Editorial Commentary: Return to Sport: An Ill-Defined Parameter

Robinson, Jonathan; Casartelli, Nicola C.; Leunig, Michael

doi:10.1016/j.arthro.2019.10.012

Cited by 6 publications

(10 citation statements)

References 14 publications

(18 reference statements)

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“…While we are not aware of any other studies that have analyzed the definitions of RTS used in the literature, the inconsistency of RTS definitions has been discussed in several studies and editorial commentaries, some with concern about patient satisfaction and safety as a result of the ill-defined parameter. 5,25,33 Of the 25 studies 2,4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]23,26,[28][29][30][31][32]35 which used standard RTS or RTP terminology, 20 studies 2,4,[7][8][9][10][12][13][14][15][16][17][18][19][20][28][29][30][31]35 (69.0% overall) defined RTS as an athlete competing in a game or other competitive play, while...…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Because of the variations in reporting, many authors have called for a more standardized approach to reporting RTS. 1 , 25 For instance, a 2018 meta-analysis of RTS after surgical treatment of femoroacetabular impingement (FAI) syndrome found an overall RTS at any level of 91% but an RTS at the same level of competition of 74%. 24 Additionally, Wörner et al 34 reported an 89% RTS after hip arthroscopy for FAI when patients were asked in a general way (return to participation in some sort of sport or exercise) but reported only a 28% RTS in the same preinjury sport at a lower competition level and a 21% RTS in the same sport at the same or higher competition level.…”

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confidence: 99%

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Defining Return to Sport: A Systematic Review

Doege

Ayres

Mackay

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Return to sport (RTS) commonly serves as a measure for assessment of clinical outcomes in orthopaedic sports medicine surgery. Unfortunately, while RTS is commonly utilized in research for this purpose, currently there is no widely accepted or standardized definition for when an athlete has officially returned to his or her sport. Purpose: To conduct a systematic review to evaluate and report the differences in specific definitions of RTS utilized in the orthopaedic surgery literature. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed using PubMed, EMBASE, and Cochrane Trials databases per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search terms consisted of variations of “RTS” combined with variations of “orthopedic surgery” and “define” to capture as many relevant articles as possible. The definition of RTS was recorded and analyzed. Results: A total of 718 articles were identified in the initial search, 29 of which met eligibility criteria, providing a clear definition of RTS. Of the 29 studies included, 20 (69.0%) defined RTS as an athlete competing in a game or other competitive play. Three (10.3%) defined this as the athlete competing in a game or other competitive play but with an explicitly stated competition-level modifier of the athlete returning to his or her preinjury level of competition. Two articles (6.9%) included returning to training or practice, and the remaining 4 articles (13.8%) used terminology other than the standard RTS. Conclusion: There is variability in the definition of RTS used in orthopaedic sports medicine literature. Most studies refer to the athlete competing in a game or other competitive play. Other variants include returning to practice/training and explicitly defined competition levels and objectives. Future studies should aim to standardize the definition of RTS to facilitate more precise assessment of outcome after sports medicine surgery. Using terminology that describes components of the recovery and rehabilitation process, such as “return to participation” and “return to performance,” in addition to RTS will allow us to more clearly understand the athlete’s recovery and associated level of competition or performance.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Defining Return to Sport: A Systematic Review

Doege

Ayres

Mackay

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…Therefore, the RTS among all sports may not be an appropriate outcome variable to estimate an accurate outcome prediction for an athlete participating in pivoting sports. 11,15,16 To help the surgeon and patient, this review focused on RTS after focal chondral lesion surgery in pivoting sports where the prevalence of cartilage injuries and the cartilage load is particularly high. [2][3][4] The purpose of this scoping review was to identify gaps in the current research and present available evidence for rates of RTS after cartilage procedures in pivoting sports athletes.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the RTS among all sports may not be an appropriate outcome variable to estimate an accurate outcome prediction for an athlete participating in pivoting sports. 11 , 15 , 16 …”

Section: Introductionmentioning

confidence: 99%

Return to Pivoting Sports after Cartilage Repair Surgery of the Knee: A Scoping Review

et al. 2023

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Objective To perform a scoping literature review evaluating and reporting on outcomes and return to pivoting sports after cartilage procedures. For this review, the following cartilage procedures were evaluated: microfracture, osteochondral autograft transplantation (OAT), osteochondral allograft transplantation (OCA), and autologous chondrocyte implantation (ACI). Design The scoping review incorporated articles identified using PubMed (MEDLINE), CINAHL, and Cochrane Central Register of Controlled Trials. Screening of reference lists of included studies and forward citation tracking were performed to identify additional studies. Reported on return to pivoting sports after cartilage surgery written in English language. Results Sixteen studies fulfilled the inclusion criteria. The return to sports (RTS) rates after microfracture ranged from 44% to 83%, and to preinjury level from 25% to 75%. The RTS rates after OAT ranged from 87% to 100%, and to preinjury level from 67% to 93%. The RTS rates after OCA ranged from 77% to 80%, and to preinjury level 64%. The RTS rates after ACI ranged from 33% to 96%, and to preinjury level from 26% to 67%. Conclusions There was a high heterogeneity and range in rates of RTS in athletes participating in pivoting sports. Most studies reported high rates of RTS; however, return to preinjury level was lower. These data may be important to clinicians in shared decision making on the type of procedure to be performed and counseling pivoting sports athletes on prognosis and expected RTS rates.

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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

Marom

Olsen

Burger

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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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.

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Editorial Commentary: Return to Sport: An Ill-Defined Parameter

Cited by 6 publications

References 14 publications

Defining Return to Sport: A Systematic Review

Defining Return to Sport: A Systematic Review

Return to Pivoting Sports after Cartilage Repair Surgery of the Knee: A Scoping Review

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

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