Rehabilitation and Return to Sport After Arthroscopic Treatment of Femoroacetabular Impingement: A Review of the Recent Literature and Discussion of Advanced Rehabilitation Techniques for Athletes

Abstract

The purpose of the article is to present an updated literature review, as well as describe our approach to rehabilitation and return to sports following hip arthroscopy for femoroacetabular impingement (FAI) with labral repair. A literature review was performed to identify articles published within the last 10 years that were focused on this topic. Relevant articles were reviewed, and reference lists were searched to identify additional articles. Findings were summarized for rehabilitation phases and return-to-sports assessment. Additionally, advanced rehabilitation topics are reviewed. Several systematic reviews and individual case series were identified. There is relative uniformity concerning the use of a four-phase approach for rehabilitation. However, there is inconsistency in terms of timing and criteria for ultimate return to sport. Advanced rehabilitation topics were reviewed, and description of their relevance at various rehabilitation phases was provided. A four-phase approach to rehabilitation following hip arthroscopy for FAI is widely used with general uniformity, although the timing and level of detail concerning assessment and readiness for return to sport are variable. Advanced rehabilitation techniques may be used in select patients returning to high-level activities.

Return to Ballet Progression for Dancers After Hip Arthroscopy for Instability or Femoroacetabular Impingement Syndrome

“…The conventional postoperative therapy program involves 4 phases ("Four R's"): (1) Recovery in the acute postoperative period, (2) Restoration of stability and mobility, (3) Ramping up of strength and ROM, and (4) Return to dance training. These phases are consistent with the general principles of rehabilitation protocols reported in the literature, 12,16 which can be tailored to the surgeon-specific postoperative programs. With a focus on recovery from the inflammatory effects of surgery, the first phase of conventional therapy is divided into two subphases: phase 1A (0-2 weeks) and phase 1B (3-6 weeks).…”

“…9,10 After hip arthroscopy, the general population undergoes a postoperative rehabilitation protocol that includes a phase of inflammation management and surgical healing, followed by progressive ROM and strengthening exercises. 11,12 However, ballet dancers require advanced rehabilitation with a balletspecific progression back to activity, allowing them to return to the rigorous demands of ballet without reinjury. Although return to sport protocols after hip arthroscopy has been described for other sports, [13][14][15] a paucity of information exists for clinicians to guide ballet dancers back to full activity.…”

Use and Effectiveness of Physical Therapy After Hip Arthroscopy for Femoroacetabular Impingement

“…11,18,27 There is significant debate regarding what should dictate progression through PT phases, whether it be time (based on expected healing rates), functional improvements, or PRO scores. 17 The results of this study suggest that a more rapid advancement through rehabilitation, even if patients are meeting functional milestones, may not ultimately be in the best interest of the patient. Rather, at least in the early phases, patients should advance based on time from surgery and/or PRO scores to ensure that they gain maximum benefit.…”