Return to sport and performance after hip arthroscopy for femoroacetabular impingement in 18- to 30-year-old athletes. A cross-sectional cohort study of 189 athletes

Key points

1. 0157.1% (108/189) returned to pre-injury sport at pre-injury level at mean 33 months follow-up
2. 02Only 29.6% of those who returned reported optimal performance and full participation, equating to 16.9% of the total cohort
3. 0389.5% of athletes with impaired performance attributed it to persistent hip or groin pain
4. 04Athletes who returned at pre-injury level had significantly better HAGOS scores across all subscales compared to those who did not (small-to-large effect sizes, P less than 0.001)
5. 05Sport level, sport type, and time to follow-up explained only 5.9% of variance in return-to-sport outcome (non-significant predictors)

How it was conducted

Design

Cross-sectional survey study using a nationwide registry

Participants

189 athletes aged 18-30 at surgery (mean age at follow-up 26.9 years, 50.8% male), drawn from the Danish Hip Arthroscopy Registry

Procedure

Hip arthroscopy including cam resection and acetabular labral surgery for FAI syndrome

Follow-up

Mean 33.1 months (range 6.3-67.8 months)

Primary outcome

Rate of return to pre-injury sport at pre-injury level, with performance and participation subclassified

Secondary outcome

Self-reported hip and groin function via Copenhagen Hip and Groin Outcome Score (HAGOS)

What they found

• 57.1% (108/189; 95% CI 50.0%-64.0%) were engaged in pre-injury sport at pre-injury level at follow-up
• 42.9% (81/189) failed to return to pre-injury sport at pre-injury level
• Of the 81 non-returners: 43.2% (95% CI 33.0%-54.1%) were playing no sport due to hip/groin pain; 32.1% (95% CI 22.9%-42.9%) were playing a different sport due to pain
• Of the 108 returners: 29.6% (95% CI 21.8%-38.8%) reported optimal performance and full participation; 24.1% (95% CI 17.0%-32.9%) had impaired performance but full participation; 46.3% (95% CI 37.2%-55.7%) had impaired performance and restricted participation
• Optimal performance and full participation corresponded to only 16.9% (95% CI 12.3%-22.9%) of the full study sample
• At 0.5 to less than 1 year follow-up, only 1 of 12 returners (8.3%) reported optimal performance; at 1 to less than 3 years, 18/57 (31.6%); at 3 to less than 6 years, 13/39 (33.3%)
• Elite athletes had higher return rates than competitive athletes (67.6% vs 49.4%); contact sport athletes had lower rates than non-contact pivoting athletes (51.8% vs 64.9%)
• Athletes returning at pre-injury level had significantly higher HAGOS scores at follow-up vs non-returners across all subscales (P less than or equal to 0.001), with effect sizes ranging from small to large (largest Cohen's d = 1.29 for participation in physical activities subscale)
• 89.5% (68/76) of athletes with impaired performance attributed it to persistent hip and/or groin pain
• 69.6% (16/23) of athletes who attempted their pre-injury sport but failed discontinued due to hip and groin pain

Limitations

• Cross-sectional design captures return-to-sport status at a single point; longitudinal trajectory cannot be determined
• Response rate of 65% introduces potential non-response bias (non-responders had significantly lower pre-surgical HAGOS pain and function scores)
• Sports performance and participation were self-reported and subjective, not validated against objective athletic performance measures
• Factors potentially modifying outcomes such as time from initial pain onset to surgery and pre-operative cartilage status were not fully accounted for

Why it matters

For patients

Athletes should expect that roughly half will return to their pre-injury sport at the same level, and fewer than 1 in 5 will do so with fully optimal performance, which is important for realistic goal-setting before agreeing to surgery.

For clinicians

Return-to-sport counselling after hip arthroscopy for FAI should move beyond simple 'returned or not' rates and include realistic expectations about performance and the high likelihood of persistent pain limiting full participation.

For readers

This study challenges the widely cited 87% return-to-sport figure by applying a stricter, consensus-based definition and drawing from a multi-centre national registry rather than a single high-volume surgical centre.