Return to Sport after Hip Arthroscopy. Perspectives on a journey with many destinations

Abstract: Femoroacetabular impingement (FAI) syndrome is often treated with hip arthroscopy (HA) with the goal of enabling return to sport. While the number of HAs has been rising, little is known about the rehabilitation process or about outcomes related to return to sport (RTS) following the procedure. The overarching aim of this thesis wasto describe the rehabilitation process following HA in Scandinavia and to investigate RTS and factors potentially associated with it.We described current rehabilitation strategies following HA in Scandinavia by surveying specialized clinicians (62 physiotherapists and 28 surgeons) in Denmark, Norway, and Sweden. We then cross-sectionally described RTS rates in 127 patients 3–39 months following HA for FAI syndrome, defining RTS on a continuum according to consensus terminology. Subsequently, we measured patient-reported and clinically measured hip function in 33 patients 6–10 months following HA, comparing these patients with a healthy control group in a cross-sectional study. Finally, we modified and validated a patient-reported outcome measure, i.e., Hip—Return to Sport after Injury (Hip-RSI) scale, to assess psychological readiness to RTS in HA patients.Clinicians rated structured rehabilitation as very important and reported similar expectations regarding the rehabilitation timeline during the first three months following HA for FAI syndrome. Approaching RTS, clinicians’ expectations increasingly varied, with surgeons being more optimistic than physiotherapists. Nine out of ten patients returned to some sort of sport or physical activity, while half returned to their previous sport and only one out of five returned to their previous performance level. During the time when patients could be expected to RTS, they displayed impairments in self-reported hip function and in measures related to hip mobility. The Hip-RSIdisplayed adequate psychometric properties to be recommended as a valid tool in the assessment of psychological readiness in HA patients.In the absence of evidence-based rehabilitation protocols following HA, a description of current clinical practice may serve as a first step toward establishing clinical consensus, also highlighting areas for future research. Our description of RTS rates may be used to create realistic patient expectations regarding RTS. Impairments in hipmobility and mobility-related performance may influence but cannot fully explain observed RTS rates and impairments in self-reported function. Psychological readiness to RTS may play an important role in the RTS process following HA and can now be assessed and investigated further with the help of the Hip-RSI.

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