Return to play after hip arthroscopy among tennis players: outcomes with minimum five-year follow-up

Abstract

Background: Playing tennis is associated with various movements that can lead to labral injuries and may require arthroscopic surgery. While hip arthroscopies have demonstrated good outcomes in athletes, there is limited literature reporting patient reported outcomes (PROs) and return to sport (RTS) in competitive or recreational tennis players after arthroscopic hip surgery. Therefore, the purpose of the present study was to (1) report minimum fiveyear PROs and RTS in tennis players who underwent arthroscopic hip surgery and (2) compare outcomes between recreational and competitive tennis players. Methods: Data for patients who underwent hip arthroscopy surgery in the setting of femoroacetabular impingement and labral tears between March 2009 and January 2014 and who played tennis within one-year of surgery were retrospectively reviewed. Patients with preoperative and minimum five-year postoperative scores for the following PROs were included: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Patient Acceptable Symptomatic State (PASS) and Minimal Clinically Important Difference (MCID) for mHHS and HOS-SSS were calculated. Results: Of 28 patients, 31 hips met all inclusion and exclusion criteria of which 28 (90.3%) had minimum 5-year follow-up (mean: 72.8 ± 13.9 months). There were 3 professional, 3 collegiate, 2 high school, 2 organized amateur, and 18 recreational level tennis players. All PROs significantly improved at latest follow-up: mHHS from 67.0 to 86.7 (P < 0.001), NAHS from 65.9 to 87.2 (P < 0.001), HOS-SSS from 50.0 to 77.9 (P = 0.009), and VAS from 5.4 to 1.8 (P < 0.001). There was a 75.0% RTS rate. Additionally, 66.7% of patients achieved MCID and 83.3% achieved PASS for mHHS, and 63.6% achieved MCID and 58.3% achieved PASS for HOS-SSS.

Return to Sports and Minimum 2-Year Outcomes of Hip Arthroscopy in Elite Athletes With and Without Coexisting Low Back Pain: A Propensity-Matched Comparison

“…Patients with symptomatic FAI have been shown to require more flexion at the hip to achieve the sitting position owing to their inability to compensate through the lumbar spine. 26,46,48,54,56 Furthermore, patients with symptomatic FAI have been shown to have less spine flexion as compared with a non-FAI control group and even patients with asymptomatic FAI. The effect of lumbopelvic motion has been well described in previous literature.…”

“…RTS was defined as a patient’s return to competitive participation in his or her sport at the same level as or higher than that of before surgery within 2 years postoperatively. 16,46…”

A longitudinal analysis of injury characteristics among elite and amateur tennis players at different tournaments from electronic newspaper reports

“…It is worth noting that the high rate of injury occurrences in tennis does not only affect the career of athletes but also has significant economic impacts on both athletes and concerned authorities ( 32 ). Despite these problems, comprehensive programs for tennis injury prevention are either lacking or inadequate ( 33 ). As such, research has indicated the need for systematic investigation to recommend useful strategies for the prevention and management of tennis-related injuries ( 4 , 6 ).…”

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

“…1,29 Although previous studies have addressed PROs and RTS rates after HA, most of the available literature discussing outcomes among athletes and nonathletes are limited to short-term follow-up. 17,18,20 Moreover, many of the current 5-year outcome studies on athletes lack direct comparisons between competitive athletes (CAs) and Controls (ie, case series), 6,7,22,25,28,30,34,43 or include a broad definition of a CA (ie, recreational athletes, high school, organized amateur), making it challenging to discern conclusions on how outcomes of high-level CAs compare with those of Control patients. 6,7,[22][23][24][25]28,30,34,43 As HA continues to become a more prevalent choice of treatment for FAIS, additional studies investigating long-term durability and efficacy are needed.…”

“…17,18,20 Moreover, many of the current 5-year outcome studies on athletes lack direct comparisons between competitive athletes (CAs) and Controls (ie, case series), 6,7,22,25,28,30,34,43 or include a broad definition of a CA (ie, recreational athletes, high school, organized amateur), making it challenging to discern conclusions on how outcomes of high-level CAs compare with those of Control patients. 6,7,[22][23][24][25]28,30,34,43 As HA continues to become a more prevalent choice of treatment for FAIS, additional studies investigating long-term durability and efficacy are needed. 29,35,37 Therefore, the primary purpose of this study was to (1) determine differences in midterm clinical outcomes at minimum 5-year follow-up between patients who are high-level CA versus propensity-matched Controls undergoing HA for FAIS, and (2) determine whether achievement rates of minimal clinically important differences (MCID) and patient acceptable symptom states (PASS) differ between the 2 groups.…”