Feairheller Michelle L, Jenkins Paul G, MacMillan Lauren, Carsen Sasha
Nemours Children's Health, Broomall, PA, USA.
Young Athlete Center, St. Louis Children's Hospital, Town and Country, MO, USA.
J Pediatr Soc North Am. 2024 Apr 11;7:100051. doi: 10.1016/j.jposna.2024.100051. eCollection 2024 May.
Hip arthroscopy is a hip preservation surgery used to manage acute pain and injury while attempting to preserve the hip joint and prevent or delay the progression of degenerative changes by restoring stability, reducing pathologic stress and instability, and preventing continued joint incongruity and impingement [1], [2], [3], [4]. Research supports a high likelihood of return to a prior level of athletic participation in athletes of all ages after hip arthroscopy with especially favorable results in athletes under the age of 18 [3-5]. The postoperative rehabilitation process is vital to correct impairments and compensatory strategies. Unfortunately, there is great variability in current rehabilitation protocols.Adolescent athletes returning to activity after hip arthroscopy may be at an increased risk of reinjury and continued pain if return to sport occurs too early [6]. Inconsistencies exist with current protocols and return to sport testing. For instance, assessing readiness for return to sport is often based upon tests and measures utilized for anterior cruciate ligament reconstruction. These tests and measures may not effectively isolate or address hip function and readiness to return to play after hip arthroscopy. This current concept review presents existing literature and a standardized rehabilitation process to restore normal function and maximize a safe return to athletics after hip arthroscopy in the young athlete.
(1)There are few evidence-based postoperative rehabilitation programs for the young athletic population to effectively guide progress toward return to play readiness.(2)Continued hip and core strengthening exercises should be implemented after the return to play to maintain hip and core strength, improve neuromuscular control, and address additional functional impairments that may lead to repeat injury and dysfunction.(3)Patient-reported outcome (PRO) measures are correlated with higher postoperative improvement and should be utilized to assess psychological and physical readiness for return to play.
髋关节镜检查是一种髋关节保留手术，用于处理急性疼痛和损伤，同时试图通过恢复稳定性、减轻病理应力和不稳定以及防止关节持续不协调和撞击来保留髋关节并预防或延缓退行性改变的进展[1,2,3,4]。研究表明，所有年龄段的运动员在接受髋关节镜检查后都有很高的可能性恢复到之前的运动参与水平，对于18岁以下的运动员，效果尤其良好[3 - 5]。术后康复过程对于纠正功能障碍和补偿策略至关重要。不幸的是，目前的康复方案存在很大差异。如果过早恢复运动，接受髋关节镜检查后恢复活动的青少年运动员再次受伤和持续疼痛的风险可能会增加[6]。当前的方案和恢复运动测试存在不一致之处。例如，评估恢复运动的准备情况通常基于用于前交叉韧带重建的测试和测量方法。这些测试和测量方法可能无法有效地分离或解决髋关节功能以及髋关节镜检查后恢复比赛的准备情况。本概念综述介绍了现有文献以及标准化的康复过程，以恢复年轻运动员髋关节镜检查后的正常功能并最大限度地安全恢复运动。
(1) 针对年轻运动员群体，几乎没有基于证据的术后康复计划来有效指导恢复比赛准备的进展。(2) 在恢复比赛后应继续进行髋关节和核心强化练习，以保持髋关节和核心力量，改善神经肌肉控制，并解决可能导致再次受伤和功能障碍的其他功能障碍。(3) 患者报告的结局 (PRO) 指标与术后更高的改善相关，应用于评估恢复比赛的心理和身体准备情况。
