Hip arthroscopy for femoroacetabular impingement in professional and non-professional footballers and time to return to play

Abstract

Introduction Femoroacetabular impingement (FAI) with associated intra-articular hip pathologies is a recognised cause of pain and disability in athletes. The purpose of this study is to report the clinical outcomes and time to return to play football between professional and non-professional athletes following hip arthroscopic surgery for femoroacetabular impingement (FAI). Methods Football players were undergoing hip arthroscopy for symptomatic FAI. Demographic data, radiographic features of FAI and operative findings were recorded. The time to return to play soccer and their level of playing were documented. Athletes completed a patient satisfaction questionnaire, a visual analogue scale for pain (VAS for pain), the modified Harris Hip Score (mHHS) and Sports-score from the Hip Osteoarthritis Outcome Score (HOOS) pre- and postoperatively after an average of 3.6 years. For statistical analysis, a Cox proportional hazards model was used to examine whether professional or non-professional footballers were more likely to return faster to soccer at the same level. Results We included 50 soccer players (60 hips); 29 were professional players (36 hips) with a mean age at the time of operation 22.3 (16–35, SD 5.18) and 21 were non-professional (24 hips) with a mean age 31.6 (17–47, SD 7.78). The mean follow-up was 43.1 months (SD 14.09). Two non-professional athletes (2 hips) did not return to play because of ageing and one professional (2 hips) because of spinal surgery. For professional footballers, the mean patient satisfaction was 9.2 and for non-professional footballers was 8.75. The mean VAS scale for pain decreased considerably from 7.3 preop to 0.38 postoperatively for professional and from 6.5 preop to 1.29 postoperatively for non-professional athletes. The mean mHHS, sports score were improved for both groups. Professional footballers returned to their pre-injury level to play at a mean of 13.26 weeks (8–22, SD 2.95) and non-professional at a mean 23.3 weeks (8–54, SD 12.7). Statistical analysis showed that the hazard ratio was 1.99 (P value 0.016) suggesting that the professional players were about twice as likely to return to play football faster, at the same level than non-professional athletes. Conclusion This study demonstrates that arthroscopic treatment for FAI and associated intra-articular pathology in football players provides a significant clinical improvement and allows athletes to return to play at the same level. Professional football players are significantly more likely to return to play football faster compared to non-professional athletes.