Post Operative Rehabilitation After Hip Arthroscopy- Dont Delay - - PowerPoint PPT Presentation

Post Operative Rehabilitation After Hip Arthroscopy- Don’t Delay Return to Sport

Misty Suri M.D.

Medical Director, Head Team Physician New Orleans Pelicans (2007-2017) Team Physician New Orleans Saints Team Physician University of New Orleans Consultant: LSU Athletics Ochsner Sports Medicine Institute

Art Villarreal M.D. (fellow)

with permisssion

with permisssion

with permisssion

• 44 hips among intercollegiate or professional

baseball players

– Return to play 42/44 (95%) at 4.3 months (3-8 mo) – Rehab:

• debridement- WBAT w/ crutches x 1 wk
• femoroplasty- WBAT w/ crutches x 4 wks
• labral repair- 50% WB x 4 wks; limit ER & max flexion
• microfracture- protected WB x 8 wks
• “structured rehab” x 12 wks followed by functional progression

toward return to sport

• 20 male professional golfers (27 hips)

– 11 labral repair, 16 labral debridement, 4 microfx – 100% return to play – avg. return to sport 4.7 mos (1 mo - 2 yrs)

• 28 NHL players

– 100% return to skating/hockey drills

• return 3.8 mos (1-5 mo)

– Rehab: 20 lbs WB & 4hrs CPM x 2 wks (8wks for microfx)

• rotation precaution boots 14-21 days
• PT progression PROM, AROM then strengthening
• IR followed by ER
• passive hip pendulums for adhesion prevention

• 66 patients

– 49 recreational athletes, 17 high level amateurs (high school/college) – return to sport: rec 94%, amateur 88% – cleared to return to play: 4-6 mos – self reported return to play:

• amateur: 9 +/- 5.3 months
• rec: 10 +/- 5.3 months

• 51 pts w/ FAI

– 48 (94%) returned to running at 8.5 +/- 4.2 mo

• Pts discontinuing running > 8mo prior to surgery with longer

return to running – 10.6 +/- 4.2 mo vs. 7.6 +/- 4.1 mo

p = 0.01

• Rehab

– 20 lb WB x 2 wks – elliptical beginning wk 6 w/ functional exercises as tol – running w/ antigravity treadmill at 12 weeks

• 31 ISHA surgeons with published rehab protocol online

– Bracing 17/31 x median 2 wks (1-6 wks) – Ice 18/31 x median 2.5 wks (1-8 wks) – CPM 16/31 x median 4 wks (2-4 wks) – 29/31 specify WB status

• NWB 1/29
• TDWB 4/29
• PWB 20/29
• WBAT 4/29

– Return to running specified by 20/31; median 12 wks (6-19 wks) – Return to sport specified by 13/31; median 15.5 wks (9-23 wks)

• Survey of 27 high volume hip arthroscopists

Recommended return to sport: 6-12 weeks 2 (7.5%) 12-16 weeks 10 (37%) 16-20 weeks 9 (33%) 20-24 weeks 4 (15%) No response 2 (7.5%) Recommended return to sport criteria

Able to perform single leg squat 5 (19%) Able to perform lateral agility drills 5 (19%) Able to perform single leg squat without pain 15 (56%) Able to perform lateral agility drills without pain 19 (70%) Able to run without pain 19 (70%) Able to jump without pain 16 (59%) Able to reproduce all motions involved in sport without pain 23 (85%) Minimal cartilage damage seen at arthroscopy 1 (4%)

Vail Sport Test

Garrison et al. The reliability of the Vail sport test as a measure of physical performance following ACL Reconstruction. IJSPT. 2012; 7 (1) 20 – 30.

“Functional tool that is reliable in assessing performance in RTS phase of rehab. When used as a component in a battery of outcome measures it may allow for effective clinician evaluation.”

Other considerations: Return to sport ratios post injury

Thorborg, K. et al. Hip adduction and abduction strength profiles in elite soccer players: implications for clinical evaluation of hip adductor muscle recovery after injury.

• An ipsilateral hip adduction/abduction strength ratio of

more than 90%, has been suggested to clinically represent adequate strength recovery with groin injury. Thorborg K, et al. Eccentric hip adduction and abduction strength in elite soccer players and matched controls: a cross sectional study Br J Sports Med. 2011.

• Lower extremity strength deficits of less than 10% on the

injured side, compared to the uninjured side, have been suggested as the clinical milestone before returning to sports following injury.

with permisssion