Arthroscopic Intervention for FAI, How Successful in Athletes?

How successful is arthroscopic intervention as treatment for femoroacetabular impingement (FAI) and painful internal snapping as a strategy for returning athletes to competitive activity? A new study provides evidence that competitive athletes can, indeed, return to sport after being treated arthroscopically with intrabursal iliopsoas fractional lengthening.

The study, “Competitive Athletes with Femoroacetabular Impingement and Painful Internal Snapping Treated Arthroscopically with Intrabursal Iliopsoas Fractional Lengthening: High Rate of Return to Sport and Favorable Midterm Functional Outcomes,” was published online on April 19, 2022, in The American Journal of Sports Medicine.

“Athletes with femoroacetabular impingement syndrome who undergo hip arthroscopy with iliopsoas fractional lengthening in the context of painful internal snapping have demonstrated favorable patient-reported outcomes, return to sport, and resolution of internal snapping symptoms at short term follow-up. Midterm outcomes have not been established,” the team from the American Hip Research Foundation wrote.

For this study, the research team collected 5-year patient-reported outcomes and return-to-sport data for competitive athletes who had been treated with primary hip arthroscopy for femoroacetabular impingement syndrome and intrabursal iliopsoas fractional lengthening.

They then compared their outcomes to a control group of athletes who had hip arthroscopy, but without painful internal snapping and iliopsoas fractional lengthening.

All the arthroscopies were performed by a single surgeon between February 2010 and December 2013. Patients were either a professional, collegiate, or high school athlete who had a minimum of 5 years of follow-up scores for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sport Specific Subscale, and Visual Analog Scale for pain.

Overall, there were 105 competitive athletes included in the iliopsoas fractional lengthening group. They all had a follow-up of 66.8 ± 6.9 months. They all showed significant improvement in all patient-reported outcomes at a minimum 5-year follow-up (p < .001).

They also had favorable rates of achieving the minimal clinically importance difference for the modified Harris Hip Score (82.0%), Nonarthritic Hip Score (85.4%), and Hip Outcome Score-Sport Specific Subscale (82.8%).

Almost 90% of the athletes in the iliopsoas fractional lengthening group successfully returned to sport. When 42 of the athletes in the iliopsoas fractional lengthening group were propensity matched to 54 control athletes, the researchers found that both groups demonstrated similar improvements in patient-reported outcomes and rates of return to sport, revision arthroscopy, and achieving psychometric thresholds.

“Competitive athletes undergoing primary hip arthroscopy and intrabursal iliopsoas fractional lengthening in the context of femoroacetabular impingement syndrome and painful internal snapping demonstrated favorable patient-reported outcomes and return to sport rate at minimum 5-year follow-up,” the researchers wrote.

Study authors included Andrew E. Jimenez, M.D., Tom George, Michael S. Lee, Jade S. Owens, David R. Maldonado, M.D., Olivia A. Paraschos, Ajay C. Lall, M.D., and Benjamin G. Domb, M.D., all of the American Hip Research Foundation.