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A 2018 meta-analysis reports an overall return to sports (RTS) rate of 91% and high patient satisfaction following hip arthroscopy for femoroacetabular impingement syndrome (‘arthroscopy’ in this paper).1 Even though three in four athletes were reported to return to pre-injury levels of sports, it remains unknown if they also reach their pre-injury level of performance. Currently, RTS is frequently defined as a binary outcome (ie, either as having returned to sport or not).
This simple definition does not reflect the complexity of the dynamic RTS process; the more complex elements that constitute RTS were highlighted in the 2016 consensus statement on RTS.2 That statement recommends reporting RTS as a continuum from return to participation through return to sport and, finally, return to performance.2 This letter reports RTS rates following arthroscopy according to the continuum approach. In addition, patients’ satisfaction regarding RTS levels attained is presented.
Applying a cross-sectional study design, all patients undergoing arthroscopy at a single surgical clinic between 2014 and 2016 (n=208) were invited to respond to an online RTS survey and included in the study if they did not report further surgery following indexed arthroscopy (see the supplementary data). Patients were asked whether they had:
Not returned to any sport or exercise.
Returned to participation in a different sport or exercise than prior to hip symptoms.
Returned to participation in the same sport or exercise but on a lower performance level.
Returned to participation in the same sport or exercise on same or higher performance level than prior to hip symptoms.
Patients were also asked for satisfaction with their current level of sports activity (binary response yes/no) and to report time from arthroscopy to RTS (in months). Our study sample (n=127, 76% men, age 34.3 (10.13)) predominantly underwent arthroscopic cam resections. Mean time since surgery was 19.4 months (SD 10.4; range 3–39). Patients who had returned to their previous sport or exercise reported a mean RTS time of 8.1 (±3.8) months.
The majority of patients (89% (95% CI 82% to 93%)) had returned to sport when reporting RTS in traditional fashion, that is, all patients who had returned to participation in some sort of sport or exercise, which qualified them as having returned to sport. However, only 28% (95% CI 21% to 37%) participated in the same sport as prior to hip symptoms but at lower performance levels, and just 21% (95% CI 15% to 29%) participated in the same sport on same or higher performance levels. Among patients >6 months following arthroscopy, about half (46% (95% CI 37% to 56%)) reported satisfaction with current RTS level (figure 1).
By describing RTS rates on a continuum, results of this study showed that only one out of five patients participated at their previous level of performance at time of data collection. Hence, in light of our findings, previously reported RTS rates of 91%1 appear realistic in relation to a return to participation but overly optimistic in relation to return to pre-injury level of sport and performance. Our data cannot be extrapolated to elite settings, where high return rates have been reported.3 Our study sample comprises athletes with varying levels of sport and exercise participation. However, as the real-world population undergoing arthroscopy does not solely consist of young high-level athletes,4 our sample may be more representative of the typical patient.
Considering the rapid increase in performed arthroscopies5 and patient expectations that often exceed realistic outcomes,6 the increasing importance of providing accurate information to the rising number of patients presenting to our clinics, applicable to their individual goals regarding RTS, should be acknowledged. We hope that the findings of this study can assist clinicians in creating realistic patient expectations regarding the postoperative reality following arthroscopy.
The authors would like to thank all patients participating in the study.
Contributors The study was designed by TW, FE and KT. Data collection was performed by TW, FE, AS and HMO. Data analysis was performed by TW and FE. All authors critically revised the manuscript and approved of the final version.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Ethics approval The study was approved by the Lund University regional ethics board (Dnr:2016/1068).
Provenance and peer review Not commissioned; externally peer reviewed.
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