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 play in competitive or recreational tennis players after hip arthroscopic surgery. Therefore, the purpose of the present study was to (1) report minimum five-year PROs and return to sport in tennis players who underwent hip arthroscopic 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 (FAI) and labral tears between March 2009 and January 2014 and who played tennis at any level 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. Patients with preoperative Tönnis osteoarthritis Grade >1, Workers’ Compensation claims, age > 60 years old, or previous ipsilateral hip surgeries or conditions were excluded. 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% return to sport 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.Conclusion: Regardless of the level of participation, tennis players who underwent hip arthroscopic surgery reported statistically significant PRO improvements. A favorable rate of return to sport was also achieved by players with a continued interest in playing. The severity of cartilage damage was shown to not influence rate of returned to sport nor PROs in this population. The data here may be useful in counseling tennis players of various levels who are considering arthroscopic treatment of a hip injury.

Basketball Players Undergoing Primary Hip Arthroscopy Exhibit Higher Grades of Acetabular Cartilage Damage but Achieve Favorable Midterm Outcomes and Return to Sports Rates Comparable With a Propensity-Matched Group of Other Cutting Sports Athletes

“…between May 2009 and March 2016. Patients were considered eligible if they underwent primary hip arthroscopy during the study period, were competitive (organized amateur, high school, college, or professional) basketball players within a year before surgery, and had preoperative and minimum 5-year follow-up PRO scores for the modified Harris Hip Score (mHHS), 2 Nonarthritic Hip Score (NAHS), 18 the Hip Outcome Score–Sport Specific Subscale (HOS-SSS), 46 and visual analog scale (VAS) for pain 15 and completed an RTS survey. Patients were excluded from the study if they had previous ipsilateral hip surgery, were unwilling to consent to participate in the American Hip Institute Hip Preservation Registry, had a Tönnis grade of osteoarthritis >1, or had a previous hip condition.…”

“…For this study, the mHHS, NAHS, HOS-SSS, VAS for pain, and patient satisfaction were measured at the preoperative and minimum 5-year postoperative time points. 2,18,37,46…”

“…For this study, the mHHS, NAHS, HOS-SSS, VAS for pain, and patient satisfaction were measured at the preoperative and minimum 5-year postoperative time points. 2,18,37,46 PRO improvement was assessed using the minimal clinically important difference (MCID) that was described by Norman et al 51 Previous studies have used this method to accurately estimate anchor-based methods. 60,62,64 Unique MCIDs were calculated for the mHHS, NAHS, HOS-SSS, and VAS for pain.…”

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 To establish baseline scores, patients completed preoperative questionnaires within a month of the surgery date: mHHS, NAHS, HOS-SSS, VAS for pain, iHOT-12 (International Hip Outcome Tool), 49 and patient satisfaction. Baseline scores for the iHOT-12 were not reported as this PRO measure was added to the institution's questionnaires well within the study period.…”