return-to-play considerations after hip arthroscopy. I'd like to thank my co-authors, Dr. Tyler Hauer, who is a former sports medicine fellow and staff at the University of Toronto, and Rob Apgar, one of our lead hip physical therapists in our institution. Here's my disclosure. So several of the considerations which are important to consider in any post-operative state, but in particularly with hip arthroscopy and return to sport, are the sport type, the level of participation, the elapsed time from stopping sport participation until surgical management, the patient goals, the phases of rehabilitation, and the return to sport testing which may be implemented. Why is this important? Well, Shane Ngo and his group in 2017 presented a retrospective comparison study of amateur and recreational athletes and their return to sport after hip arthroscopy. They divided the return to sport into level, both amateur and professional athletes, as well as recreational athletes. They further divided the group into a helpful comparison groups of cutting, flexibility, contact, impingement, asymmetric and endurance types of sports, which has been previously reported by Brian Kelly and his group. Their group in this report found that, on average, high-level athletes returned one month earlier, but really there was no return to sport difference based on sport type. Overall, 88% of the amateur athletes and 94% of recreational athletes returned to their level of sport. What do we know about return to sport specific considerations? A further report reviewed this and found return to sport rates ranging from 87 to 93%. And there's really no consensus on rehab protocol or return to sport readiness testing in the hip arthroscopy world. Most reports in the literature report a seven-month return to sport timeframe, and athletes who withdrew from sport greater than eight months prior to surgery had a slower return to sport. Further, really the difference in return to sport was very similar between soccer, basketball, lacrosse, cutting sports, football, baseball, contact sports, and endurance sports, such as rowing, had a potentially lower return to sport in some reports. Further follow-up meta-analysis looked at, is there a difference in return to sport based on sport type? This report in 2021 reported that there was no statistically significant difference in rate and time to return to sport among the six subgroups reported. Overall, the return to sport type was about 88%, with the flexibility sports reporting 94%, endurance sports 93%, and contact sport 87%. So how do we break this up? Well, we've heard in other reports about the early postoperative state, the return to motor control phase three, which can include return to running and plyometrics, and then eventual return to sport. And most patients takes minimum of about four months, but as was reported, it can be upwards of a year in some cases. How do we structure these programs? Well, Ben Dome and his group sought to determine if a structured physical therapy protocol leads to differences in PROs and return to sports. And they determined in their report that patients that followed these structured physical therapy protocols had significant improvements in their PROs. And despite successful return to sport, these protocols, it was unclear which protocol in particular was most successful. So this really underlines the necessity of following a guided approach to rehabilitation. Once patients have progressed to the point of returning to sport, it's important to continue with rehabilitation to address the remaining deficits on a patient-specific approach. So for our patients, we generally provide these guidelines, which allow them some material to take to their physical therapists, their athletic trainers, in helping them to return to sport in a safe fashion. Our guidelines basically outline phased activities and examples of exercises and activities that may be appropriate for patients at this phase. So for example, the on-field phase in number one, it's the introduction of dynamic activities. This can lead to jogging progression, agility progressions. And we give many examples for the patient to take back to the athletic trainer and physical therapy to begin working on. We then move into sports skills movement and execution in phases two and three. And then ultimately return to full participation, which is a buildup of endurance, competitive movements, contact, working against defenders that are seen in the phase four of the return to sport. We also break down for the patients some examples of what types of workout and warmup to use. These go through many different types of dynamic workout, progression with the running, both on the treadmill and on the track, the progression to sprinting, and giving some examples to build up both intensity, duration, complexity of movement with spring, the intensity outlined in the different stages. Once the patient is able to progress to 100% intensity, this progression builds both in terms of the timing, intensity, and repetitions. We also introduce the hopping progressions, which is a more dynamic plyometric, which may be achieved at different phases based on the patient progression. So this introduces double leg hopping, single leg hopping, broad jump, working on more complex movement in a side-to-side fashion. And this can be all done under the direction of the physical therapist to ensure a safe return to sport. So how has this been utilized in other areas? Well, ACL surgery is certainly the most researched and has the most return to sport literature and protocols. We really don't have the same standard in the hip arthroscopy world. So we've sought to utilize the guidelines that we've created as well as the literature that's out there on return to sport testing to create a program for our patients. This program presented here in the Journal of Sports and Physical Therapy basically defined that range of motion, strength, functional testing, and psychological readiness all need to be within acceptable means before return to sport. But although at this point, we really do not have specifically outlined and defined minimum levels to ensure a safe return to sport that we have in the same way with other injury patterns such as ACL. So in general, we feel that the return to play considerations must be mindful of the literature and successful protocols that have been published in the literature thus far. We also think it's important to be very patient-specific in the approach and use guidelines that you can help to guide your patient back to sport in a safe way. So in general, we recommend incorporating the patient's sport early into the rehab process to increase buy-in and enhance their psychological readiness. We feel that athletes should be exposed to the demands of the sport within the rehabilitation continuum. We feel that continuous strength testing and objective measures should be taken so the results of the return to sport test should not be a surprise. And we advocate to not underestimate the psychological aspect of the rehab process as many athletes take time to trust their hip again, much in the same way as a return to sport after an ACL reconstruction. Thank you very much for this opportunity to present on return to sport considerations following hip arthroscopy surgery.

hip arthroscopy

athlete recovery

rehab protocols

return-to-sport rates

sport-specific rehab