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Editorial Commentary: Hip Arthroscopy Wins the National Basketball Association Slam Dunk Contest!
Editorial Commentary: Hip Arthroscopy Wins the National Basketball Association Slam Dunk Contest! David R. Maldonado, M.D., Editorial Board
Abstract: Hip arthroscopy has proved its efficacy and value in the management of femoroacetabular impingement syndrome in recreational and professional athletes. However, needs, expectations, and economic burden are remarkable and astonishingly different within the elite sport world. When considering hip arthroscopy to address a femoroacetabular impingement condition, 3 big questions are asked by every athlete and must be answered: (1) Can I play again? (2) Will I play at the same level? (3) When can I return to sport? Regarding the National Basketball Association, approximately 88% of athletes return to play at the same level in about 6 months.
See related article on page 473
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rofessional American baseball, hockey, football, and baseball leagues are referred to as the “Big Four” in the United States. Studies addressing outcomes and the rate of return to sport after hip arthroscopy have been published for the first 3 sports1-3 and for professional soccer.4 However, such data and research have not yet been published for the National Basketball Association (NBA). In the study “Performance and Return to Sport After Hip Arthroscopy in National Basketball Association,” Jack, Sochacki, Hirase, Vickery, McCulloch, Lintner, and Harris,5 with an impeccable methodologic work, roll up the blinds and reveal the answers to the 3 big questions asked by athletes after hip arthroscopy surgery: (1) Can I play again? (2) Will I play at the same level? (3) When can I return to sport? In answer to the first question, the study concludes that 87.5% of the NBA players were able to return to sport. Addressing the second question, regarding level of play, the study reveals that NBA players return with performance statistics similar to their preoperative levels and those of matched controls. Finally, to
The author reports the following potential conflicts of interest or sources of funding: D.R.M. receives nonfinancial support from Arthrex (travel/lodging and food/beverage), Stryker (travel/lodging and food/beverage), Smith & Nephew (travel/lodging and food/beverage), and Ossur (food/beverage). Full ICMJE author disclosure forms are available for this article online, as supplementary material. Ó 2019 by the Arthroscopy Association of North America 0749-8063/191292/$36.00 https://doi.org/10.1016/j.arthro.2019.10.027
answer the question surrounding the timeline, the study shows that NBA athletes return after an average of 5.7 2.6 months. Previously, Begly et al.6 reported their outcomes after hip arthroscopy for femoroacetabular impingement in professional basketball players. NBA, Women’s National Basketball Association, and EuroLeague patients were part of this case series. Begly et al. concluded, similarly to Jack et al.,5 that elite basketball players returned to play at a very high rate after hip arthroscopy. This naturally leads to the following question: Can these good results be expected for nonNBA players? We recently published our results on outcomes and return to basketball after hip arthroscopy at minimum 2-year follow-up.7 Besides the statistically significant improvement in several patient-reported outcomes, this study found that 83.9% of athletes returned to playing basketball at the most recent follow-up and 74.2% subjectively reported their ability level as being the same or higher. Of the patients, 96.8% were nonprofessional players. Finally, the inclusion of a control group for comparison purposes with rigorous matching parameters added meaningful value to the study of Jack et al.5 For example, I have learned that the career length for an NBA player who underwent hip arthroscopy is comparable to that of an NBA matched control group, results that I personally found fascinating. Still, work needs to be done, and we must strive for studies with the highest level of evidence that the medical community expects and demands within hip arthroscopy. Yet, I applaud the work by Jack et al.5 and
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 36, No 2 (February), 2020: pp 479-480
479
480
EDITORIAL COMMENTARY
give kudos to the Houston Methodist Orthopedics & Sports Medicine team. As a result, I wish the Rockets the best of luck.
4.
References 1. Frangiamore SJ, Mannava S, Briggs KK, McNamara S, Philippon MJ. Career length and performance among professional baseball players returning to play after hip arthroscopy. Am J Sports Med 2018;46:2588-2593. 2. Menge TJ, Briggs KK, Philippon MJ. Predictors of length of career after hip arthroscopy for femoroacetabular impingement in professional hockey players. Am J Sports Med 2016;44:2286-2291. 3. Schallmo MS, Fitzpatrick TH, Yancey HB, Marquez-Lara A, Luo TD, Stubbs AJ. Return-to-play and performance outcomes of professional athletes in North America after hip
5.
6.
7.
arthroscopy from 1999 to 2016. Am J Sports Med 2018;46: 1959-1969. Locks R, Utsunomiya H, Briggs KK, McNamara S, Chahla J, Philippon MJ. Return to play after hip arthroscopic surgery for femoroacetabular impingement in professional soccer players. Am J Sports Med 2018;46:273-279. Jack RA II, Sochacki KR, Hirase T, et al. Performance and return to sport after hip arthroscopy in National Basketball Association. Arthroscopy 2020;36:473-478. Begly JP, Buckley PS, Utsunomiya H, Briggs KK, Philippon MJ. Femoroacetabular impingement in professional basketball players: Return to play, career length, and performance after hip arthroscopy. Am J Sports Med 2018;46:3090-3096. Chen AW, Craig MJ, Mu BH, et al. Return to basketball after hip arthroscopy: Minimum 2-year follow-up. Arthroscopy 2019;35:2834-2844.
Abstract: Hip arthroscopy has proved its efficacy and value in the management of femoroacetabular impingement syndrome in recreational and professional athletes. However, needs, expectations, and economic burden are remarkable and astonishingly different within the elite sport world. When considering hip arthroscopy to address a femoroacetabular impingement condition, 3 big questions are asked by every athlete and must be answered: (1) Can I play again? (2) Will I play at the same level? (3) When can I return to sport? Regarding the National Basketball Association, approximately 88% of athletes return to play at the same level in about 6 months.
See related article on page 473
P
rofessional American baseball, hockey, football, and baseball leagues are referred to as the “Big Four” in the United States. Studies addressing outcomes and the rate of return to sport after hip arthroscopy have been published for the first 3 sports1-3 and for professional soccer.4 However, such data and research have not yet been published for the National Basketball Association (NBA). In the study “Performance and Return to Sport After Hip Arthroscopy in National Basketball Association,” Jack, Sochacki, Hirase, Vickery, McCulloch, Lintner, and Harris,5 with an impeccable methodologic work, roll up the blinds and reveal the answers to the 3 big questions asked by athletes after hip arthroscopy surgery: (1) Can I play again? (2) Will I play at the same level? (3) When can I return to sport? In answer to the first question, the study concludes that 87.5% of the NBA players were able to return to sport. Addressing the second question, regarding level of play, the study reveals that NBA players return with performance statistics similar to their preoperative levels and those of matched controls. Finally, to
The author reports the following potential conflicts of interest or sources of funding: D.R.M. receives nonfinancial support from Arthrex (travel/lodging and food/beverage), Stryker (travel/lodging and food/beverage), Smith & Nephew (travel/lodging and food/beverage), and Ossur (food/beverage). Full ICMJE author disclosure forms are available for this article online, as supplementary material. Ó 2019 by the Arthroscopy Association of North America 0749-8063/191292/$36.00 https://doi.org/10.1016/j.arthro.2019.10.027
answer the question surrounding the timeline, the study shows that NBA athletes return after an average of 5.7 2.6 months. Previously, Begly et al.6 reported their outcomes after hip arthroscopy for femoroacetabular impingement in professional basketball players. NBA, Women’s National Basketball Association, and EuroLeague patients were part of this case series. Begly et al. concluded, similarly to Jack et al.,5 that elite basketball players returned to play at a very high rate after hip arthroscopy. This naturally leads to the following question: Can these good results be expected for nonNBA players? We recently published our results on outcomes and return to basketball after hip arthroscopy at minimum 2-year follow-up.7 Besides the statistically significant improvement in several patient-reported outcomes, this study found that 83.9% of athletes returned to playing basketball at the most recent follow-up and 74.2% subjectively reported their ability level as being the same or higher. Of the patients, 96.8% were nonprofessional players. Finally, the inclusion of a control group for comparison purposes with rigorous matching parameters added meaningful value to the study of Jack et al.5 For example, I have learned that the career length for an NBA player who underwent hip arthroscopy is comparable to that of an NBA matched control group, results that I personally found fascinating. Still, work needs to be done, and we must strive for studies with the highest level of evidence that the medical community expects and demands within hip arthroscopy. Yet, I applaud the work by Jack et al.5 and
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 36, No 2 (February), 2020: pp 479-480
479
480
EDITORIAL COMMENTARY
give kudos to the Houston Methodist Orthopedics & Sports Medicine team. As a result, I wish the Rockets the best of luck.
4.
References 1. Frangiamore SJ, Mannava S, Briggs KK, McNamara S, Philippon MJ. Career length and performance among professional baseball players returning to play after hip arthroscopy. Am J Sports Med 2018;46:2588-2593. 2. Menge TJ, Briggs KK, Philippon MJ. Predictors of length of career after hip arthroscopy for femoroacetabular impingement in professional hockey players. Am J Sports Med 2016;44:2286-2291. 3. Schallmo MS, Fitzpatrick TH, Yancey HB, Marquez-Lara A, Luo TD, Stubbs AJ. Return-to-play and performance outcomes of professional athletes in North America after hip
5.
6.
7.
arthroscopy from 1999 to 2016. Am J Sports Med 2018;46: 1959-1969. Locks R, Utsunomiya H, Briggs KK, McNamara S, Chahla J, Philippon MJ. Return to play after hip arthroscopic surgery for femoroacetabular impingement in professional soccer players. Am J Sports Med 2018;46:273-279. Jack RA II, Sochacki KR, Hirase T, et al. Performance and return to sport after hip arthroscopy in National Basketball Association. Arthroscopy 2020;36:473-478. Begly JP, Buckley PS, Utsunomiya H, Briggs KK, Philippon MJ. Femoroacetabular impingement in professional basketball players: Return to play, career length, and performance after hip arthroscopy. Am J Sports Med 2018;46:3090-3096. Chen AW, Craig MJ, Mu BH, et al. Return to basketball after hip arthroscopy: Minimum 2-year follow-up. Arthroscopy 2019;35:2834-2844.