaying arthroscopic treatment in athletes more than a season may be detrimental. Also, that severity of rim chondral damage and microfracture chondroplasty did not adversely affect outcome supports that even grade 4 full-thickness anterosuperior rim lesions on preoperative MRI are not a contraindication to hip arthroscopy in this athletic subset of patients. Finally, the gender differences in the diagnosis, treatment and participating type of sports activities are interesting. In particular, that female athletes had more hip instability than male athletes did not surprise me. However, that they did as well in terms of return to sport and high level of play did surprise me, and that is encouraging.

    • Dean K. Matsuda, MD
    • Orthopedics Today Editorial Board Member

    Disclosures: Matsuda reports no relevant financial disclosures.