Hip Arthroscopy for Femoroacetabular Impingement in Athletes: Return to Sport Outcomes
DOI:
https://doi.org/10.5281/zenodo.22327550Keywords:
Femoroacetabular impingement, Hip arthroscopy, Return to sport, Labral repair, Athletic performanceAbstract
Background: Femoroacetabular impingement (FAI) syndrome is a leading cause of hip and groin pain in athletes, and hip
arthroscopy is now the dominant surgical treatment. Objective: To synthesise evidence on labral management, osteoplasty, return-to-sport (RTS) rates, comparison with structured physiotherapy, and predictors of successful RTS after arthroscopy for FAI in athletes.
Methods: Narrative review of randomised trials, comparative cohorts, and meta-analyses. Findings: Pooled RTS after arthroscopy ranges from roughly 75-90% across sports, but return to prior performance is substantially lower (37-49% in soccer). Labral repair and capsular closure outperform debridement and unrepaired capsulotomy. Randomised trials (UK FASHIoN, Mansell) show arthroscopy gives modestly superior early functional gains over personalised hip therapy. Younger age, smaller postoperative alpha angle, and cutting/contact sport participation predict better RTS. Conclusions: Arthroscopic FAI correction reliably returns most athletes to sport, though restoring pre-injury performance remains inconsistent and warrants standardised reporting.
References
Hale, R.F., Melugin, H.P., Zhou, J., LaPrade, M.D., Bernard, C., Leland, D., Levy, B.A., Krych, A.J. (2021) Incidence of femoroacetabular impingement and surgical management trends over time. American Journal of Sports Medicine, 49(1): 35-41.
Girardi, N., et al. (2026) Return to sport in elite-level athletes undergoing hip arthroscopy varies based on return-to-sport definition: a systematic review. Arthroscopy, in press.
Mohtadi, N.G., Griffin, D.R., Pedersen, M.E., Chan, D., Safran, M.R., Parsons, N., Sekiya, J.K., Martin, H.D., Byrd, J.W.T., Kelly, B.T., Lee, J.B.L., Ayeni, O.R., Clohisy, J.C., Leunig, M. (2012) The development and validation of a self-administered quality-of-life outcome measure for young, active patients with symptomatic hip disease: the International Hip Outcome Tool (iHOT-33). Arthroscopy, 28(4): 595-605.
Thorborg, K., Holmich, P., Christensen, R., Petersen, J., Roos, E.M. (2011) The Copenhagen Hip and Groin Outcome Score (HAGOS): development and validation according to the COSMIN checklist. British Journal of Sports Medicine, 45(6): 478-491.
Krych, A.J., Thompson, M., Larson, C.M., Byrd, J.W.T., Kelly, B.T. (2013) Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: a prospective randomized study. Arthroscopy, 29(1): 46-54.
Kucharik, M.P., Abraham, P.F., Nazal, M.R., Varady, N.H., Eberlin, C.T., Meek, W.M., Martin, S.D. (2022) Arthroscopic acetabular labral repair versus labral debridement: long-term survivorship and functional outcomes. Orthopaedic Journal of Sports Medicine, 10(6): 23259671221109012.
Riff, A.J., Kunze, K.N., Movassaghi, K., Hijji, F., Beck, E.C., Nho, S.J., Chahla, J. (2019) Systematic review of hip arthroscopy for femoroacetabular impingement: the importance of labral repair and capsular closure. Arthroscopy, 35(2): 646-661.e3.
Kunze, K.N., Vadhera, A., Devinney, A., Nwachukwu, B.U., Kelly, B.T., Nho, S.J., Chahla, J. (2021) Effect of capsular closure after hip arthroscopy for femoroacetabular impingement syndrome on achieving clinically meaningful outcomes: a meta-analysis of prospective and comparative studies. Orthopaedic Journal of Sports Medicine, 9(7): 23259671211017467.
Hartwell, M.J., Morgan, A.M., Nemsick, M., Fenn, T.W., Gerhardt, M.B., Gursoy, S., Chahla, J., Nho, S.J. (2021) Isolated acetabuloplasty for femoroacetabular impingement: favorable patient-reported outcomes and sustained survivorship at minimum 5-year follow-up. Arthroscopy, 37(9): 2818-2826.
Alradwan, H., Philippon, M.J., Farrokhyar, F., Chu, R., Whelan, D., Bhandari, M., Ayeni, O.R. (2012) Return to preinjury activity level after surgical management of femoroacetabular impingement in athletes. Arthroscopy, 28(10): 1567-1576.
Menge, T.J., Briggs, K.K., Rasmussen, M.T., Philippon, M.J. (2021) Cutting, impingement, contact, endurance, flexibility, and asymmetric/overhead sports: is there a difference in return-to-sport rate after arthroscopic femoroacetabular impingement surgery? A systematic review and meta-analysis. American Journal of Sports Medicine, 49(9): 2497-2507.
Ifabiyi, M., Patel, M., Cohen, D., Simunovic, N., Ayeni, O.R. (2024) Return-to-sport rates after hip arthroscopy for femoroacetabular impingement syndrome in flexibility sports athletes: a systematic review. Sports Health, 16(6): 940-948.
Marom, N., Olsen, R., Burger, J.A., Dooley, M.S., Coleman, S.H., Ranawat, A.S., Kelly, B.T., Nawabi, D.H. (2023) Majority of competitive soccer players return to soccer following hip arthroscopy for femoroacetabular impingement: female and older aged players are less likely to return to soccer. Knee Surgery, Sports Traumatology, Arthroscopy, 31(7): 2721-2729.
Sjovall Anari, S., Olsson, A., Ohlin, A., Desai, N., Hamrin Senorski, E., Sansone, M., Lindman, I. (2023) High-level soccer players have a low rate of return to performance after hip arthroscopy for femoroacetabular impingement syndrome. Knee Surgery, Sports Traumatology, Arthroscopy, 31(6): 2071-2078.
Owens, J.S., Jimenez, A.E., Lee, M.S., Hawkins, G.C., Maldonado, D.R., Domb, B.G. (2022) Basketball players undergoing primary hip arthroscopy exhibit higher grades of acetabular cartilage damage but achieve favorable midterm outcomes and return to sports rates comparable with a propensity-matched group of other cutting sports athletes. American Journal of Sports Medicine, 50(9): 2429-2438.
Reiman, M.P., Rhon, D.I., Fraser, J.J., Wilkinson, D.P., Kolber, M.J., Goode, A.P. (2018) Most military service members return to activity duty with limitations after surgery for femoroacetabular impingement syndrome: a systematic review. Arthroscopy, 34(6): 1833-1841.
Nwachukwu, B.U., Fields, K., Yeom, J., Rasio, J., Nawabi, D.H., Kelly, B.T., Ranawat, A.S. (2019) Return-to-play and performance outcomes of professional athletes in North America after hip arthroscopy from 1999 to 2016. American Journal of Sports Medicine, 47(6): 1488-1495.
Slawaska-Eng, D., Jamieson, N., de Sa, D., Simunovic, N., Ayeni, O.R. (2025) Performance and return to sport outcomes following hip arthroscopy in National Hockey League players. Knee Surgery, Sports Traumatology, Arthroscopy, 33(6): 2110-2118.
McDonald, J.E., Herzog, M.M., Philippon, M.J. (2013) Return to play after hip arthroscopy with microfracture in elite athletes. Arthroscopy, 29(2): 330-335.
Jimenez, A.E., Owens, J.S., Monahan, P.F., Maldonado, D.R., Saks, B.R., Sabetian, P.W., Ankem, H.K., Lall, A.C., Domb, B.G. (2022) Return to sports and minimum 2-year outcomes of hip arthroscopy in elite athletes with and without coexisting low back pain: a propensity-matched comparison. American Journal of Sports Medicine, 50(4): 976-985.
Griffin, D.R., Dickenson, E.J., Wall, P.D.H., Achana, F., Donovan, J.L., Griffin, J., Hobson, R., Hutchinson, C.E., Jepson, M., Parsons, N.R., Petrou, S., Realpe, A., Smith, J., Foster, N.E. (2018) Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet, 391(10136): 2225-2235.
Kemp, J.L., Mosler, A.B., Hunt, M.A., Rio, E., Semciw, A.I., Girdwood, M., King, M.G., Fransen, M., Bruns, E., Crossley, K.M. (2021) Multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapist-led care for femoroacetabular impingement (FAI) syndrome on hip cartilage metabolism: the Australian FASHIoN trial. BMC Musculoskeletal Disorders, 22: 685.
Mansell, N.S., Rhon, D.I., Meyer, J., Slevin, J.M., Marchant, B.G. (2018) Arthroscopic surgery or physical therapy for patients with femoroacetabular impingement syndrome: a randomized controlled trial with 2-year follow-up. American Journal of Sports Medicine, 46(6): 1306-1314.
Schwabe, M.T., Clohisy, J.C., Cheng, A.L., Pascual-Garrido, C., Harris-Hayes, M., Hunt, D.M., Harris, M.D., Prather, H., Nepple, J.J. (2020) Short-term clinical outcomes of hip arthroscopy versus physical therapy in patients with femoroacetabular impingement: a systematic review and meta-analysis of randomized controlled trials. Orthopaedic Journal of Sports Medicine, 8(11): 2325967120968490.
Monahan, P.F., Maldonado, D.R., Owens, J.S., Ankem, H.K., Saks, B.R., Jimenez, A.E., Lall, A.C., Domb, B.G. (2022) Postoperative alpha angle is predictive of return to sport in athletes undergoing hip arthroscopy for femoroacetabular impingement. Arthroscopy, 38(3): 810-818.
Nikou, S., et al. (2025) Ten-year outcomes of hip arthroscopy for femoroacetabular impingement with osteoarthritis: sustained functional benefits but high conversion to total hip arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy, 33(6): 2050-2059.
Gilat, R., Vogel, M.J., Alvero, A.B., Jan, K., Kazi, O., Danilkowicz, R.M., Nho, S.J. (2025) The THA-10 score for predicting conversion to total hip arthroplasty after contemporary hip arthroscopy for femoroacetabular impingement syndrome at a minimum 10-year follow-up. American Journal of Sports Medicine, 53(8): 1826-1835.
