So, elite female athletes demonstrate comparable improvement in midterm patient reported outcome scores and rate of return to sport compared to elite male athletes after hip arthroscopy. A sex-based comparison in professional and collegiate athlete, Dr. Jiménez, I apologize. Thank you. No problem. Okay. So, I'm Andrew Jiménez. I'm an assistant professor at Yale University. This paper is from my time as a hip preservation fellow at the American Hip Institute in Chicago. All disclosures are listed on the AOS website, none are relevant to this talk. In terms of a background, considerable research has evaluated outcomes of hip arthroscopy in the male population, but there's a relative lack of studies in female athletes. This disparity is incongruous with the growing number of female athletes being treated for FAI with arthroscopic techniques. Few studies have compared midterm outcomes between matched cohorts of male and female athletes undergoing hip arthroscopy for the treatment of FAI. In terms of the purpose, it was two-fold, one, to report minimum five-year PROs, return to sport, and continuation of sport for elite female athletes undergoing hip arthroscopy for the treatment of FAI, and two, to compare these outcomes with a matched cohort of elite male athletes. Our hypothesis was that female athletes would demonstrate favorable outcomes and return to sport rates at minimum five-year follow-up, secondarily that these outcomes would be similar to a matched control group of male athletes. In terms of our methods, we looked at professional and collegiate female athletes undergoing primary hip arthroscopy for FAI between 2009 and 2016. We looked at minimum five-year PROs, and we also looked at return to sport and continuation of sport data and rates of achieving psychometric thresholds. These female athletes were then matched to male athletes for a control group. In terms of our cohort, we had 65 female hips in the study group. The average age was 24 years, average follow-up was 68 months. These were matched one-to-one to 65 male controls based on age, BMI, competition level, LCEA, sport type, and TANUS grade. And also both groups had similar proportions of professional versus collegiate athletes. In terms of interoperative findings, female athletes demonstrated less severe labeled tear patterns, ALAD grades, and that's tabular out of reach grades, compared to a matched control group of male patients. Further, in terms of surgical procedures, there were baseline differences between groups regarding surgical procedures, specifically female athletes undergoing capsule repair more commonly, and femoroplasty less commonly than male athletes. In terms of return to sport outcomes, the ability to return to sport at any time point was similar between groups, with 80% rate in the female athletes and the 77% rate in the male athletes. Further, continuation of sport was also similar between groups among athletes who had successfully returned to sport and attempted to continue playing at a minimum five-year follow-up, and that rate was 97% in the females and 93% in the males. In terms of our PRO results, you will notice that for every PRO that we looked at, modified Harris-Hipps score, NAHS, HOSSS, and VAS for pain, the female athletes had lower preoperative scores but similar postoperative scores at minimum five-year follow-up. Further, female athletes demonstrated similar rates of achieving psychometric thresholds compared to male athletes for the modified Harris-Hipps score, NAHS, HOSSS, and VAS. In terms of our discussion, the elite female athletes undergoing primary hyperarthroscopy demonstrated significant improvements in PROs from baseline to minimum five-year follow-up. They achieved favorable rates of return to sport, continuation of sport, and rates of achieving psychometric thresholds. The female athletes demonstrated less acetabular chondro injury, were more likely to undergo capsule repair, and were less likely to undergo femoroplasty compared to a mass control group of male athletes. They had lower preoperative but similar postoperative scores compared to male athletes for all of the evaluated PROs. Lastly, the rates of return to sport, continuation of sport, and achievement of psychometric thresholds were similar between male and female athletes despite baseline differences in intraoperative findings in surgical procedures. In terms of limitations, this is a retrospective analysis from a single surgeon at a single institution. This study was performed over a long study period of seven years with evolving surgical technique over that time. There is baseline differences between treatment groups regarding intraoperative pathology as well as surgical treatments. There's also possible ceiling effects of PROs in competitive athletes, particularly the modified Harris-Hipps score. It was also a heterogeneous group of athletes in terms of both level and sport type. And lastly, return to sport and continuation of sport were considered a binary outcome. So in conclusion, elite female athletes undergoing primary hyperarthroscopy demonstrated favorable PROs and high rates of return to sport and continuation of sport at minimum five-year follow-up. And these results were comparable with a propensity match group of elite male athletes. Thank you.

study

elite female athletes

hip arthroscopy

femoroacetabular impingement (FAI)

outcomes