Good morning, everyone. I want to thank AOSSM for the opportunity to present our work. I'm Niv Marom, a former HSS sports fellow currently working in Israel. Nothing to disclose. So hip arthroscopy is known as an effective treatment for the treatment of symptomatic FAI in the athletic population with multiple studies reporting on return to sport rates across different sports and level of play. Majority of studies reporting on rates higher than 86%. Of all sports, running is one of the most popular forms of physical activity. It is considered high impact activity with increased loads across lower body joints, and this includes the hip. Only a few studies, though, reported on return to running after a hip scope, and these studies reported on different rates of return to running, as you can appreciate, with different methodologies used. We should also acknowledge and remember that running is not one sport. There are different types of running and different types of runners, and this was the reason for the purpose of this study. We decided we want to determine the return to long-distance running rates and changes in running performance in long-distance runners undergoing hip arthroscopy for the treatment of FAI, and to possibly identify possible risk factors associated with not returning to long-distance running. So the HSS Hip Preservation Registry was retrospectively reviewed for patients self-identified as long-distance runners who were indicated for and underwent a primary hip arthroscopy for FAI between 2010 and 2017. Patients demographics and injury characteristics as well as clinical and radiographic findings were recorded, and all patients were contacted for return to running information using a running-specific return to sport questionnaire. The questionnaire was administered by telephone or email. Runners who denied completing at least one long-distance running race prior to their hip symptoms were excluded, and the questionnaire included questions on various aspects of running and running performance prior to their hip symptoms, after presentation of symptoms, and after surgery, as well as specific running metrics. So 68 long-distance runners with 78 hips, so 10 where bilaterals were included, 56% of them were female. The mean age, as you can appreciate, is 38, and this is very similar to the reported average age of marathon runners, as you can see on the right. Mean BMI was 24, and mean follow-up time was 6 years. Mean weekly running mileage prior to injury or prior to symptoms was 34.5 miles. Mean duration of hip symptoms was 77 weeks, which is more than one year and a half. And interestingly, around 90% of the runners had to stop or modify their running for a mean duration of 44 weeks prior to surgery due to their hip symptoms. Most common procedure performed was a labral repair with AIS and decompression. All capsules were closed with four to five sutures in the majority of cases. So 50 runners actually returned to running. This is 74% of the cohort at the mean time of 32 weeks. But only 25 runners returned to long-distance running, completing half or full marathon races at a mean time of 65 years. This is 37% of the whole cohort. When asked about their post-surgery running, a runner estimated their running performance or running ability when compared to pre-symptomatic as better or the same. And you can see here in the pre-symptomatic period that most of them estimated that they run the same level or better level than their pre-symptoms. And 74% of them estimated they run better when compared their post-surgery running to their just immediately before surgery and after symptoms started. When looking at all 50 runners, comparing pre-symptomatic period to post-surgery running, you can see that there is a decrease in all running metrics. As you can appreciate yourselves, everything is statistically significant. Symptoms for not returning to run, the most common was hip pain or discomfort followed by fear of re-injury. Overall satisfaction was 85%. It was 92% for those who returned to running. But surprisingly or not, also two-thirds of those not returning to running were satisfied with their surgery results. Multivariable logistic regression analysis revealed that females were less likely to return to running with an odds ratio of 0.17. So this study confirms that long-distance runners represent a distinctive and unique subgroup of runners. They are older. They are experiencing increased loads across their hips that are secondary to the running volumes and overall intensity of their trainings. They're resilient and motivated, which is usually a good thing, but also a reason for delayed medical care. And we need to remember that in this population, return to sport means training and coming or going back to races, marathon races. So majority of long-distance runners benefited from surgery despite low rates of return to long-distance running or racing. 74% returned to running. Most of them reported their return to the same or better running ability as prior to their hip symptoms. Overall satisfaction rate was 85%, and two of three runners who did not return to any running were still satisfied with the results of the surgery. Female runners were 5.8 times less likely to return to running compared to male runners. We recently published similar results for soccer players, and reasons are not clear yet, and this should be further investigated. We should also appreciate an important point. I mean, there is high variability in defining, evaluating and reporting patterns of RTS data after hip arthroscopy, and I encourage you to look at the methods used in all the studies reporting on RTS, and you'll probably be surprised. So clinicians should carefully evaluate methods used in studies reporting on RTS after hip arthroscopy and interpret findings appropriately. So to conclude, majority of long-distance runners returned to running after a hip arthroscopy for FAI. Only half of those returning to running got back to running long-distance races. Female runners were less likely to return to running after surgery. Satisfaction from surgery, however, was not necessarily related to return to running. Runners who understand the implication of their injury may decide not to return to long-distance running with the purpose of prolonging their hip longevity and health, and this data obviously can better guide clinicians and long-distance runners with realistic expectations related to the arthroscopic management of symptomatic FAI. On the right, you can see the event that initiated this study during my fellowship at HSS, and I want to thank you and thank all my co-authors for their help with this study. Thanks.

long-distance running

hip arthroscopy

femoroacetabular impingement

HSS Hip Preservation Registry

return to running