Summary

The inability of elite athletes to compete due to hip injury, which persists despite treated conservatively, can be addressed and resolved with hip arthroscopy procedures.

Abstract

Introduction

During the last 20 years, hip arthroscopy has vastly progressed, showing an increased incidence in the athletic population. Athletes with hip pathology can be promptly and accurately diagnosed and treated appropriately, so as to return to their pre-surgical professional level of performance in due time.

Purpose

To examine the role of hip arthroscopy in high-level athletes.

Methods

From January 2003 to March 2015, 35 elite athletes who compete in national and first division teams in Greece and Cyprus (martial art, track & field athletes; weightlifters, soccer, basketball and water-polo players; 23 males and 12 females, mean age 29 y.o.) were diagnosed with hip pathology and treated arthroscopically in our practice. Diagnosis was based on clinical examination, imaging studies (MRI arthrography and AP pelvic, cross-table and false-profile view radiographs). Final diagnosis was made intra-operatively. All athletes had experienced deterioration of their condition, causing disability and diminished performance for at least two months before proceeding to surgery. All athletes had labral detachment and femoroacetabular impingement (mixed 22/35, pincer 3/35, cam 10/35). 5 of them had additionally acetabular cartilage lesions. All issues were addressed arthroscopically. Labrum repair was performed with bioabsorbable anchors and FAI lesions were excised with the burr. Subjects with cartilage defects were aditionally treated with subchondral bone micro-fractures. Post-operatively, all patients followed similar rehabilitation programs by the same physiotherapist, especially modified for the microfracture group. Finally, our assessment tool of choice was the modified Harris Hip Score, 1 week pre-operatively and during the 12th post-operative week.

Results

The modified Harris Hip Score had a mean of 69 pre-operatively, which improved to 92 at 12 weeks after surgery, showing overall excellent results. 29/35 athletes returned to full activity at 12 weeks with their symptoms completely alleviated long-term. 3/35 had residual pain due to iliopsoas tendinopathy which was treated conservatively, delaying their return to the pre-operative level of activity (between 15-18 weeks). 3/35 developed heterotopic ossification, but continued participating in sports. None needed another surgery.

Conclusion

Our cohort of athletes showed excellent results with the above hip arthroscopy procedures, addressing intra-articular pathology. Arthroscopy seems to be the safe method of choice for treating such pathology in elite athletes, allowing them to continue their career unrestricted.