Functional Outcomes and Return to Sport Following Arthroscopic Surgery for Femoroacetabular Impingement in Rugby Union Players

Functional Outcomes and Return to Sport Following Arthroscopic Surgery for Femoroacetabular Impingement in Rugby Union Players | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Functional Outcomes and Return to Sport Following Arthroscopic Surgery for Femoroacetabular Impingement in Rugby Union Players Adrien Portet, Pierre-Jean Lambrey, Lebenin Souberou, Jean-Philippe Hager, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5388962/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: Femoroacetabular impingement (FAI) is a common cause of hip pain and decreased quality of life among athletes, particularly in sports involving multidirectional movements. Despite its prevalence, there is a lack of specific studies on the outcomes of FAI surgery in rugby union players (RUP). To analyze the functional results and return to sport (RTS) after arthroscopic surgery in RUP suffering from FAI. Methods: This before/after cohort study included RUP under 35 years who underwent primary hip arthroscopy for FAI. Data collected included demographic information, rugby level, type of FAI, and radiographic arthritis stage. Functional outcomes were measured using various scores, including Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), IHOT-12, Tegner Activity Scale (TAS), and Pain on Visual Analog Scale (VAS). Statistical analysis was performed to compare scores pre- and post-operatively and identify factors associated with return to rugby. Results: Forty-six hips in 36 patients were analyzed. At a mean follow-up of 3.9 years, significant improvements were observed in all functional scores, except the TAS. mHHS improved by +21.8 points, and the IHOT-12 by +46.1 points. 41% of patients returned to their previous or higher level of rugby, 46% resumed rugby at a lower level, and 13% ceased playing. Age, preoperative sports level, symptom duration, and radiographic arthritis stage were significant factors for partial resumption or cessation of rugby. Conclusion: Arthroscopic surgery for FAI in RUP yields satisfactory functional outcomes. However, factors such as age, preoperative sports level, symptom duration, and radiographic arthritis stage significantly influence the likelihood of RTS. Study design: Level IV, Retrospective cohort study femoroacetabular impingement Hip surgery Rugby return to sport Figures Figure 1 Introduction Hip and groin pains present significant rehabilitation challenges for many athletes and can account for between 10–23% of all injuries in pivot-contact sports [ 1 – 5 ]. Femoroacetabular Impingement (FAI) is three times more likely to occur in athletes than in the general population and is more commonly described in men [ 6 ]. It is defined as impingement of the junction between the femoral head and neck with the acetabular rim [ 7 ], ultimately leading to damage to the hip joint, such as damage to the labrum and possibly osteoarthritis [ 8 – 10 ]. The diagnosic criteria of FAI was defined in the Warwick Agreement and is based on a triad of symptoms, clinical signs and imaging findings [ 11 ]. FAI can initially be treated with conservative care, including intra-articular injection and physiotherapy [ 12 , 13 ]. The alternative treatment is surgery (arthroscopic or open) aimed at correcting the hip morphology to achieve impingement-free movement. Meta-analyses by Zhu et al [ 14 ] and Gatz et al [ 15 ] have demonstrated the superiority of surgical treatment over conservative treatment. There are currently numerous series on the return to sport and functional results after FAI surgery in footballers[ 16 ], basketball players [ 17 ] and hockey players [ 18 ], with satisfactory results and a high rate of return to sport. However, there is very little data on rugby union players (RUP), apart from a case report of a player who underwent bilateral FAI surgery [ 19 ]. The primary objective of this study was to analyze the return to sport and functional outcomes in this population of RUP, which is underrepresented in the literature, who have undergone surgery for FAI. The secondary objective was to analyze the factors associated with partial return to or cessation of rugby. Our hypothesis was that more than 50% of RUP operated on for FAI were able to resume this activity at an equivalent or higher level. Material and Method This was a monocentric, single-operator, before/after study. The study received IRB approval from our local committee (IRB00010835). The collection of patients functional scores during follow-up is part of standard care. Inclusion criteria were RUP under 35 years undergoing primary hip arthroscopy for FAI after failing conservative treatment (defined as at least 6 months of physiotherapy and resistant to intra-articular injections). Exclusion criteria included previous surgery on the same hip or cessation of rugby at least 6 months before surgery without intention to resume. Between 2012 and 2023, 831 hip arthroscopies for FAI were performed at our center. We were able to identify 55 hips from 43 RUP through the medical records. Three patients (3 hips) were excluded because they had stopped playing rugby at least 6 months before the surgery and did not wish to resume. Five patients (6 hips) were lost to follow-up, representing 11.5% of the cohort. A total of 46 hips (36 patients) were analyzed (Fig. 1 ). Surgical Technique: All patients underwent the “outside in extracapsular approach” described by Thaunat et al [ 20 ]. Three portals were used: anteromedial, anterolateral, and distal. Capsular incision was followed by traction to explore the joint cavity and suture potential labral tears. Twenty-nine hips (63%) had a labral lesion requiring debridement and reattachment with anchors. After traction release, femoral cam resection was performed using a motorized burr. Multiple fluoroscopic images ensured optimal correction. The capsule was closed post-resection, and patients were allowed weight-bearing with crutches for one month. Preventive anticoagulation is prescribed for 10 days, along with extended-release nonsteroidal anti-inflammatory drugs (NSAIDs) for 15 days, and analgesics adjusted to pain levels. Physiotherapy started immediately postoperatively, initially passive, then active, avoiding external rotation for one month. Outcome Measures: Primary outcome was functional evolution between the preoperative period and the last follow-up using various scores: Harris Hip Score (mHHS)[ 21 ], Non-Arthritic Hip Score (NAHS)[ 22 ], International Hip Outcome Tool-12 (iHOT-12)[ 23 ], Tegner Activity Scale (TAS)[ 24 ], and pain on visual analog scale (VAS). Secondary outcomes included the number of patients resuming rugby and factors associated with partial resumption or cessation. Demographic data collected included age, sex, body mass index (BMI), symptom duration, rugby level before surgery (amateur, semi-professional, and professional), player position, FAI type, and Tonnis grade on true anteroposterior x rays [ 25 ]. Amateur players do not receive a salary for playing rugby. They may have full-time or part-time jobs outside of rugby and primarily play for leisure or passion. Semi-professional players receive compensation for playing, but this does not constitute their main source of income. They may have parallel jobs but dedicate a significant amount of their time to rugby. Professional players, on the other hand, are compensated full-time for their rugby activities. Rugby is their primary source of income, and they train and compete at a high competitive level. Intraoperative data included cartilage wear using Beck classification [ 26 ] and the labrum management (suture and number of anchors). Postoperative complications, surgical revisions, return-to-sport (RTS) duration after surgery were collected. Reasons for rugby cessation, and patient satisfaction (rated on a Likert scale by the patient from 0 (no result) to 10 (optimal result)) were also recorded at last follow up. Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS) were calculated for mHHS (MCID, 8 points; PASS, 74) and iHOT-12 (MCID, 13 points; PASS, 75,2)[ 27 ]. The factors analyzed for their association with the cessation or partial resumption of rugby were as follows: age, BMI, level of sport, playing position, duration of symptoms, radiographic and arthroscopic stage of arthritis, type of FAI, and labrum repair. Statistical Analysis: Qualitative variables were described by frequencies and percentages, and quantitative variables by mean and standard deviation. Differences in scores before and after surgery were evaluated using Wilcoxon tests. Factors associated with rugby cessation or partial resumption were analyzed using univariate logistic regressions. Significance was set at p < 0.05, and analyses were performed using R software (version 4.2.1 (2022-06-23)). Results For the 46 included hips, the mean age at the time of surgery was 22.5 +/- 5.3 years, with males representing 98% of the cohort (n=45), and the mean BMI was 26.1 +/- 4.3 kg/m2. Twenty-nine (63%) hips were amateur level, 10 (22%) semi-professional, and 7 (15%) professionals. The backs represented 54% of the patients operated on for FAI with a predominance for the fly-half position (22%). The mean duration of symptoms before surgery was 3.3 +/- 4 years. Twenty-six hips were Tönnis 0 (57%) and 3 hips (6%) were Tönnis 2. Mixed-type FAI was predominant with 29 hips (63%). There was no pincer-type FAI. Forty-four (96%) had grade ≥ 2 cartilage lesions on Beck classification during perioperative assessment. Labrum repair and reattachment were performed for 29 hips (63%). The characteristics of the patients at inclusion are described in Table 1. Functional Outcome Analysis: With a mean follow-up of 3.9 (2.6) years, there was a significant improvement in all functional scores (Table 2). Indeed, between the preoperative period and the last follow-up, the VAS decreased by 4 points; mHHS and NAHS showed almost similar improvements with 21.8 points and 21.7 points, respectively. iHOT-12 improved by 46.1 points. Furthermore, for mHHS and iHOT-12, 76% and 93% of patients achieved the MCID, respectively; 91% and 82% achieved the PASS. Only the Tegner score showed a significant decrease of 0.8 points at the last follow-up. The patient satisfaction score at the last follow-up was 8.2 (2.1). Analysis of Factors Associated with Rugby Cessation or Partial Resumption: Across the entire cohort, no surgical revisions were performed. The mean time between surgery and RTS was 4.4 +/- 3.4 months. At the last follow-up, 16 patients (41%, 19 hips) had resumed rugby at the same or a higher level than before surgery. Fifteen patients (46%, 21 hips) had resumed rugby but did not regain their pre-surgical level, and 5 patients (13%, 6 hips) had permanently stopped playing rugby. The reported reasons for permanent cessation or partial resumption were persistent pain for 8 patients (41%, 11 hips), apprehension for 11 patients (56%, 15 hips), and a lifestyle change for 1 patient (3%, 1 hip). Among the 5 professional players (7 hips), 4 (86%, 6 hips) had resumed at the same level, and 1 (14%) had resumed but without regaining his previous level. Among the 8 semi-professional players (10 hips), 5 (62.5%, 6 hips) had resumed at the same level, and 3 (37.5%, 4 hips) had resumed but at a lower level. Among the 22 amateur players (29 hips), 7 (32%, 7 hips) had resumed at the same level, 10 (45%, 15 hips) had resumed but at a lower level, and 5 (23%, 7 hips) had permanently stopped playing rugby. Age, preoperative sports level, duration of symptoms before surgery, and radiographic stage were factors associated with partial resumption or non-resumption of rugby after surgery. An increase in age raised the risk of stopping or partially resuming rugby by 21%. When the preoperative sports level was professional or semi-professional, the risk of stopping or partially resuming was reduced by 78%. An increased radiographic stage multiplied the risk of stopping or partial resumption of rugby by 3.44. Finally, a longer duration of symptoms before surgery increased the risk of stopping or partial resumption by 27%. Table 3 shows the factors associated with partial resumption and/or cessation of rugby. Discussion At an mean follow-up of 3.9 +/- 2.6 years, this study showed significant improvement in all functional scores, except for the Tegner score, after arthroscopic surgery for FAI in RUP with very satisfactory PASS and MCID rates for IHOT-12 and mHHS. Despite very encouraging results, only 41% of players were able to resume rugby at the same or a higher level, 46% resumed but did not regain their previous level, and 15% had to stop permanently. These results invalidate our initial hypothesis, namely that more than 50% of rugby players who underwent surgery were able to resume their rugby activities at an equivalent or higher level. The significant reduction in the Tegner score bears witness to these results. Annin et al [ 28 ] in a systematic review of athletes of all levels, found significant improvement in all functional scores; however, over 70% of operated patients resumed sport at the same or a higher level. This difference can be explained by the physical demands of rugby. Indeed, once the injuries are established by large and repeated movements, participation in a high-impact sport can limit the players' return, unlike other sports that may be less demanding from a functional standpoint. Minkara et al [ 29 ] in a meta-analysis including 1981 hips found a return to sport similar to ours of 87.7% without specifying the level of return. There is a notable disparity in our results based on the preoperative level of the player. Indeed, 86% of professional players regained their previous level compared to only 32% of amateur players. When the preoperative sports level was professional or semi-professional, the risk of stopping or partial resumption was reduced by 78%. These findings are observed in the meta-analysis by Reiman et al [ 30 ] with significantly higher return-to-sport rates among professional athletes compared to non-professional athletes. We observe that the mean return to sport after surgery in this meta-analysis was 7 months, compared to just 4.4 months in our study. Like Lindman et al [ 31 ], who evaluated 64 elite athletes at 5 years after FAI surgery, we found that advanced age and longer symptom duration before surgery were significant factors associated with partial resumption or cessation of sport. Similar to the position of a hockey goalie [ 32 ] facing movements that favor similar conditions during stops, it is interesting to note that the fly-half position was the most represented in our cohort. This position involves frequent kicking, reproducing the flexion-adduction-internal rotation movement, which increases the risk of labral conflict and hip injury in the presence of FAI [ 26 ]. In this cohort, advanced radiographic arthritis increased the risk of stopping or partial resumption of rugby by 3.44. Byrd et al [ 33 , 34 ] did not find significant differences in functional scores and return to sport according to arthritis progression. However, Chandresekaran et al [ 35 ] showed a 40.5% conversion rate to arthroplasty at 2-year follow-up for patients with Tönnis grade 2, compared to a 10.8% conversion rate among a matched group with Tönnis grades 0 or 1. Farrell et al [ 36 ] evaluated 20 professional rugby players from an Irish province by MRI and clinically. The MRI results showed that 95% of the players had an abnormality on imaging, 80% had a labrum tear, 55% had a CFA and 25% had chondral lesions. These results show the need for regular screening for hip pathologies in this category of sportsmen and women, where the risk of injury is high and the consequences can be serious. The strength of this study is that it is, to our knowledge, the first cohort describing the functional outcomes of arthroscopic FAI surgery in RUP. Additionally, the use of multiple PROMs improves the representativeness and reliability of our results. The study's limitations include its monocentric, single operator and the small number of included patients. Furthermore, 11.5% of patients were lost to follow-up. Conclusion Arthroscopic surgery for FAI in RUP shows very satisfactory functional outcomes. Age, preoperative sports level, symptom duration before surgery, and radiographic stage were factors associated with partial resumption or non-resumption of rugby after surgery. Abbreviations BMI : Body Mass Index FAI : Femoroacetabular Impingement iHOT-12 : International Hip Outcome Tool-12 IRB : Institutional Review Board MCID : Minimal Clinically Important Difference mHHS : Modified Harris Hip Score NAHS : Non-Arthritic Hip Score PASS : Patient Acceptable Symptom State RTS : Return to Sport RUP : Rugby Union Players TAS : Tegner Activity Scale VAS : Visual Analog Scale Declarations Informed consent: All patients gave valid consent to participate Human ethics and consent to participate declaration (IRB) Référence Direction Recherche et Enseignement Ramsay Santé COS-RGDS-2024-06-005-THAUNAT-M – n° RB00010835 Competing Interests Dr Mathieu Thaunat, has potential conflict of interest. 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J Sci Med Sport 19:893–897. https://doi.org/10.1016/j.jsams.2016.01.005 Tables Table 1: Patient Characteristics (n = 46 hips) Variable Value Age at surgery (y, SD) 22,5 (5,3) Sexe (n, %) - Male - Female 45 (98 %) 1 (2 %) Lateraly (n, %) - Left - Right 24 (52 %) 22 (48 %) BMI (kg/m 2 , SD) 26,1 (4,3) Level of play (n, %) - Amateur - Semi Professional - Professional 29 (63 %) 10 (22%) 7 (15 %) Playing position (n, %) - Prop - Hooker - Lock - Flanker - Scrum-half - Fly-half - Centre - Wing - Fullback 2 (4 %) 4 (9 %) 7 (15 %) 8 (18 %) 2 (4 %) 10 (22 %) 5 (11 %) 6 (13 %) 2 (4 %) FAI type (n, %) - Cam - Pincer - Mixed 17 (37%) 0 (0 %) 29 (63 %) Tönnis grade (n, %) - 0 - 1 - 2 26 (57 %) 17 (37 %) 3 (6 %) Beck grade (n, %) - 0 - 1 - 2 - 3 - 4 1 (2 %) 1 (2 %) 19 (42 %) 18 (40 %) 7 (14 %) Labrum reattachment (n, %) - Yes - No 29 (63 %) 17 (37 %) S D : Standard Deviation, BMI : Body Mass Index, FAI : Femoroacetabular Impingement Table 2: Outcome Scores and MCID/PASS Achievement Outcome Measure* Preoperative Last Follow-Up Δ Post vs Pre p Achieved MCID* Achieved PASS* VAS 5,3 (1) 1,3 (1,7) -4 <0,01 Tegner 7,8 (1,1) 7 (1) -0,8 <0,01 HHSm 65,4 (15,2) 87,2 (7) +21,8 <0,01 35/46 (76%) 42/46 (91%) NAHS 67,8 (14,9) 89,5 (6,9) +21,7 <0,01 IHOT-12 39,7 (15,7) 85,5 (11,4) +45,8 <0,01 43/46 (93%) 38/46 (82%) Satisfaction 8,2 (2,1) *MCID: Minimal Clinically Important Difference, PASS: Patient Acceptable Symptom State, VAS: Visual Analog Scale, mHHS: Modified Harris Hip Score, NAHS: Non-Arthritic Hip Score, IHOT-12: International hip outcome tool-12 Table 3: factors associated with partial resumption and cessation of rugby. Variable OR (CI-95%)* p-value Age 1,21 (1,07 – 1,43) < 0,05 BMI* 1,145 (0,98 – 1,38) 0,108 Level of practice 0,22 (0,07 – 0,58) < 0,05 Playing position 0,92 (0,25 – 3,22) 0,24 Duration of symptom before surgery 1,27 (1,01 – 1,83) < 0,05 Radiographic stage 3,44 (1,18 – 12,33) < 0,05 Arthroscopic stage 1,96 (0,94 – 4,64) 0,07 FAI type* 1,78 (0,97 – 3,4) 0,06 Labrum reattachment 0,99 (0,29 – 3,35) 0,99 *OR: Odd-Ratio, CI: Confidence interval, BMI: Body Mass Index, FAI: Femoroacetabular Impingement Additional Declarations Competing interest reported. Dr Mathieu Thaunat, has potential conflict of interest. Dr Thaunat is consultant for Arthrex Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5388962","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":377358065,"identity":"c96f32cd-ab83-462f-bde3-70a672864010","order_by":0,"name":"Adrien Portet","email":"","orcid":"","institution":"Ramsay Santé, Hôpital Privé Jean Mermoz","correspondingAuthor":false,"prefix":"","firstName":"Adrien","middleName":"","lastName":"Portet","suffix":""},{"id":377358066,"identity":"fe03163d-44b2-4870-9f31-9ca0b7604be4","order_by":1,"name":"Pierre-Jean Lambrey","email":"","orcid":"","institution":"Centre Hospitalier Universitaire de Lille","correspondingAuthor":false,"prefix":"","firstName":"Pierre-Jean","middleName":"","lastName":"Lambrey","suffix":""},{"id":377358067,"identity":"799708c1-e6fd-451f-8c3f-dfa4063fe9ff","order_by":2,"name":"Lebenin Souberou","email":"","orcid":"","institution":"Ramsay Santé, Hôpital Privé Jean Mermoz","correspondingAuthor":false,"prefix":"","firstName":"Lebenin","middleName":"","lastName":"Souberou","suffix":""},{"id":377358068,"identity":"e10886a8-8300-4b4e-9d22-0901d93aaaae","order_by":3,"name":"Jean-Philippe Hager","email":"","orcid":"","institution":"Ramsay Santé, Hôpital Privé Jean Mermoz","correspondingAuthor":false,"prefix":"","firstName":"Jean-Philippe","middleName":"","lastName":"Hager","suffix":""},{"id":377358069,"identity":"a9f3737b-6c6d-4f73-a261-59e45de57cd0","order_by":4,"name":"Mathieu Thaunat","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYHACNoYEIGkA4dgwMEhAadyAGaxFAqIlIQ2qJY2AFgaElsOEtei2nz/24EHF4Tpz9jNmD37+OJ/YP7v54AOGhHs4tZidSWY3SDhzWMKyJ8fcsCfhduKMO8eSDRgSinFrOZDMJpHYdljC4ECOmQQPUEvDDSCD8UcCbi3nHwO1/ANqOf/GTPJPwrnE+SAtDAl4tNwA2dIA1AJUKc2TcCBxA2Etj80kEo6lS2648axMWiYt2XjjjbRkgwR8Ws4nPpP8UWPNb3A+eZvkGxs72Xk3kg8++IBHCwZwbACRJGhgYLAnRfEoGAWjYBSMDAAAycNZK1hCDQYAAAAASUVORK5CYII=","orcid":"","institution":"Ramsay Santé, Hôpital Privé Jean Mermoz","correspondingAuthor":true,"prefix":"","firstName":"Mathieu","middleName":"","lastName":"Thaunat","suffix":""}],"badges":[],"createdAt":"2024-11-04 14:38:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5388962/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5388962/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":71556070,"identity":"90e21372-a592-4537-93a0-41047514878e","added_by":"auto","created_at":"2024-12-16 16:23:41","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":323504,"visible":true,"origin":"","legend":"\u003cp\u003eFlow-Chart of the Study\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5388962/v1/b883209ffac0500031935388.jpg"},{"id":76521211,"identity":"f6a25914-94c0-47b5-8882-30e4c36785e1","added_by":"auto","created_at":"2025-02-18 04:46:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":978431,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5388962/v1/a1e23423-bc6b-4f04-83e9-2c25cf24238d.pdf"}],"financialInterests":"Competing interest reported. Dr Mathieu Thaunat, has potential conflict of interest. Dr Thaunat is consultant for Arthrex","formattedTitle":"Functional Outcomes and Return to Sport Following Arthroscopic Surgery for Femoroacetabular Impingement in Rugby Union Players","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHip and groin pains present significant rehabilitation challenges for many athletes and can account for between 10\u0026ndash;23% of all injuries in pivot-contact sports [\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Femoroacetabular Impingement (FAI) is three times more likely to occur in athletes than in the general population and is more commonly described in men [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. It is defined as impingement of the junction between the femoral head and neck with the acetabular rim [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], ultimately leading to damage to the hip joint, such as damage to the labrum and possibly osteoarthritis [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The diagnosic criteria of FAI was defined in the Warwick Agreement and is based on a triad of symptoms, clinical signs and imaging findings [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFAI can initially be treated with conservative care, including intra-articular injection and physiotherapy [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The alternative treatment is surgery (arthroscopic or open) aimed at correcting the hip morphology to achieve impingement-free movement.\u003c/p\u003e \u003cp\u003eMeta-analyses by Zhu et al [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and Gatz et al [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] have demonstrated the superiority of surgical treatment over conservative treatment.\u003c/p\u003e \u003cp\u003eThere are currently numerous series on the return to sport and functional results after FAI surgery in footballers[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], basketball players [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and hockey players [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], with satisfactory results and a high rate of return to sport. However, there is very little data on rugby union players (RUP), apart from a case report of a player who underwent bilateral FAI surgery [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe primary objective of this study was to analyze the return to sport and functional outcomes in this population of RUP, which is underrepresented in the literature, who have undergone surgery for FAI. The secondary objective was to analyze the factors associated with partial return to or cessation of rugby. Our hypothesis was that more than 50% of RUP operated on for FAI were able to resume this activity at an equivalent or higher level.\u003c/p\u003e"},{"header":"Material and Method","content":"\u003cp\u003eThis was a monocentric, single-operator, before/after study. The study received IRB approval from our local committee (IRB00010835).\u003c/p\u003e \u003cp\u003eThe collection of patients functional scores during follow-up is part of standard care.\u003c/p\u003e \u003cp\u003eInclusion criteria were RUP under 35 years undergoing primary hip arthroscopy for FAI after failing conservative treatment (defined as at least 6 months of physiotherapy and resistant to intra-articular injections). Exclusion criteria included previous surgery on the same hip or cessation of rugby at least 6 months before surgery without intention to resume.\u003c/p\u003e \u003cp\u003eBetween 2012 and 2023, 831 hip arthroscopies for FAI were performed at our center. We were able to identify 55 hips from 43 RUP through the medical records. Three patients (3 hips) were excluded because they had stopped playing rugby at least 6 months before the surgery and did not wish to resume. Five patients (6 hips) were lost to follow-up, representing 11.5% of the cohort. A total of 46 hips (36 patients) were analyzed (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSurgical Technique:\u003c/p\u003e \u003cp\u003eAll patients underwent the \u0026ldquo;outside in extracapsular approach\u0026rdquo; described by Thaunat et al [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Three portals were used: anteromedial, anterolateral, and distal. Capsular incision was followed by traction to explore the joint cavity and suture potential labral tears. Twenty-nine hips (63%) had a labral lesion requiring debridement and reattachment with anchors. After traction release, femoral cam resection was performed using a motorized burr. Multiple fluoroscopic images ensured optimal correction. The capsule was closed post-resection, and patients were allowed weight-bearing with crutches for one month. Preventive anticoagulation is prescribed for 10 days, along with extended-release nonsteroidal anti-inflammatory drugs (NSAIDs) for 15 days, and analgesics adjusted to pain levels. Physiotherapy started immediately postoperatively, initially passive, then active, avoiding external rotation for one month.\u003c/p\u003e \u003cp\u003eOutcome Measures:\u003c/p\u003e \u003cp\u003ePrimary outcome was functional evolution between the preoperative period and the last follow-up using various scores: Harris Hip Score (mHHS)[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], Non-Arthritic Hip Score (NAHS)[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], International Hip Outcome Tool-12 (iHOT-12)[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], Tegner Activity Scale (TAS)[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], and pain on visual analog scale (VAS). Secondary outcomes included the number of patients resuming rugby and factors associated with partial resumption or cessation.\u003c/p\u003e \u003cp\u003eDemographic data collected included age, sex, body mass index (BMI), symptom duration, rugby level before surgery (amateur, semi-professional, and professional), player position, FAI type, and Tonnis grade on true anteroposterior x rays [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmateur players do not receive a salary for playing rugby. They may have full-time or part-time jobs outside of rugby and primarily play for leisure or passion. Semi-professional players receive compensation for playing, but this does not constitute their main source of income. They may have parallel jobs but dedicate a significant amount of their time to rugby. Professional players, on the other hand, are compensated full-time for their rugby activities. Rugby is their primary source of income, and they train and compete at a high competitive level.\u003c/p\u003e \u003cp\u003eIntraoperative data included cartilage wear using Beck classification [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and the labrum management (suture and number of anchors). Postoperative complications, surgical revisions, return-to-sport (RTS) duration after surgery were collected. Reasons for rugby cessation, and patient satisfaction (rated on a Likert scale by the patient from 0 (no result) to 10 (optimal result)) were also recorded at last follow up. Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS) were calculated for mHHS (MCID, 8 points; PASS, 74) and iHOT-12 (MCID, 13 points; PASS, 75,2)[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe factors analyzed for their association with the cessation or partial resumption of rugby were as follows: age, BMI, level of sport, playing position, duration of symptoms, radiographic and arthroscopic stage of arthritis, type of FAI, and labrum repair.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis:\u003c/h2\u003e \u003cp\u003eQualitative variables were described by frequencies and percentages, and quantitative variables by mean and standard deviation. Differences in scores before and after surgery were evaluated using Wilcoxon tests. Factors associated with rugby cessation or partial resumption were analyzed using univariate logistic regressions. Significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, and analyses were performed using R software (version 4.2.1 (2022-06-23)).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFor the 46 included hips, the mean age at the time of surgery was 22.5 +/- 5.3 years, with males representing 98% of the cohort (n=45), and the mean BMI was 26.1 +/- \u0026nbsp; 4.3 kg/m2. Twenty-nine (63%) hips were amateur level, 10 (22%) semi-professional, and 7 (15%) professionals. The backs represented 54% of the patients operated on for FAI with a predominance for the fly-half position (22%). The mean duration of symptoms before surgery was 3.3 +/- 4 years. Twenty-six hips were T\u0026ouml;nnis 0 (57%) and 3 hips (6%) were T\u0026ouml;nnis 2. Mixed-type FAI was predominant with 29 hips (63%). There was no pincer-type FAI. Forty-four (96%) had grade \u0026ge; 2 cartilage lesions on Beck classification during perioperative assessment. Labrum repair and reattachment were performed for 29 hips (63%). The characteristics of the patients at inclusion are described in Table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunctional Outcome Analysis:\u003c/p\u003e\n\u003cp\u003eWith a mean follow-up of 3.9 (2.6) years, there was a significant improvement in all functional scores (Table 2). Indeed, between the preoperative period and the last follow-up, the VAS decreased by 4 points; mHHS and NAHS showed almost similar improvements with 21.8 points and 21.7 points, respectively. iHOT-12 improved by 46.1 points. Furthermore, for mHHS and iHOT-12, 76% and 93% of patients achieved the MCID, respectively; 91% and 82% achieved the PASS. Only the Tegner score showed a significant decrease of 0.8 points at the last follow-up. The patient satisfaction score at the last follow-up was 8.2 (2.1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnalysis of Factors Associated with Rugby Cessation or Partial Resumption:\u003c/p\u003e\n\u003cp\u003eAcross the entire cohort, no surgical revisions were performed. The mean time between surgery and RTS was 4.4 +/- 3.4 months. At the last follow-up, 16 patients (41%, 19 hips) had resumed rugby at the same or a higher level than before surgery. Fifteen patients (46%, 21 hips) had resumed rugby but did not regain their pre-surgical level, and 5 patients (13%, 6 hips) had permanently stopped playing rugby. The reported reasons for permanent cessation or partial resumption were persistent pain for 8 patients (41%, 11 hips), apprehension for 11 patients (56%, 15 hips), and a lifestyle change for 1 patient (3%, 1 hip). Among the 5 professional players (7 hips), 4 (86%, 6 hips) had resumed at the same level, and 1 (14%) had resumed but without regaining his previous level. Among the 8 semi-professional players (10 hips), 5 (62.5%, 6 hips) had resumed at the same level, and 3 (37.5%, 4 hips) had resumed but at a lower level. Among the 22 amateur players (29 hips), 7 (32%, 7 hips) had resumed at the same level, 10 (45%, 15 hips) had resumed but at a lower level, and 5 (23%, 7 hips) had permanently stopped playing rugby. Age, preoperative sports level, duration of symptoms before surgery, and radiographic stage were factors associated with partial resumption or non-resumption of rugby after surgery. An increase in age raised the risk of stopping or partially resuming rugby by 21%. When the preoperative sports level was professional or semi-professional, the risk of stopping or partially resuming was reduced by 78%. An increased radiographic stage multiplied the risk of stopping or partial resumption of rugby by 3.44. Finally, a longer duration of symptoms before surgery increased the risk of stopping or partial resumption by 27%. Table 3 shows the factors associated with partial resumption and/or cessation of rugby.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAt an mean follow-up of 3.9 +/- 2.6 years, this study showed significant improvement in all functional scores, except for the Tegner score, after arthroscopic surgery for FAI in RUP with very satisfactory PASS and MCID rates for IHOT-12 and mHHS. Despite very encouraging results, only 41% of players were able to resume rugby at the same or a higher level, 46% resumed but did not regain their previous level, and 15% had to stop permanently. These results invalidate our initial hypothesis, namely that more than 50% of rugby players who underwent surgery were able to resume their rugby activities at an equivalent or higher level. The significant reduction in the Tegner score bears witness to these results.\u003c/p\u003e \u003cp\u003eAnnin et al [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] in a systematic review of athletes of all levels, found significant improvement in all functional scores; however, over 70% of operated patients resumed sport at the same or a higher level. This difference can be explained by the physical demands of rugby. Indeed, once the injuries are established by large and repeated movements, participation in a high-impact sport can limit the players' return, unlike other sports that may be less demanding from a functional standpoint. Minkara et al [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] in a meta-analysis including 1981 hips found a return to sport similar to ours of 87.7% without specifying the level of return. There is a notable disparity in our results based on the preoperative level of the player. Indeed, 86% of professional players regained their previous level compared to only 32% of amateur players. When the preoperative sports level was professional or semi-professional, the risk of stopping or partial resumption was reduced by 78%. These findings are observed in the meta-analysis by Reiman et al [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] with significantly higher return-to-sport rates among professional athletes compared to non-professional athletes. We observe that the mean return to sport after surgery in this meta-analysis was 7 months, compared to just 4.4 months in our study.\u003c/p\u003e \u003cp\u003eLike Lindman et al [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], who evaluated 64 elite athletes at 5 years after FAI surgery, we found that advanced age and longer symptom duration before surgery were significant factors associated with partial resumption or cessation of sport. Similar to the position of a hockey goalie [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] facing movements that favor similar conditions during stops, it is interesting to note that the fly-half position was the most represented in our cohort. This position involves frequent kicking, reproducing the flexion-adduction-internal rotation movement, which increases the risk of labral conflict and hip injury in the presence of FAI [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this cohort, advanced radiographic arthritis increased the risk of stopping or partial resumption of rugby by 3.44. Byrd et al [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] did not find significant differences in functional scores and return to sport according to arthritis progression. However, Chandresekaran et al [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] showed a 40.5% conversion rate to arthroplasty at 2-year follow-up for patients with T\u0026ouml;nnis grade 2, compared to a 10.8% conversion rate among a matched group with T\u0026ouml;nnis grades 0 or 1. Farrell et al [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] evaluated 20 professional rugby players from an Irish province by MRI and clinically. The MRI results showed that 95% of the players had an abnormality on imaging, 80% had a labrum tear, 55% had a CFA and 25% had chondral lesions. These results show the need for regular screening for hip pathologies in this category of sportsmen and women, where the risk of injury is high and the consequences can be serious.\u003c/p\u003e \u003cp\u003eThe strength of this study is that it is, to our knowledge, the first cohort describing the functional outcomes of arthroscopic FAI surgery in RUP. Additionally, the use of multiple PROMs improves the representativeness and reliability of our results. The study's limitations include its monocentric, single operator and the small number of included patients. Furthermore, 11.5% of patients were lost to follow-up.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eArthroscopic surgery for FAI in RUP shows very satisfactory functional outcomes. Age, preoperative sports level, symptom duration before surgery, and radiographic stage were factors associated with partial resumption or non-resumption of rugby after surgery.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBMI : Body Mass Index\u003c/p\u003e\n\u003cp\u003eFAI : Femoroacetabular Impingement\u003c/p\u003e\n\u003cp\u003eiHOT-12 : International Hip Outcome Tool-12\u003c/p\u003e\n\u003cp\u003eIRB : Institutional Review Board\u003c/p\u003e\n\u003cp\u003eMCID : Minimal Clinically Important Difference\u003c/p\u003e\n\u003cp\u003emHHS : Modified Harris Hip Score\u003c/p\u003e\n\u003cp\u003eNAHS : Non-Arthritic Hip Score\u003c/p\u003e\n\u003cp\u003ePASS : Patient Acceptable Symptom State\u003c/p\u003e\n\u003cp\u003eRTS : Return to Sport\u003c/p\u003e\n\u003cp\u003eRUP : Rugby Union Players\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTAS : Tegner Activity Scale\u003c/p\u003e\n\u003cp\u003eVAS : Visual Analog Scale\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eInformed consent:\u003c/h2\u003e\n\u003cp\u003eAll patients gave valid consent to participate\u003c/p\u003e\n\u003ch2\u003eHuman ethics and consent to participate declaration (IRB)\u003c/h2\u003e\n\u003cp\u003eR\u0026eacute;f\u0026eacute;rence Direction Recherche et Enseignement Ramsay Sant\u0026eacute; COS-RGDS-2024-06-005-THAUNAT-M \u0026ndash; n\u0026deg; RB00010835\u003c/p\u003e\n\u003ch2\u003eCompeting Interests\u003c/h2\u003e\n\u003cp\u003eDr Mathieu Thaunat, has potential conflict of interest. Dr Thaunat is consultant for Arthrex\u003c/p\u003e\n\u003ch2\u003eFundings:\u003c/h2\u003e\n\u003cp\u003eNo funding was obtained for this study\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eAP : data collection, writing, proofreadingPJL : writing, proofreadingLS : data collection JPH : design, proofreading MT : design, proofreading\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWerner J, H\u0026auml;gglund M, Wald\u0026eacute;n M, Ekstrand J (2009) UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med 43:1036\u0026ndash;1040. https://doi.org/10.1136/bjsm.2009.066944\u003c/li\u003e\n\u003cli\u003eH\u0026ouml;lmich P, Thorborg K, Dehlendorff C, et al (2014) Incidence and clinical presentation of groin injuries in sub-elite male soccer. Br J Sports Med 48:1245\u0026ndash;1250. https://doi.org/10.1136/bjsports-2013-092627\u003c/li\u003e\n\u003cli\u003eEpstein DM, McHugh M, Yorio M, Neri B (2013) Intra-articular hip injuries in national hockey league players: a descriptive epidemiological study. Am J Sports Med 41:343\u0026ndash;348. https://doi.org/10.1177/0363546512467612\u003c/li\u003e\n\u003cli\u003eJackson TJ, Starkey C, McElhiney D, Domb BG (2013) Epidemiology of Hip Injuries in the National Basketball Association: A 24-Year Overview. Orthop J Sports Med 1:2325967113499130. https://doi.org/10.1177/2325967113499130\u003c/li\u003e\n\u003cli\u003eFeeley BT, Powell JW, Muller MS, et al (2008) Hip injuries and labral tears in the national football league. Am J Sports Med 36:2187\u0026ndash;2195. https://doi.org/10.1177/0363546508319898\u003c/li\u003e\n\u003cli\u003eFrank JM, Harris JD, Erickson BJ, et al (2015) Prevalence of Femoroacetabular Impingement Imaging Findings in Asymptomatic Volunteers: A Systematic Review. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 31:1199\u0026ndash;1204. https://doi.org/10.1016/j.arthro.2014.11.042\u003c/li\u003e\n\u003cli\u003eTibor LM, Leunig M (2012) The pathoanatomy and arthroscopic management of femoroacetabular impingement. Bone Jt Res 1:245\u0026ndash;257. https://doi.org/10.1302/2046-3758.110.2000105\u003c/li\u003e\n\u003cli\u003eTannast M, Goricki D, Beck M, et al (2008) Hip damage occurs at the zone of femoroacetabular impingement. Clin Orthop 466:273\u0026ndash;280. https://doi.org/10.1007/s11999-007-0061-y\u003c/li\u003e\n\u003cli\u003eAgricola R, Heijboer MP, Bierma-Zeinstra SMA, et al (2013) Cam impingement causes osteoarthritis of the hip: a nationwide prospective cohort study (CHECK). Ann Rheum Dis 72:918\u0026ndash;923. https://doi.org/10.1136/annrheumdis-2012-201643\u003c/li\u003e\n\u003cli\u003eZhang C, Li L, Forster BB, et al (2015) Le conflit f\u0026eacute;moro-ac\u0026eacute;tabulaire et la coxarthrose. Can Fam Physician 61:e535\u0026ndash;e541\u003c/li\u003e\n\u003cli\u003eGriffin DR, Dickenson EJ, O\u0026rsquo;Donnell J, et al (2016) The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med 50:1169\u0026ndash;1176. https://doi.org/10.1136/bjsports-2016-096743\u003c/li\u003e\n\u003cli\u003ePennock AT, Bomar JD, Johnson KP, et al (2018) Nonoperative Management of Femoroacetabular Impingement: A Prospective Study. Am J Sports Med 46:3415\u0026ndash;3422. https://doi.org/10.1177/0363546518804805\u003c/li\u003e\n\u003cli\u003eWall PDH, Fernandez M, Griffin DR, Foster NE (2013) Nonoperative treatment for femoroacetabular impingement: a systematic review of the literature. PM R 5:418\u0026ndash;426. https://doi.org/10.1016/j.pmrj.2013.02.005\u003c/li\u003e\n\u003cli\u003eZhu Y, Su P, Xu T, et al (2022) Conservative therapy versus arthroscopic surgery of femoroacetabular impingement syndrome (FAI): a systematic review and meta-analysis. J Orthop Surg 17:296. https://doi.org/10.1186/s13018-022-03187-1\u003c/li\u003e\n\u003cli\u003eGatz M, Driessen A, Eschweiler J, et al (2020) Arthroscopic surgery versus physiotherapy for femoroacetabular impingement: a meta-analysis study. Eur J Orthop Surg Traumatol Orthop Traumatol 30:1151\u0026ndash;1162. https://doi.org/10.1007/s00590-020-02675-6\u003c/li\u003e\n\u003cli\u003eLocks R, Utsunomiya H, Briggs KK, et al (2018) Return to Play After Hip Arthroscopic Surgery for Femoroacetabular Impingement in Professional Soccer Players. Am J Sports Med 46:273\u0026ndash;279. https://doi.org/10.1177/0363546517738741\u003c/li\u003e\n\u003cli\u003eBegly JP, Buckley PS, Utsunomiya H, et al (2018) Femoroacetabular Impingement in Professional Basketball Players: Return to Play, Career Length, and Performance After Hip Arthroscopy. Am J Sports Med 46:3090\u0026ndash;3096. https://doi.org/10.1177/0363546518801320\u003c/li\u003e\n\u003cli\u003eLindman I, L\u0026ouml;fskog M, \u0026Ouml;hlin A, et al (2022) Return to Sport for Professional and Subelite Ice Hockey Players After Arthroscopic Surgery for Femoroacetabular Impingement Syndrome. Orthop J Sports Med 10:23259671221089984. https://doi.org/10.1177/23259671221089984\u003c/li\u003e\n\u003cli\u003eChinzei N, Hashimoto S, Hayashi S, et al (2017) Consecutive Bilateral Hip Arthroscopy for Symptomatic Bilateral Femoroacetabular Impingement in an Elite Rugby player: A Case Report. J Nippon Med Sch Nippon Ika Daigaku Zasshi 84:280\u0026ndash;285. https://doi.org/10.1272/jnms.84.280\u003c/li\u003e\n\u003cli\u003eThaunat M, Murphy CG, Chatellard R, et al (2014) Capsulotomy First: A Novel Concept for Hip Arthroscopy. Arthrosc Tech 3:e599\u0026ndash;e603. https://doi.org/10.1016/j.eats.2014.06.016\u003c/li\u003e\n\u003cli\u003eKumar P, Sen R, Aggarwal S, et al (2019) Reliability of Modified Harris Hip Score as a tool for outcome evaluation of Total Hip Replacements in Indian population. J Clin Orthop Trauma 10:128\u0026ndash;130. https://doi.org/10.1016/j.jcot.2017.11.019\u003c/li\u003e\n\u003cli\u003eChristensen CP, Althausen PL, Mittleman MA, et al (2003) The Nonarthritic Hip Score: Reliable and Validated. Clin Orthop Relat Res 406:75\u003c/li\u003e\n\u003cli\u003eDion M-O, Simonyan D, Faure P-A, et al (2021) Validation of the French version of the Self-Administered International Hip Outcome Tool-12 Questionnaire and determination of the Minimal Clinically Important Difference (MCID) in the French speaking population. Orthop Traumatol Surg Res OTSR 107:103083. https://doi.org/10.1016/j.otsr.2021.103083\u003c/li\u003e\n\u003cli\u003eTegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 43\u0026ndash;49\u003c/li\u003e\n\u003cli\u003eBusse J, Gasteiger W, T\u0026ouml;nnis D (1972) [A new method for roentgenologic evaluation of the hip joint--the hip factor]. Arch Orthop Unfallchir 72:1\u0026ndash;9. https://doi.org/10.1007/BF00415854\u003c/li\u003e\n\u003cli\u003eBeck M, Kalhor M, Leunig M, Ganz R (2005) Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br 87:1012\u0026ndash;1018. https://doi.org/10.1302/0301-620X.87B7.15203\u003c/li\u003e\n\u003cli\u003eWang AS, Lamba A, Okoroha KR, et al (2023) Long-Term Outcomes of Primary Hip Arthroscopy With Labral Repair for Femoroacetabular Impingement: Results at Minimum 9-Year Follow-up. Orthop J Sports Med 11:23259671231204337. https://doi.org/10.1177/23259671231204337\u003c/li\u003e\n\u003cli\u003eAnnin S, Lall AC, Yelton MJ, et al (2021) Patient-Reported Outcomes in Athletes Following Hip Arthroscopy for Femoroacetabular Impingement With Subanalysis on Return to Sport and Performance Level: A Systematic Review. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 37:2657\u0026ndash;2676. https://doi.org/10.1016/j.arthro.2021.03.064\u003c/li\u003e\n\u003cli\u003eMinkara AA, Westermann RW, Rosneck J, Lynch TS (2019) Systematic Review and Meta-analysis of Outcomes After Hip Arthroscopy in Femoroacetabular Impingement. Am J Sports Med 47:488\u0026ndash;500. https://doi.org/10.1177/0363546517749475\u003c/li\u003e\n\u003cli\u003eReiman MP, Peters S, Sylvain J, et al (2018) Femoroacetabular impingement surgery allows 74% of athletes to return to the same competitive level of sports participation but their level of performance remains unreported: a systematic review with meta-analysis. Br J Sports Med 52:972\u0026ndash;981. https://doi.org/10.1136/bjsports-2017-098696\u003c/li\u003e\n\u003cli\u003eLindman I, \u0026Ouml;hlin A, Desai N, et al (2020) Five-Year Outcomes After Arthroscopic Surgery for Femoroacetabular Impingement Syndrome in Elite Athletes. Am J Sports Med 48:1416\u0026ndash;1422. https://doi.org/10.1177/0363546520908840\u003c/li\u003e\n\u003cli\u003eRoss JR, Bedi A, Stone RM, et al (2015) Characterization of symptomatic hip impingement in butterfly ice hockey goalies. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 31:635\u0026ndash;642. https://doi.org/10.1016/j.arthro.2014.10.010\u003c/li\u003e\n\u003cli\u003eByrd JWT, Jones KS, Bardowski EA (2018) Influence of T\u0026ouml;nnis grade on outcomes of arthroscopy for FAI in athletes: a comparative analysis. J Hip Preserv Surg 5:162\u0026ndash;165. https://doi.org/10.1093/jhps/hny011\u003c/li\u003e\n\u003cli\u003eByrd JWT, Bardowski EA, Jones KS (2018) Influence of T\u0026ouml;nnis Grade on Outcomes of Arthroscopic Management of Symptomatic Femoroacetabular Impingement. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 34:2353\u0026ndash;2356. https://doi.org/10.1016/j.arthro.2018.03.021\u003c/li\u003e\n\u003cli\u003eChandrasekaran S, Darwish N, Gui C, et al (2016) Outcomes of Hip Arthroscopy in Patients with T\u0026ouml;nnis Grade-2 Osteoarthritis at a Mean 2-Year Follow-up: Evaluation Using a Matched-Pair Analysis with T\u0026ouml;nnis Grade-0 and Grade-1 Cohorts. J Bone Joint Surg Am 98:973\u0026ndash;982. https://doi.org/10.2106/JBJS.15.00644\u003c/li\u003e\n\u003cli\u003eFarrell G, McGrath F, Hogan B, et al (2016) 95% prevalence of abnormality on hip MRI in elite academy level rugby union: A clinical and imaging study of hip disorders. J Sci Med Sport 19:893\u0026ndash;897. https://doi.org/10.1016/j.jsams.2016.01.005\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Patient Characteristics (n = 46 hips)\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"608\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eValue\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003eAge at surgery (y, SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003e22,5 (5,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003eSexe (n, %)\u003c/p\u003e- Male\u0026nbsp;\u003cbr\u003e- Female\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e45 (98 %)\u003cbr\u003e1 (2 %)\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003eLateraly (n, %)\u003c/p\u003e- Left\u0026nbsp;\u003cbr\u003e- Right\u0026nbsp;\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e24 (52 %)\u003cbr\u003e22 (48 %)\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e, SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003e26,1 (4,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003eLevel of play (n, %)\u003c/p\u003e- Amateur\u0026nbsp;\u003cbr\u003e- Semi Professional\u003cbr\u003e- Professional\u0026nbsp;\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e29 (63 %)\u003cbr\u003e10 (22%)\u003cbr\u003e7 (15 %)\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003ePlaying position (n, %)\u003c/p\u003e- Prop\u003cbr\u003e- Hooker\u003cbr\u003e- Lock\u0026nbsp;\u003cbr\u003e- Flanker\u0026nbsp;\u003cbr\u003e- Scrum-half\u003cbr\u003e- Fly-half\u003cbr\u003e- Centre\u003cbr\u003e- Wing\u0026nbsp;\u003cbr\u003e- Fullback\u0026nbsp;\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e2 (4 %)\u003cbr\u003e4 (9 %)\u003cbr\u003e7 (15 %)\u003cbr\u003e8 (18 %)\u003cbr\u003e2 (4 %)\u003cbr\u003e10 (22 %)\u003cbr\u003e5 (11 %)\u003cbr\u003e6 (13 %)\u003cbr\u003e2 (4 %)\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003eFAI type (n, %)\u003c/p\u003e- Cam\u003cbr\u003e- Pincer\u0026nbsp;\u003cbr\u003e- Mixed\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e17 (37%)\u003cbr\u003e0 (0 %)\u003cbr\u003e29 (63 %)\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003eT\u0026ouml;nnis grade (n, %)\u003c/p\u003e- 0\u003cbr\u003e- 1\u003cbr\u003e- 2\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e26 (57 %)\u003cbr\u003e17 (37 %)\u003cbr\u003e3 (6 %)\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003eBeck grade (n, %)\u003c/p\u003e- 0\u003cbr\u003e- 1\u003cbr\u003e- 2\u003cbr\u003e- 3\u003cbr\u003e- 4\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e1 (2 %)\u003cbr\u003e1 (2 %)\u003cbr\u003e19 (42 %)\u003cbr\u003e18 (40 %)\u003cbr\u003e7 (14 %)\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003eLabrum reattachment (n, %)\u003c/p\u003e- Yes\u003cbr\u003e- No\u003cbr\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 304px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e29 (63 %)\u003cbr\u003e17 (37 %)\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 608px;\"\u003e\n \u003cp\u003eS\u003cem\u003eD : Standard Deviation, BMI : Body Mass Index, FAI : Femoroacetabular Impingement\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Outcome Scores and MCID/PASS Achievement\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"699\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome Measure*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLast Follow-Up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026Delta;\u003csub\u003ePost vs Pre\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAchieved MCID*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAchieved PASS*\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eVAS\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e5,3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e1,3 (1,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0,01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eTegner\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e7,8 (1,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e7 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e-0,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0,01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eHHSm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e65,4 (15,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e87,2 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e+21,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0,01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e35/46 (76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e42/46 (91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eNAHS\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e67,8 (14,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e89,5 (6,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e+21,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0,01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eIHOT-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e39,7 (15,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e85,5 (11,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e+45,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0,01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e43/46 (93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e38/46 (82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eSatisfaction\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e8,2 (2,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e*MCID: Minimal Clinically Important Difference, PASS: Patient Acceptable Symptom State, VAS: Visual Analog Scale, mHHS: Modified Harris Hip Score, NAHS: Non-Arthritic Hip Score, IHOT-12: International hip outcome tool-12\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: factors associated with partial resumption and cessation of rugby.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (CI-95%)*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1,21 (1,07 \u0026ndash; 1,43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt; 0,05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003eBMI*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1,145 (0,98 \u0026ndash; 1,38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0,108\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003eLevel of practice\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0,22 (0,07 \u0026ndash; 0,58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt; 0,05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003ePlaying position\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0,92 (0,25 \u0026ndash; 3,22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0,24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003eDuration of symptom before surgery\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1,27 (1,01 \u0026ndash; 1,83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt; 0,05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003eRadiographic stage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e3,44 (1,18 \u0026ndash; 12,33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt; 0,05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003eArthroscopic stage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1,96 (0,94 \u0026ndash; 4,64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0,07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003eFAI type*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1,78 (0,97 \u0026ndash; 3,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0,06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003eLabrum reattachment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0,99 (0,29 \u0026ndash; 3,35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0,99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e*OR: Odd-Ratio, CI: Confidence interval, BMI: Body Mass Index, FAI: Femoroacetabular Impingement\u0026nbsp;\u003c/em\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"femoroacetabular impingement, Hip surgery, Rugby, return to sport","lastPublishedDoi":"10.21203/rs.3.rs-5388962/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5388962/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eFemoroacetabular impingement (FAI) is a common cause of hip pain and decreased quality of life among athletes, particularly in sports involving multidirectional movements. Despite its prevalence, there is a lack of specific studies on the outcomes of FAI surgery in rugby union players (RUP). To analyze the functional results and return to sport (RTS) after arthroscopic surgery in RUP suffering from FAI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis before/after cohort study included RUP under 35 years who underwent primary hip arthroscopy for FAI. Data collected included demographic information, rugby level, type of FAI, and radiographic arthritis stage. Functional outcomes were measured using various scores, including Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), IHOT-12, Tegner Activity Scale (TAS), and Pain on Visual Analog Scale (VAS). Statistical analysis was performed to compare scores pre- and post-operatively and identify factors associated with return to rugby.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eForty-six hips in 36 patients were analyzed. At a mean follow-up of 3.9 years, significant improvements were observed in all functional scores, except the TAS. mHHS improved by +21.8 points, and the IHOT-12 by +46.1 points. 41% of patients returned to their previous or higher level of rugby, 46% resumed rugby at a lower level, and 13% ceased playing. Age, preoperative sports level, symptom duration, and radiographic arthritis stage were significant factors for partial resumption or cessation of rugby.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Arthroscopic surgery for FAI in RUP yields satisfactory functional outcomes. However, factors such as age, preoperative sports level, symptom duration, and radiographic arthritis stage significantly influence the likelihood of RTS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design: \u003c/strong\u003eLevel IV, Retrospective cohort study\u003c/p\u003e","manuscriptTitle":"Functional Outcomes and Return to Sport Following Arthroscopic Surgery for Femoroacetabular Impingement in Rugby Union Players","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-16 16:23:20","doi":"10.21203/rs.3.rs-5388962/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d4348f15-92db-46e2-b234-fc4e2dd4c0ce","owner":[],"postedDate":"December 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-18T04:38:34+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-16 16:23:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5388962","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5388962","identity":"rs-5388962","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}