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Favorable Patient-Reported Outcomes and High Return to Sport Rates Following Hip Arthroscopy in Adolescent Athletes: A Systematic Review

      Purpose

      The purpose of this systematic review is to synthesize the existing literature surrounding hip arthroscopy in the adolescent athlete population to determine patient-reported outcomes, return to sport rates, complications, and reoperations associated with this intervention.

      Methods

      A systematic literature review was performed using PubMed (MEDLINE), Cochrane Library, and Embase according to PRISMA guidelines. Studies were included if they were published in English with greater than 2 participants, contained patients aged 10-19 years old or classified as “high school athletes” or “middle school athletes,” and reported postoperative patient-reported outcomes and return to sport. Patient-reported outcomes (PROs) and their associated P values were recorded. Finally, return-to-sport outcomes and sports played were also extracted from the included studies. Weighted kappa was used to assess inter-reviewer agreement.

      Results

      Eleven studies included in the final analysis, resulting in 344 patients and 408 hips were analyzed by this review. Patient-reported outcomes (PROs) were reported in all studies. The modified Harris Hip Score (mHHS) was used in all but 1 study. Six of the 11 studies reported a 100% return-to-sport rate, for a total of 98/98 athletes returning to sport. Fabricant et al. did note that a majority of athletes who returned to sport were able to do so at a subjective “nearly normal” level. Only 4 of the studies reported complications, with the majority being transient neuropraxias.

      Conclusions

      Adolescent athletes who undergo hip arthroscopy demonstrate favorable postoperative patient-reported outcome scores, high rates of return to sport, and an overall low complication rate. The heterogeneity in both surgical methodology and outcome measures used for evaluation and treatment leads to continued ambiguity with regard to the optimal method for managing adolescent athletes with hip pathology.

      Level of Evidence

      V, systematic review of Level II-V studies

      Key Words

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      References

        • Carton P.
        • Filan D.
        • Mullins K.
        Survivorship rate and clinical outcomes 10 years after arthroscopic correction of symptomatic femoroacetabular impingement.
        Am J Sports Med. 2021; 50 (036354652110554)
        • Jack R.A.
        • Sochacki K.R.
        • Hirase T.
        • et al.
        Performance and return to sport after hip arthroscopy in the National Basketball Association.
        Arthroscopy. 2020; : 36473-36478
        • Jack R.A.
        • Sochacki K.R.
        • Hirase T.
        • Vickery J.W.
        • Harris J.D.
        Performance and return to sport after hip arthroscopy for femoroacetabular impingement in professional athletes differs between sports.
        Arthroscopy. 2019; 35: 1422-1428
        • Schairer W.W.
        • Nwachukwu B.U.
        • Suryavanshi J.R.
        • Yen Y.M.
        • Kelly B.T.
        • Fabricant P.D.
        A shift in hip arthroscopy use by patient age and surgeon volume: A New York state-based population analysis 2004 to 2016.
        Arthroscopy. 2019; 35: 2847-2854
        • Hassan M.M.
        • Hussain Z.B.
        • Rahman O.F.
        • Kocher M.S.
        Trends in adolescent hip arthroscopy from the PHIS database 2008-2018.
        J Pediatr Orthop. 2021; 41: e26-e29
        • Frank J.S.
        • Gambacorta P.L.
        • Eisner E.A.
        Hip pathology in the adolescent athlete.
        J Am Acad Orthop Surg. 2013; 21: 665-674
        • Schroeder P.B.
        • Nicholes M.A.
        • Schmitz M.R.
        Hip injuries in the adolescent athlete.
        Clin Sports Med. 2021; 40: 385-398
        • Ganz R.
        • Parvizi J.
        • Beck M.
        • Leunig M.
        • Nötzli H.
        • Siebenrock K.A.
        Femoroacetabular impingement: A cause for osteoarthritis of the hip.
        Clin Orthop Related Res. 2003; 417: 112-120
        • Safran M.R.
        Microinstability of the hip—Gaining acceptance.
        J Am Acad Orthop Surg. 2019; 27: 12-22
        • Kocher M.S.
        • Kim Y.J.
        • Millis M.B.
        • et al.
        Hip arthroscopy in children and adolescents.
        J Pediatr Orthop. 2005; 25: 680-686
        • Flanum M.E.
        • Keene J.S.
        • Blankenbaker D.G.
        • DeSmet A.A.
        Arthroscopic treatment of the painful “internal” snapping hip: Results of a new endoscopic technique and imaging protocol.
        Am J Sports Med. 2007; 35: 770-779
        • Ross J.R.
        • Larson C.M.
        • Bedi A.
        Indications for hip arthroscopy.
        Sports Health. 2017; 9: 402-413
        • Jamil M.
        • Dandachli W.
        • Noordin S.
        • Witt J.
        Hip arthroscopy: Indications, outcomes and complications.
        Int J Surg. 2018; 54: 341-344
        • Nwachukwu B.U.
        • McFeely E.D.
        • Nasreddine A.Y.
        • Krcik J.A.
        • Frank J.
        • Kocher M.S.
        Complications of hip arthroscopy in children and adolescents.
        J Pediatr Orthop. 2011; 31: 227-231
        • Aprato A.
        • Jayasekera N.
        • Villar R.N.
        Does the modified Harris Hip Score reflect patient satisfaction after hip arthroscopy?.
        Am J Sports Med. 2012; 40: 2557-2560
        • Levy D.M.
        • Kuhns B.D.
        • Chahal J.
        • Philippon M.J.
        • Kelly B.T.
        • Nho S.J.
        Hip arthroscopy outcomes with respect to patient acceptable symptomatic state and minimal clinically important difference.
        Arthroscopy. 2016; 32 (4): 1877-1886
        • Stone A.V.
        • Jacobs C.A.
        • Luo T.D.
        • et al.
        High degree of variability in reporting of clinical and patient-reported outcomes after hip arthroscopy.
        Am J Sports Med. 2018; 46: 3040-3046
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.
        BMJ. 2009; 339: 332-336
        • Hohmann E.
        • Feldman M.
        • Hunt T.J.
        • Cote M.P.
        • Brand J.C.
        Research pearls: How do we establish the level of evidence?.
        Arthroscopy. 2018; 34: 3271-3277
        • Griffin D.W.
        • Kinnard M.J.
        • Formby P.M.
        • McCabe M.P.
        • Anderson T.D.
        Outcomes of hip arthroscopy in the older adult: A systematic review of the literature.
        Am J Sports Med. 2017; 45: 1928-1936
        • Neyeloff J.L.
        • Fuchs S.C.
        • Moreira L.B.
        Meta-analyses and Forest plots using a microsoft excel spreadsheet: Step-by-step guide focusing on descriptive data analysis.
        BMC Res Notes. 2012; 5: 52
        • Slim K.
        • Nini E.
        • Forestier D.
        • Kwiatkowski F.
        • Panis Y.
        • Chipponi J.
        Methodological index for non-randomized studies (Minors): Development and validation of a new instrument.
        ANZ J Surg. 2003; 73: 712-716
        • Chen S.L.
        • Maldonado D.R.
        • Go C.C.
        • Kyin C.
        • Lall A.C.
        • Domb B.G.
        Outcomes of hip arthroscopic surgery in adolescents with a subanalysis on return to sport: A systematic review.
        Am J Sports Med. 2020; 48: 1526-1534
        • Chona D.V.
        • Bonano J.C.
        • Ayeni O.R.
        • Safran M.R.
        Definitions of return to sport after hip arthroscopy: Are we speaking the same language and are we measuring the right outcome?.
        Orthop J Sport Med. 2020; 8 (2325967120952990)
        • Fabricant P.D.
        • Heyworth B.E.
        • Kelly B.T.
        Hip arthroscopy improves symptoms associated with FAI in selected adolescent athletes.
        Clin Orthop Relat Res. 2012; 470: 261-269
        • Tran P.
        • Pritchard M.
        • O’Donnell J.
        Outcome of arthroscopic treatment for cam type femoroacetabular impingement in adolescents.
        ANZ J Surg. 2013; 83: 382-386
        • Byrd J.W.T.
        • Jones K.S.
        • Gwathmey F.W.
        Femoroacetabular impingement in adolescent athletes: Outcomes of arthroscopic management.
        Am J Sports Med. 2016; 44: 2106-2111
        • d’Entremont A.G.
        • Cooper A.P.
        • Johari A.
        • Mulpuri K.
        What clinimetric evidence exists for using hip-specific patient-reported outcome measures in pediatric hip impingement?.
        Clin Orthop Relat Res. 2015; 473: 1361-1367
        • Minkara A.A.
        • Westermann R.W.
        • Rosneck J.
        • Lynch T.S.
        Systematic review and meta-analysis of outcomes after hip arthroscopy in femoroacetabular impingement.
        Am J Sports Med. 2019; 47: 488-500
        • Litrenta J.
        • Mu B.H.
        • Ortiz-Declet V.
        • et al.
        Hip arthroscopy successfully treats femoroacetabular impingement in adolescent athletes.
        J Pediatr Orthop. 2020; 41: e98
        • Agricola R.
        • Bessems J.H.J.M.
        • Ginai A.Z.
        • et al.
        The development of cam-type deformity in adolescent and young male soccer players.
        Am J Sports Med. 2012; 40: 1099-1106
        • Siebenrock K.A.
        • Ferner F.
        • Noble P.C.
        • Santore R.F.
        • Werlen S.
        • Mamisch T.C.
        The cam-type deformity of the proximal femur arises in childhood in response to vigorous sporting activity.
        Clin Orthop Relat Res. 2011; 469: 3229-3240
        • Agricola R.
        • Heijboer M.P.
        • Ginai A.Z.
        • et al.
        A cam deformity is gradually acquired during skeletal maturation in adolescent and young male soccer players: A prospective study with minimum 2-year follow-up.
        Am J Sports Med. 2014; 42: 798-806
        • Roy D.R.
        The use of hip arthroscopy in the management of the pediatric hip.
        J Hip Preserv Surg. 2016; 3: 97-107
        • Chen A.
        • Youderian A.
        • Watkins S.
        • Gourineni P.
        Arthroscopic femoral neck osteoplasty in slipped capital femoral epiphysis.
        Arthroscopy. 2014; 30: 1229-1234
        • Rahm S.
        • Jud L.
        • Jungwirth-Weinberger A.
        • et al.
        Mid-term results after in situ pinning and hip arthroscopy for mild slipped capital femoral epiphysis: A minimum five-year follow-up.
        J Child Orthop. 2020; 14: 521-528
        • Kirsch J.M.
        • Khan M.
        • Bedi A.
        Does hip arthroscopy have a role in the treatment of developmental hip dysplasia?.
        J Arthroplasty. 2017; 32: S28-S31
        • Thanacharoenpanich S.
        • Boyle M.J.
        • Murphy R.F.
        • et al.
        Periacetabular osteotomy for developmental hip dysplasia with labral tears: is arthrotomy or arthroscopy required?.
        J Hip Preserv Surg. 2018; 5: 23-33
        • Kanatli U.
        • Ayanoglu T.
        • Ozer M.
        • Ataoglu M.B.
        • Cetinkaya M.
        Hip arthroscopy for Legg-Calvè-Perthes disease in paediatric population.
        Acta Orthop Traumatol Turc. 2019; 53: 203-208
        • Christian R.A.
        • Lubbe R.J.
        • Chun D.S.
        • Selley R.S.
        • Terry M.A.
        • Hsu W.K.
        Prognosis following hip arthroscopy varies in professional athletes based on sport.
        Arthroscopy. 2019; 35: 837-842.e1
        • Worner T.
        • Thorborg K.
        • Eek F.
        High prevalence of hip and groin problems in professional ice hockey players, regardless of playing position.
        Knee Surg Sports Traumatol Arthrosc. 2020; 28: 2302-2308
        • Sheppard M.
        • Nicknair J.
        • Goetschius J.
        Early sport specialization and subjective hip and groin dysfunction in collegiate ice hockey athletes.
        J Athl Train. 2020; 55: 232-237
        • Philippon M.J.
        • Ho C.P.
        • Briggs K.K.
        • Stull J.
        • LaPrade R.F.
        Prevalence of increased alpha angles as a measure of cam-type femoroacetabular impingement in youth ice hockey players.
        Am J Sports Med. 2013; 41: 1357-1362
        • Ayeni O.R.
        • Banga K.
        • Bhandari M.
        • et al.
        Femoroacetabular impingement in elite ice hockey players.
        Knee Surg Sports Traumatol Arthrosc. 2014; 22: 920-925
        • Anderson S.A.
        • Keene J.S.
        Results of arthroscopic iliopsoas tendon release in competitive and recreational athletes.
        Am J Sports Med. 2008; 36: 2363-2371
        • Hetsroni I.
        • Larson C.M.
        • Dela Torre K.
        • Zbeda R.M.
        • Magennis E.
        • Kelly B.T.
        Anterior inferior iliac spine deformity as an extra-articular source for hip impingement: A series of 10 patients treated with arthroscopic decompression.
        Arthroscopy. 2012; 28: 1644-1653
        • Nishikino S.
        • Hoshino H.
        • Koyama H.
        • Furuhashi H.
        • Matsuyama Y.
        Hip arthroscopic surgery after a diagnosis of premature osteoarthritis of the hip in three unicyclists: A case series.
        J Orthop Case Rep. 2018; 8: 51-54
        • Cvetanovich G.L.
        • Weber A.E.
        • Kuhns B.D.
        • et al.
        Clinically meaningful improvements after hip arthroscopy for femoroacetabular impingement in adolescent and young adult patients regardless of gender.
        J Pediatr Orthop. 2018; 38: 465-470
        • Larson C.M.
        • McGaver R.S.
        • Collette N.R.
        • et al.
        Arthroscopic surgery for femoroacetabular impingement in skeletally immature athletes: Radiographic and clinical analysis.
        Arthroscopy. 2019; 35: 1819-1825
        • McConkey M.O.
        • Chadayammuri V.
        • Garabekyan T.
        • Mayer S.W.
        • Kraeutler M.J.
        • Mei-Dan O.
        Simultaneous bilateral hip arthroscopy in adolescent athletes with symptomatic femoroacetabular impingement.
        J Pediatr Orthop. 2019; 39: 193-197
        • Philippon M.J.
        • Yen Y.M.
        • Briggs K.K.
        • Kuppersmith D.A.
        • Maxwell R.B.
        Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient: A preliminary report.
        J Pediatr Orthop. 2008; 28: 705-710