Summary

In summary, patients were able to return to sport at a high rate following hip arthroscopy and perform activities at near pre-injury levels with chondrolabral delamination being a predictor for more extra-artricular procedures and revision arthroscopy.

Abstract

Background

Hip pain has been increasingly associated with structural abnormalities of the hip joint leading to labral tears and chondrolabral delamination. Hip arthroscopy has been established as a safe and efficacious method of diagnosing and treating a wide variety of intra-articular hip pathology. There is a significant literature gap describing outcomes and RTS times following hip arthroscopy in the high school and college athletes. Given the high level of performance expected of these athletes, many of whom play multiple sports over the course of a calendar year, more comprehensive data regarding outcomes and RTS times following hip arthroscopy is necessary.

Purpose

1) Determine the rate of high school and college athletes returning to sport following hip arthroscopy, and 2) report outcomes in this population at a minimum of two years following surgery.

Study Design: Retrospective clinical observation study; Level IV

Methods

This study included all patients between age 13 and 23 at the time of surgery undergoing hip arthroscopy following failure of comprehensive non-operative management from one of three surgeons working within the Sports Medicine Department of Mayo Clinic. Patients were consented to participate in post-operative research following approval of the study design by Institutional Review Board at Mayo Clinic. The study population included all patients who underwent hip arthroscopy between April 2009 and June 2014 for whom two-year outcome scores were available. Collected outcome measures included modified Harris Hip Score and Hip Outcome Scores (HOS) for activities of daily living (ADLs) and Sport intraoperatively and at the 1 and 2-year time marks, sport played, return to sport rates, and Tegner Scores measured pre-injury and at 2 years post-operatively.

Results

Return to sport rate was 92% (46/50) overall with no significant difference in rate of return among recreational and competitive athletes. Overall median Harris Hip, HOS ADL, and HOS Sport outcome scores were: 91, 95.6, and 87.2 for the entire cohort, 91, 97.1 and 89.7 for the group that returned to sport and 58.2, 81.6, and 47.2 for the group that did not return to sport, respectively. Median pre-injury Tegner level was 8 and median post-operative Tegner level was 7. Performance of associated procedures such as chondrolabral debridement during arthroscopy was associated with significantly lower Harris Hip, HOS ADL and HOS Sport scores (p=0.03, p= 0.04, p=0.04); labral takedown and reattachment was associated with lower HOS ADL and Sport Outcome scores (p=0.01, p=0.02); chondroplasty was associated with improved HOS Sport Outcome scores (p=0.01), and ligamentum teres debridement was associated with lower HOS Sport Outcome scores (p=0.04)

Conclusion

In summary, patients were able to return to sport at a high rate following hip arthroscopy and perform activities at near pre-injury levels. Chondrolabral delamination often led to performance of more extra-articular procedures as well as revision arthroscopy however, it alone was not associated with poorer outcomes. Chondroplasty was associated with improved outcomes.