Return to Play Data Post-Arthroscopy
Tracey Romero • Mon, April 9th, 2018
Despite improved patient-reported outcomes (PROS) and lower complication rates after hip arthroscopy, there are still no evidence-based return-to-play (RTP) criteria or validated functional test for getting back on the field or court after surgery, according to a new study, “Return to Play After Hip Arthroscopy: A Systematic Review & Meta-analysis,” published online on March 29, 2018 in the American Journal of Sports Medicine.
T. Sean Lynch, M.D., assistant professor of orthopedic surgery at Columbia University Medical Center/ New York-Presbyterian Hospital, and colleagues conducted a systematic review and meta-analysis to determine if there is enough evidence in current literature to support return to play protocol and functional assessment after hip arthroscopy.
“Standardized RTP protocols are important as they serve as a guideline to ensure that patients are returning to activity safely after their hip arthroscopy. Without objective measures, patients are left to the subjective evaluation of the physician and therapists that might under- or over-estimate their recovery, which can place them at risk of re-injury,” Lynch told OTW.
Out of 263 articles reviewed, 22 were included in the study and 1,296 patients with 1,442 total hips were identified. RTP timeline, rehabilitation protocols and conditional criteria measures were all assessed.
According to the data, 54.5% (12 of 22) of the studies did not provide a guideline for return to play duration after hip arthroscopy, while 36.4% (8 of 22) of them recommended a duration of 4 months and 9.1% (2 of 22) instead suggested 3 months. The common postoperative rehabilitation protocols used in the studies were weightbearing guidelines (15 studies) and passive motion exercises (9 studies). Only 2 studies were considered to have sufficient RTP protocol and only 3 had a specific replicable test for RTP.
In order to achieve evidence-based standardized protocols Lynch said there needs to be an understanding of the role of muscle atrophy in the post-operative patient and muscle reactivation during rehabilitation.
He said, “We are currently studying this at Columbia so that we can optimize our rehabilitation phases to link with their muscle recovery with the goal to help our patients safely return to sports faster.”
He added, “An athlete's safe return requires sophisticated assessment of strength, endurance and neuromuscular control that should not be time-dependent. Criteria for return to sport is complex and therefore no single test can determine an athlete's readiness to return. Clinical measures should include a battery of tests that include: pain level, patient's confidence with their hip, range of motion, core and lower extremity strength and patient-reported outcome scores. Finally integration of a functional sports assessment that can assess a patient's neuromuscular control which performing real game-like activities.”
“Dealing with patients with athletic hip injuries that require hip arthroscopy with labral repair really requires a ‘team effort’ between sports medicine providers, physical therapists, and athletic trainers to guarantee a successful outcome. These athletes typically have symptoms for an extended period of time before seeking treatment, which places them at risk for developing compensatory issues including core muscle injuries, hip muscle imbalance, and sacroiliac joint /lumbar spine dysfunction. The recognition and correction of these issues is an equally important part of the rehabilitation and if ignored can delay recovery or lead to sub-optimal outcome.”