Competitive Athletes with Femoroacetabular Impingement and Painful Internal Snapping Treated Arthroscopically with Intrabursal Iliopsoas Fractional Lengthening: High Rate of Return to Sport and Favorable Midterm Functional Outcomes

Abstract

Background: Athletes with femoroacetabular impingement syndrome (FAIS) who undergo hip arthroscopy with iliopsoas fractional lengthening (IFL) in the context of painful internal snapping have demonstrated favorable patient–reported outcomes (PROs), return to sport (RTS), and resolution of internal snapping symptoms at short term follow–up. Midterm outcomes have not been established. Purposes: (1) To report minimum 5–year PROs and RTS rate in competitive athletes who underwent primary hip arthroscopy for FAIS and intra–bursal IFL for painful internal snapping and (2) to compare these clinical results with those of a propensity score–matched control group of competitive athletes who underwent primary hip arthroscopy without painful internal snapping and IFL. Study Design: Cohort study; Level of evidence, 3. Methods: Data were reviewed for consecutive surgeries performed by a single surgeon between February 2010 and December 2013. Patients were considered eligible if they were professional, collegiate, or high school athletes and received a primary hip arthroscopy for FAIS and intra–bursal IFL without extended capsulotomy for painful internal snapping. Indications for IFL were painful internal snapping on preoperative physical examination. Inclusion criteria were preoperative and minimum 5–year follow–up scores for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Sport Specific Subscale, and visual analog scale for pain. Rates of achieving the minimal clinically important difference were also reported. For comparison, athletes in the IFL group were propensity matched by age, sex, body mass index, lateral and anterior center–edge angles, and sports level to a control group of athletes without internal snapping who underwent primary hip arthroscopy for FAIS without IFL. Results: A total of 105 competitive athletes in the IFL group were included in the study with a follow–up of 66.8 ± 6.9 months (mean ± SD). The IFL cohort showed significant improvement in all recorded PROs at minimum 5–year follow–up ( P < .001). Furthermore, they demonstrated favorable rates of achieving the minimal clinically important difference for the modified Harris Hip Score (82.0%), Nonarthritic Hip Score (85.4%), and Hip Outcome Score–Sport Specific Subscale (82.8%). Further, 89.5% of athletes in the IFL cohort successfully returned to sport. A total of 42 athletes in the IFL group were propensity matched to 54 control athletes. When groups were compared, they demonstrated similar improvement in PROs and rates of RTS, revision arthroscopy, and achieving psychometric thresholds. Conclusion: Competitive athletes undergoing primary hip arthroscopy and intra–bursal IFL in the context of FAIS and painful internal snapping demonstrated favorable PROs and RTS rate at minimum 5–year follow–up. These results were comparable with those of a control group of athletes not requiring IFL.

The role of iliopsoas fractional lengthening in hip arthroscopy: a systematic review

“…and Perets et al . evaluate the use of IFL and the impact on return to sport [ 5 , 6 ]. In the Jimenez et al .…”

“…In the Jimenez et al . study, athletes with FAI and painful ISHS were identified as a specific patient population that could benefit from intrabursal IFL [ 5 ]. The study found that this treatment approach was effective for managing hip pain in these athletes, allowing them to return to their pre-injury level of sport and achieve favorable functional outcomes.…”

High-Level Competitive Athletes Who Undergo Hip Arthroscopy Demonstrate Durable 5-Year Outcomes and Lower Subjective Pain: A Propensity-Matched Analysis

“…Patients completed the majority of surveys while in clinic or via electronic database platforms, although some were collected via a telephone interview as has been performed previously. 21,33,43 Clinically significant outcomes including MCID and PASS were calculated using previously published thresholds for arthroscopic labral repair at 5-year follow-up including the HOS-SS (MCID, 15.2; PASS, 80.9), HOS-ADL (MCID, 10.2; PASS, 92.2), mHHS (MCID, 11.4; PASS, 83.6), and iHOT-12 (MCID, 15.1; PASS, 74.3). 39 The secondary outcome measure was RTS rate and duration.…”

Elite Female Athletes Demonstrate a Comparable Improvement in Midterm Patient-Reported Outcome Scores and Rate of Return to Sport Compared With Elite Male Athletes After Hip Arthroscopic Surgery: A Sex-Based Comparison in Professional and Collegiate Athletes

“…38,46,63 Although recent studies have established favorable outcomes in athletes at midterm follow-up, to our best knowledge, there are no studies that have evaluated sex-based differences in the presentation and outcomes of these athletes. 25,33,43,57,58 The purpose of this study was (1) to report minimum 5year patient-reported outcome (PRO) scores as well as RTS and continuation of sport (CTS) rates for elite female athletes undergoing hip arthroscopic surgery for FAIS and (2) to compare clinical results with those of a matched control group of elite male athletes. It was hypothesized that elite female athletes would achieve favorable outcomes at midterm follow-up and that these outcomes would be similar to those of a control group of elite male athletes.…”

“…38,46,63 Although recent studies have established favorable outcomes in athletes at midterm follow-up, to our best knowledge, there are no studies that have evaluated sex-based differences in the presentation and outcomes of these athletes. 25,33,43,57,58…”