Minimally Invasive Intraoperative Strategies May Influence Success Rate and Return to Sport in Arthroscopic Treatment of Patellar Tendinopathy: A Systematic Review of Prospective Studies

Although the majority of patients with patellar tendinopathy (PT) can be treated nonoperatively, operative management may be indicated for recalcitrant cases. While several surgical techniques have been described, there is limited understanding of postoperative outcomes and expectations regarding return to activity and sport. The purpose of this study was to characterize the clinical outcomes associated with the surgical management of PT with an emphasis on return to sport (RTS) rates. We hypothesized that surgical management would lead to clinically important improvements in patient-reported outcomes (PROs) with high rates of RTS and RTS at the same level. A comprehensive search of the PubMed, Medline, and Embase databases was performed in December 2020. Level of evidence studies I through IV, investigating results of surgical management for PT (PRO, functional outcomes, pain, and/or RTS), were included. The search was performed in accordance with the Preferred Reported Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Forty clinical studies reporting on surgery for PT satisfied inclusion criteria, with 1,238 total knees undergoing surgery for PT. A comparison of pre- and postoperative Victorian Institute of Sport Assessment, patellar tendon (VISA-P) scores (mean difference: 41.89, p < 0.00001), Lysholm scores (mean difference: 41.52, p < 0.00001), and visual analogue scale (VAS) pain scores (mean difference: 5, p < 0.00001) demonstrated clinically and statistically significant improvements after surgery. The overall RTS rate following operative management was 89.8% (95% confidence interval [CI]: 86.4-92.8, I 2 = 56.5%) with 76.1% (95% CI: 69.7.5-81.9, I 2 = 76.4%) of athletes returning to the same level of activity. Surgery for PT provides meaningful improvement in patient reported outcomes and pain while allowing athletes to RTS at high rates with levels of participation similar to that of preinjury. Comparative studies of open and/or arthroscopic surgery are still limited but current evidence suggests better rates of RTS for arthroscopic surgery compared with open surgery. This is a systematic review of level-I to -IV studies.

Background: Patellar Tendinopathy (Jumper’s Knee) affects up to 17% of the general population and may become recalcitrant in up to 20% of cases. While these cases often require surgery, it is unclear whether an open or arthroscopic procedure should be performed. Methods: A systematic search of articles published 2000-present studying outcomes after surgical intervention for patellar tendinopathy was performed across PubMed, Embase, CINAHL, Scopus, and Cochrane databases and screened using PRISMA guidelines. Outcomes assessed included Patient Reported Outcome Measures (PROM), ie Victorian Institute of Sports Assessment (VISA-P), Visual Analog Scale (VAS), modified Blazina, Lysholm, Tegner, IKDC, and SANE scores, and subjective Success and Return to Sport (RTS) data at follow-up. Descriptive statistics with weighted averages were used to assess differences between groups but no meta-analysis was performed due to heterogeneity of intervention groups. Results: 21 studies were included for analysis that analyzed 13 arthroscopic, 8 open, and 2 combined treatment groups with follow-up ranging from 6-96 months. 2 retrospective studies directly compared open vs arthroscopic and reported earlier RTS time in arthroscopic patients (mean 5.5 vs 8.0mo) but no differences in VISA-P, overall success, or RTS rate. Open surgical patients required repeat surgery in 4 instances. Summary analysis of all data showed arthroscopic patients had earlier RTS (3.8 vs 8.7mo) and slightly higher RTS rate (88.5% vs 74.9%), but similarly high rates of overall success (89.1% vs 83.1%). Arthroscopic groups generally had higher average VISA-P and Blazina scores compared to Open groups. Combined open/arthroscopic procedures exhibited a mean success and RTS rate of 86.6% and 91.3%. Complications were reported in 3 open groups (surgical site complication, repeat surgery required, algodystrophy), 2 arthroscopic groups (failed tendon release, new-onset PFPS), and 1 combined group (repeat surgery required). Conclusions: In patients with refractory patellar tendinopathy and varying baseline activity levels, both open and arthroscopic surgical approaches, as well as combined procedures, lead to high rates of success and return to sport. Arthroscopic approaches may lead to quicker return to sport and greater improvements in patient-reported outcome measures than open procedures. Clinical Relevance: Arthroscopic intervention may yield similar or better clinical outcomes compared to open techniques with quicker return to sport for patellar tendinopathy refractory to conservative management.

Return to Sport After Ulnar Collateral Ligament Tears Treated with Platelet Rich Plasma Injections Is influenced by Length of Rehabilitation and Leukocyte Content of Injections: A Systematic Review

To evaluate patient-reported outcomes, return to sport (RTS) rates and complications following proximal hamstring (PH) repair in elite and non-elite athletes. We hypothesized that PH repair leads to improved patient-reported and clinical outcomes and high RTS rates with relatively few associated complications. In accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, PubMed, Embase and Cochrane Library databases were searched in August 2024. Studies were included if they evaluated athletes at various levels of competition who underwent PH repair and reported RTS rates, complication rates or patient-reported outcomes. Due to high heterogeneity between studies, qualitative comparative analysis was conducted. The initial screen identified 1398 studies; 22 were included. Each study had non-comparative study design with low risk of bias. Overall, 168 patients across 6 studies were included in the elite athlete cohort, and 759 patients across 16 studies were included in the non-elite athlete cohort. Elite athletes had overall RTS rate of 95.6% with time to RTS from 3.0 to 7.0 months, and RTS at pre-injury level between 90.0% and 98.4%. RTS rate in non-elite athletes was 64.8%. Mean lower extremity functional scale scores were 77.9-78.0 in elite athletes and 73.8-89.0 in non-elite athletes. The overall complication rate in the elite athlete cohort was 11.6%, and in the non-elite cohort was 14.2%. Nerve-related symptoms were the most common complication in both cohorts, with rates of 2.9% and 10.9%, respectively. Elite athletes are more likely to RTS following PH repair and do so faster compared to their non-elite counterparts. Minor neurologic complications account for the majority of complications in both patient cohorts, with minimal incidence of operative failure or other complications. This can guide preoperative decision-making and patient counselling based on a patient's athletic status and desire to RTS. Level IV, systematic review of Levels III and IV studies.

Periacetabular Osteotomy in Athletes With Symptomatic Hip Dysplasia Allows for Participation in Low-, Moderate-, and High-Impact Sports, With Greater Than 70% Return to Sport for Competitive Athletes: A Systematic Review

Comparable and Improved Clinical Outcomes, Pain Relief, Return to Sport, and Low Popeye Deformity Rates in Inlay Versus Onlay Open Subpectoral Biceps Tenodesis: A Systematic Review.

IntroductionPrimary patella resurfacing (PPR) in primary total knee arthroplasty (TKA) is a topic without clear clinical evidence. Using Patient Reported Outcome Measurements (PROM), previous work found TKA patients without PPR to have more pain postoperatively, but little is known whether this may impede patients from returning to their usual leisure sport. This observational study aimed at evaluating the treatment effect of PPR, with PROMs and return to sport (RTS).Materials and methods156 primary TKA patients were retrospectively included from August 2019 to November 2020, from a single hospital in Germany. PROMs were measured with the Western Ontario McMaster University Osteoarthritis Index (WOMAC) and the EuroQoL Visual Analog Scale (EQ-VAS), preoperatively and 1 year postoperatively. Leisure sport with three levels of intensity (never, sometimes, regular) were requested. The treatment effect of PPR was evaluated with a difference-in-difference (DiD) approach, with several confounders.ResultsDescriptively, the mean WOMAC total score and the mean WOMAC pain score were postoperatively better with PPR, ( – 4.8 points, – 1.1 points), then without PPR. The mean improvements of the WOMAC total score were better with PPR ( – 7.8 points). Mean improvements for the WOMAC pain score were also better with PPR ( – 1.2 points). Mean EQ-VAS were postoperatively similar, and the mean improvements were better with PPR (3.4 points). Rate of RTS was 93% for patients with PPR and 95% for patients without PPR. The DiD revealed minor differences in PROMs and RTS, not to result in statistically significant treatment effects.ConclusionsThere was no treatment effect for TKA with PPR, regarding PROMs and RTS, and descriptive differences were below published thresholds for clinical relevance. Rate of RTS was high for all patients, regardless of PPR. For the two endpoint categories, there was no measurable advantage of TKA with PPR over TKA without PPR.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00402-023-04930-x.

Objectives: To identify predictive factors for successful return to sport (RTS) following anterior cruciate ligament reconstruction (ACL-R) with quadriceps tendon (QT) autograft. Methods: Data was retrospectively collected on consecutive patients who underwent ACL-R with QT autograft at a single institution between 2010-2020. Patient demographics, knee range of motion (ROM), injury characteristics, and intraoperative data were collected from the electronic medical record. Full RTS was defined as the patient returning to their prior level of sport and the presence of a clinical documentation of no further complications. Univariate and multivariate cox regression were utilized to conduct time-to-event analyses to identify predictors of early RTS clearance by surgeon. Additionally, both logistic regression analysis and generalized estimating equations were used to identify significant predictors of successful full RTS. STATA 16SE software was utilized for all analyses with statistical significance set to p &lt; 0.05. Results: A total of 307 patients were included, consisting of 176 males (57.3%) and 131 females (42.7%), with an average of 20.7 ± 7.1 years of age and 14.5 ± 8.9 months follow-up. Ten patients (3.3%) were professional/semi-professional athletes, 38 (12.4%) were collegiate athletes, 144 (46.9%) were high school athletes (46.9%), and 115 (37.5%) were recreational athletes. Complete knee extension was achieved by 64.1% of patients at 6 weeks postoperatively, by 77.7% at 3 months, by 84.4% at 6 months, and by 84.7% at 1 year. Full knee extension at 3 (HR: 1.55, 95% CI: 1.13–2.12, p = 0.007) and 6 months (HR: 1.49, 95% CI: 1.05–2.12, p = 0.025) postoperatively were predictors of a higher rate of RTS clearance. Moreover, patients who achieved full knee extension at 3 months follow-up had a greater rate of RTS (1.02/person-years) compared to patients who did not achieve full knee extension at 3 months (0.83 per person-years). When considering RTS, only full knee extension at 4-6 weeks (OR:2.02, 95% CI:1.02–4.03, p = 0.045) and at 3 months (OR:2.36, 95% CI: 1.12–4.99, p = 0.024) postoperatively were predictive of successful RTS. No other significant predictors were identified. Conclusions: Restoration of full knee extension was strongly associated with higher rates of both surgeon clearance and successful RTS. The role of full knee extension in the ability to regain strength at 6 months, as measured by limb symmetry indices, after ACL-R has been previously described. While both ROM and strength play crucial roles in the rehabilitation process, achieving full ROM typically precedes restoration of full strength. Lack of full extension 3 months postoperatively may require further investigation and serves as a possible opportunity for a goal metric to maximize RTS rates and minimize complications after ACL-R.

Category:Sports; AnkleIntroduction/Purpose:No meta-analysis has been conducted to examine the clinical outcomes following operative and nonoperative management of high ankle sprain injuries in elite athletes. the purpose of this systematic review was (1) To report the rate and time to return to sport (RTS) following high ankle syndesmotic injury in elite athletes (2) To examine the rate and time of RTS as well as the postoperative complications in elite athletes who underwent surgical treatment of high ankle syndesmotic injury with screw versus suture button fixation.Methods:Three electronic databases were searched for eligible articles. Two reviewers independently screened the titles, abstract and full-text articles using pre-specified criteria. Eligible articles were those that reported the rate of return to sport following operative and nonoperative treatment of ankle syndesmotic injuries in elite athletes (collegiate or professional level). Data collected were type of sport, type of treatment received (operative versus nonoperative), surgical technique (screw versus suture button fixation), rate and time to return to the preinjury level of competition, and complications. A random-effects model was used for meta-analysis.Results:The estimated overall rate of RTS was 99% (95% CI 95.5-99.9). The mean time to RTS was 38 +- 18 (range: 14-137) days. Of the 440 athletes, 269 (269/440,61%) were treated nonoperatively (nonoperative group); the rate of RTS was 99.6% and the athletes returned at a mean time of 29+-14 (range: 13-45) days. A total of 171 athletes (171/440,39%) underwent surgical treatment (operative group); All (171/171,100%) athletes returned at a mean time of 50.3+-13 (range:41-137) days. Almost all athletes who underwent surgery had suture button fixation (164/171 athletes,96%) and the mean time to RTS was 7 weeks with 9.1% complication rate.Conclusion:Elite athletes with ankle syndesmosis injury return to sport at an extremely high rates, following operative or nonoperative treatment. Suture button fixation remains the gold standard technique in elite athletes with syndesmotic injury requiring surgical treatment. Return to the preinjury level of competition should be expected at 4 weeks and 7 weeks in high-level athletes who undergo nonoperative and operative management, respectively.

Background:Patellofemoral instability most commonly affects young patients and is often associated with concomitant chondral injury, the incidence of which increases with each dislocation event. The impact of these chondral injuries on the function and pain levels of patients who undergo isolated medial patellofemoral ligament (MPFL) reconstruction without bony realignment remains unclear.Purpose/Hypothesis:The purpose of this study was to compare patient-reported outcome measures (PROMs) between individuals who underwent isolated MPFL reconstruction with concomitant cartilage restoration versus those patients who did not require a concomitant cartilage procedure at the time of their MPFL reconstruction. It was hypothesized that cartilage injury that required intervention in patients with patellofemoral instability would be associated with worse preoperative PROMs compared with patients without chondral injury and that these differences would be mitigated by concomitant surgical intervention to address chondral damage performed in addition to their MPFL reconstruction.Study Design:Cohort study; Level of evidence, 3.Methods:Patients with recurrent patellar instability were collected in an institutional registry beginning March 2014. All patients underwent primary, unilateral, isolated MPFL reconstruction regardless of their bony anatomic features. PROMs, episodes of recurrent instability, and return to sport (RTS) data were obtained at baseline and annually. Patients were retrospectively assigned to the cartilage intervention group if they underwent concomitant particulated juvenile cartilage allograft, osteochondral allograft, open reduction internal fixation, microfracture, or removal of loose body. Those without intervention or isolated chondroplasty comprised the comparison group. PROMs were assessed at baseline and at 2 and 5 years after surgical intervention.Results:A total of 138 patients underwent MPFL reconstruction without bony correction between March 2014 and December 2019. Two patients were excluded for concomitant anterior cruciate ligament reconstruction. A total of 22 patients underwent concomitant cartilage restoration, whereas 114 patients underwent chondroplasty or no concomitant cartilage intervention. In total, 50 patients were evaluated at ≥5 years, of whom 40 (80%) completed follow-up PROMs. A total of 119 patients were evaluated at ≥2 years, of whom 89 (75%) completed follow-up PROMs. All PROMs improved significantly over time except for the Pediatric Functional Activity Brief Scale (Pedi-FABS) (P = .095). Baseline PROMs were significantly lower for the concomitant cartilage injury group compared with the MPFL-only group for Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life subscale (P = .0075), KOOS Pain Score (PS) (P = .0138), and Kujala score (P = .0481). However, at 2 years after surgery, no statistically significant difference in PROMs was found between the cartilage and no-cartilage intervention groups, a finding that was maintained at 5 years after surgery. Patients in the cartilage intervention group displayed a lower overall RTS than patients in the no-intervention group (64.29% vs 92.41%; P = .0103). The patients who achieved RTS had a shorter time to RTS after cartilage intervention compared with no intervention (7.55 vs 9.46 months; P = .0461).Conclusion:The treatment of cartilage lesions in addition to MPFL reconstruction for recurrent patellar instability was associated with similar improvement in PROMs compared with isolated MPFL reconstruction without cartilage intervention at 2 and 5 years after surgery, despite lower preoperative PROMs in the group requiring cartilage intervention. Patients who underwent cartilage intervention had lower overall RTS rates. Future work will seek to confirm the durability of these results with longer term follow-up.

Background: High tibial osteotomy (HTO) is usually performed in patients older than 50 years with medial knee osteoarthritis. However, little is known about return-to-sport (RTS) and return-to-work (RTW) rates when HTO is performed in younger patients. Moreover, the risk factors for RTS and the impact of kinesiophobia on RTS have been poorly investigated. Purpose: To assess RTS and RTW rates, risk factors for RTS, complications, and activity levels at long-term follow-up in young and active patients after isolated HTO. Study Design: Case series; Level of evidence, 4. Methods: Consecutive HTO procedures performed at a single institution with a minimum 2-year follow-up were screened. Data were collected regarding clinical scores (Lysholm score, visual analog scale for pain, Tampa Scale for Kinesiophobia, Subjective Patient Outcome for Return to Sports score, Tegner activity score, Likert scale), RTS and RTW rates, type of sport, and impact activity level. Multivariate regression analysis evaluated the effect of sex, age, body mass index, Tegner score, and Tampa score on RTS. Differences were considered statistically significant if P < .05. Results: A total of 60 patients with a mean age at the time of surgery of 28.9 ± 7.5 years were included at a mean follow-up of 8.8 ± 3.8 years. There were 4 (6.7%) major complications. The overall RTS rate was 86.7%, and 68.3% of patients were still participating in sports at the final follow-up (mean, 3.7 ± 2.1 h/wk). Additionally, 34.6% returned to the same sport level, 21.2% improved their status, and 44.2% decreased their sport level. Moreover, patients playing soccer had a lower RTS rate compared with the rest of the patients (72.7% vs 94.7%, respectively; P = .04). The overall RTW rate was 100.0%, with a mean time to RTW of 5.9 ± 6.2 months. The Tampa score was the only predictor of absolute RTS (P = .015; coefficient = –0.13). Conclusion: HTO performed in a young and active population resulted in high RTS rates and continuous sport participation even up to 9 years after surgery. Interestingly, the Tampa score was the only predictive factor for a reduced RTS rate. Finally, soccer participation was associated with a lower RTS rate compared with other sports.

Objectives:Hip arthroscopy has been proven to be an effective treatment for femoroacetabular impingement syndrome (FAIS) in both competitive athletes and non-competitive athletes, with favorable patient reported outcomes (PROs), and low rates of complications. Previous data demonstrates a high return to sport (RTS) rate, reported up to 88% to 92%. Although PROs and RTS have previously been evaluated, many studies are limited to short-term follow-up and do not differentiate between competitive and non-competitive athletes. The objectives of this study were to (1) determine differences in mid-term clinical outcomes at 5-years follow-up between patients who are high-level competitive athletes (CA) versus propensity matched, non-competitive athletes (NCA) undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS), (2) determine whether achievement rates of minimal clinically important differences (MCID) and patient acceptable symptomatic states (PASS) differ between the two groups, and (3) determine return to sport (RTS) rate in CA.Methods:Patients who were collegiate, semi-professional, or professional athletes and underwent primary hip arthroscopy for FAIS from January 2012 to April 2017 were identified. Patients were propensity matched on a 1:4 basis to NCA controls by age, sex, and body mass index (BMI). Preoperative and postoperative radiographs were assessed. Patient reported outcomes (PROs) collected preoperatively and at 5-years included international Hip Outcome Tool (iHOT-12), modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living subscale (HOS-ADL) and Sports subscale (HOS-SS), and Visual Analog Scale (VAS) for Pain and Satisfaction. MCID and PASS rates were determined using previously-published thresholds for iHOT-12, mHHS, HOS-ADL, HOS-SS, and VAS Pain. RTS rate and duration was collected retrospectively.Results:A total of 57 high-level CA who underwent primary hip arthroscopy for FAIS (33 female, age: 21.7 ± 4.2 years, BMI: 23.1 ± 2.8kg/m2) were propensity matched to 228 NCA controls (132 female, p > 0.999; age: 23.3 ± 5.8 years, p = 0.022; BMI: 23.8 ± 4.3 kg/m2, p = 0.239). There were no statistically significant differences between any radiographic parameters in any of the pre- or postoperative radiographic parameters between groups. Of note, competitive athletes had higher outcome scores prior to surgery in HOS-ADL (CA: 74.9 ± 13.7 vs NCA: 66.4 ± 18.4, p = 0.001) and mHHS (CA: 64.7 ± 12.9 vs NCA: 59.7 ± 14.3, p = 0.040). Both groups demonstrated significant postoperative improvements in all outcome scores measured (p ≤ 0.001). At 5-years postoperatively, CA had lower VAS pain than NCA (CA: 17.3 ± 17.6 vs NCA: 24.7 ± 25.9, p=0.017). There were no significant differences in achieving MCID or PASS for HOS-ADL, HOS-SS, mHHS, or iHOT-12 at final follow-up. CA returned to sport (RTS) at a median of 25.2 weeks (Q1 22.4 – Q3 30.7) with an overall RTS rate of 90%. The CA participated in a multitude of sports (Figure 1) however, there was no significant differences in comparing RTS between individual sports (p = 0.163) (Figure 2).Conclusions:CA patients demonstrated significant and durable improvements in PROs as well as high MCID and PASS achievement rates following primary hip arthroscopy, which were comparable to non- competitive controls. Clinicians should be aware that CA patients demonstrate higher preoperative mHHS and HOS-ADL scores than controls and achieve lower average self-reported pain at 5-years postoperatively. CA patients demonstrate high rate of RTS (˜90%) at a median of ˜25 weeks post- operatively.

Studies directly comparing Lisfranc injuries treated with primary arthrodesis or open reduction and internal fixation show no significant difference in return to sport and complications: A systematic review and meta-analysis.

Distal triceps rupture is a rare injury that is commonly surgically repaired to improve elbow strength and function. Most patients are active and have goals to return to specific activities and sports. There is no gold standard rehabilitation protocol for return to sport (RTS) after distal triceps repair. To identify in the literature any criteria used for RTS after distal triceps repair. Scoping review; Level of evidence, 4. Under PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, level 1 to 4 studies that examined distal triceps repair and had a minimum follow-up duration of 12 months were deemed eligible for study inclusion. Exclusion criteria encompassed studies that employed nonoperative treatment, lacked specific RTS criteria, or involved revision cases. The selected studies underwent assessment regarding RTS outcomes, timelines, rates, and methodological quality. Of the initial 378 unique studies, 6 studies (including 116 patients involved in 16 different sports) met the inclusion criteria. Four of the studies reported RTS rates, with a mean of 89.3%. The duration of time for returning to sport was reported in 2 studies and varied from 4 to 6 months. The parameters most emphasized in the rehabilitation protocols were progressive range of motion exercises, followed by early immobilization and progressive strengthening exercises. Supervised therapy was reported in only 2 (33%) studies. Although all studies included a rehabilitation protocol and 5 studies included a timeline for RTS, only 1 study provided subjective criteria, and no studies utilized specific objective measurement criteria. The overall study quality was fair. This review demonstrated that the overall RTS rate after distal triceps repair was high (89.3%), with no consensus on RTS criteria. Most studies included initial immobilization followed by progressive range of motion and strengthening. Timing after surgery was used as a measure to RTS in the minority of studies and varied between 4 and 6 months. Further research is needed to develop functional and performance-based metrics to better standardize RTS criteria and rehabilitation protocols.

Background:Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain, which can prevent ice hockey players from sports participation. Hip arthroscopy is often performed to relieve pain and enable the player to return to sport (RTS) and return to performance (RTP).Purpose:To determine the RTS and RTP rates for ice hockey players at the professional and subelite levels after hip arthroscopy for FAIS.Study Design:Case series; Level of evidence, 4.Methods:High-level ice hockey players who underwent hip arthroscopy for FAIS between 2011 and 2019 were identified using a local hip arthroscopy registry. The player’s level was confirmed with ice hockey–specific web pages and was stratified as subelite or professional. Data on the players’ careers were extracted from these web pages. Player position was divided into goalkeepers, defensemen, and forwards. Data on participation in games included the season before onset of symptoms, the season before surgery, and the first and second seasons after surgery. RTS was defined as returning to ice hockey after surgery, and RTP was considered as returning to the same league at a comparable level to before symptoms.Results:A total of 80 ice hockey players were included. Comparing presymptom performance with the first season after surgery, the RTS rate was 72%, of which 94% of the players returned to the same or higher level of play. Comparing the presurgery season with the first season after surgery, the RTS rate was 78%. At the second season after surgery, 64% of players still played ice hockey, with a significantly higher return rate among professional players compared with subelite players (96% vs 69%; P = .014). Overall, 85% goalkeepers, 74% forwards, and 60% defensemen returned to sport. Only 28% played at least the same number of games during the first season after surgery as they did during the presymptom season.Conclusion:High-level ice hockey players who underwent hip arthroscopy for FAIS had a high RTS rate, in which the majority returned to the same league. However, only 28% played the same number of games the first season after surgery as they did at the presymptom level. Professional ice hockey players returned more frequently than players on the subelite level.