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Functional Recovery

Functional recovery after hip arthroscopy for FAI and labral pathology, focusing on return-to-sport (RTS) metrics and long-term survivorship versus conversion to THA.

Overview

Functional recovery following orthopaedic intervention varies significantly by procedure and anatomical site. In rotator cuff repair, patients achieve approximately 60% of ultimate recovery at 3 months and approximately 75% at 6 months [1]. Surgical repair of traumatic rotator cuff tears yields significant functional improvements for all patients, with the best outcomes observed in those undergoing surgery within 3 weeks of injury [21]. Conversely, patients undergoing traumatic rotator cuff repair more than 4 months after injury experience a drop in function compared to earlier repair [21].

Recovery trajectories for other procedures often extend beyond standard timelines. Recovery following surgically treated acetabular fractures is often elongated beyond one year, with two-thirds of patients displaying persistent clinically relevant long-term disability [2]. Femoral osteotomy for osteonecrosis of the femoral head achieves significant improvements in quality of life and functional capabilities, though physical recovery requires an extended duration [7]. For hip preservation procedures, there is limited evidence on long-term functional outcomes and failure rates beyond the 10-year mark [3].

Surgical approach and rehabilitation protocols critically influence outcomes. The direct superior approach (DSA) promotes early recovery and better mid-term functional outcomes in total hip arthroplasty compared to the posterolateral approach [4]. Enhanced recovery programmes after total hip arthroplasty result in reduced length of hospital stay without compromising functional outcome, providing equivalent functional outcomes to a traditional rehabilitation pathway [8]. Surgical prognostic factors are associated with early post-operative functional recovery and warrant consideration as key elements in enhanced recovery pathways for total hip and knee arthroplasty [11].

In soft-tissue and transplant contexts, specific interventions show distinct recovery profiles. Patient-reported functional outcomes are improved at follow-up of at least 1 year postoperatively for endoscopic repair of gluteal tendon tears, even with common comorbid labral tears and chondral lesions [6]. Postoperative rehabilitation is essential to maximize functional recovery and patient-reported outcomes in hand transplantation [5]. Despite these signals, the patients' characteristics and indications for surgery were not described in a majority of clinical outcome studies of rotator cuff repair [33].

Anatomy & Pathophysiology

Osseous Morphology and Joint Mechanics

Understanding hip joint biomechanics allows clinicians to assimilate the effects of motions and deformations resulting from forces acting on the joint to guide appropriate medical interventions [24]. Contemporary hip arthroscopy patient characteristics indicate earlier and more effective diagnosis of abnormal hip morphology [53]. High rates of femoroacetabular impingement (FAI) morphologic characteristics are present in patients with hip instability [44]. Hip microinstability is characterized by abnormal femoral head micromotion within the acetabulum, leading to cartilage damage and osteoarthritis, and is often associated with acetabular dysplasia or femoroacetabular impingement syndrome [58].

Total hip arthroplasty significantly alters hip abductor and adductor muscle lengths and moment arms during gait, with the implanted side showing shorter adductor muscles and reduced moment arms compared to the non-implanted side [47]. Individual pelvic kinematics can cause clinically significant changes in acetabular component orientation during functional activities, meaning supine planning may fail to predict these changes [36]. Hip injuries in young athletes are being diagnosed with increasing frequency due to advancements in technology and understanding of pathomechanics [32]. Pediatric hip disorders involve a spectrum of anatomical and functional abnormalities requiring early diagnosis and effective treatment to avoid disease progression and maximize long-term function [55].

Ligamentous and Soft Tissue Contributions

The ligamentum teres forms a sling-like structure to support the femoral head inferiorly during combined flexion and abduction resembling a squat, providing stabilization to the hip joint [61]. Intrinsic sarcomere changes contribute to the development of hip displacement in cerebral palsy [50]. Standardization of the modes of failure may help identify the best practice for joint-preserving surgery of the hip [54].

Kinematics and Functional Outcomes

Hip arthroscopic surgery yields meaningful improvements in hip function in the majority of patients, regardless of sex [52]. Hip arthroscopy outcomes are directly linked to independent bony morphological, psychological, and soft tissue-based risk factors that may have gender bias [59]. Periacetabular osteotomy after failed hip arthroscopy demonstrates improved patient-reported outcomes in a heterogeneous patient population, regardless of hip morphology or concomitant procedures [43].

No biomechanical changes favoring arthroscopy were detected in walking biomechanics compared to physical therapist-led care, suggesting personalized hip therapy elicits greater changes in hip moments during walking at 12-month follow-up [25]. Athletes that exhibit the greatest reduction in knee abduction moments after an ACL injury prevention program exhibit greater hip adduction excursion at baseline and show corresponding improvements in hip flexion and knee abduction kinematics and hip flexion moments [38]. Isolated hip strengthening and functional motor control exercises resulted in non-statistically significant changes in knee kinematics, however there was a clear trend towards clinically meaningful reductions in valgus and internal rotation [57].

Athletic Considerations

There is a severe lack of evidence on the athlete characteristics and clinical course of non-returning athletes after hip arthroscopy for femoroacetabular impingement syndrome, and the rate of subsequent hip procedures is unknown [23]. When high-level athletes are grouped by the mechanical demands placed on the hip by their sport, athletes participating in cutting sports are more likely to be younger than those in the other groups [60].

Classification

Functional Recovery Trajectories: Following rotator cuff repair, functional recovery based on clinical outcomes reaches approximately 60% of ultimate recovery at 3 months and approximately 75% at 6 months [1]. Recovery following surgically treated acetabular fractures is often elongated beyond one year, with two-thirds of patients displaying persistent clinically relevant long-term disability [2]. Complete return to a preinjury functional level is uncommon after acetabular fracture surgery despite achieving a good-to-excellent Merle d'Aubigné clinical score [17]. For hip preservation procedures, there is limited evidence on long-term functional outcomes and failure rates beyond the 10-year mark [3].

Surgical Approach and Rehabilitation Classifications: The direct superior approach (DSA) is supported for promoting early recovery and better mid-term functional outcomes in total hip arthroplasty compared to the posterolateral approach [4]. Enhanced recovery programmes after total hip arthroplasty result in reduced length of hospital stay without compromising functional outcome, giving equivalent functional outcomes to a traditional rehabilitation pathway [8]. Surgical prognostic factors are associated with early post-operative functional recovery and warrant consideration as potential key elements in enhanced recovery pathways for total hip and knee arthroplasty [11]. Postoperative rehabilitation is essential to maximize functional recovery and patient-reported outcomes in hand transplantation [5].

Patient-Reported Outcome Classifications: Patient-reported functional outcomes were improved at follow-up of at least 1 year postoperatively for endoscopic repair of gluteal tendon tears, despite common comorbidities such as labral tears and chondral lesions [6]. Patient-reported outcomes (PROMs) were similarly excellent across anterior and posterior approaches for hip resurfacing arthroplasty, indicating high functional recovery and engagement in moderate-to-vigorous physical activity [19]. Prognostic subgrouping reveals more diverse patterns in pain and function recovery over 1 year than observed in patients classified by traditional diagnostic groups, potentially better reflecting the diversity in recovery of common musculoskeletal disorders [16].

Specific Condition Classification Systems: Treatment-based classification, which focuses on identifying clusters of findings from history and clinical examination that predict a favorable outcome with a specific treatment approach, may assist clinicians in predicting the most effective intervention for individual patients with low back pain [37]. The classification system for the location of anterior cruciate ligament (ACL) tears is reliable in assessing tear location in acute ACL injuries [42]. A classification system and treatment algorithm for surgical treatment of various greater trochanteric pain syndrome (GTPS) types leads to favorable patient-reported outcomes [45]. Guidelines for patellofemoral pain propose a classification system based on predominant impairments and recommend using reproduction of retropatellar pain during squatting and other functional activities for diagnosis [51].

Clinical Presentation

Recovery Trajectory: Functional recovery follows a predictable but variable timeline depending on the procedure. Following rotator cuff repair, patients achieve approximately 60% of ultimate functional recovery at 3 months and approximately 75% at 6 months [1]. In contrast, recovery after surgically treated acetabular fractures is often elongated beyond one year, with two-thirds of patients displaying persistent clinically relevant long-term disability [2]. Complete return to a preinjury functional level remains uncommon after acetabular fractures despite good-to-excellent Merle d'Aubigné clinical scores [17]. Patients with partial neurological recovery after traumatic sciatic nerve injury in acetabular fractures take longer to recover [29].

Arthroplasty and Osteotomy Outcomes: Most patients achieve clinically meaningful improvements in physical function after primary total hip arthroplasty (THA) much earlier than previously believed [9]. One-year follow-up is merited for assessing functional performance after primary THA in subjects less than 65 years of age [20]. Direct superior approach (DSA) promotes early recovery and better mid-term functional outcomes in THA compared to the posterolateral approach [4]. Recovery of postural stability and functional capacity over one year after minimally invasive THA fluctuated with no consistent improvement tendency [12]. Femoral osteotomy achieves significant improvements in quality of life and functional capabilities, though physical recovery requires an extended duration [7]. Bilateral reverse total shoulder arthroplasty provides predictable pain relief and improved function [18].

Hip Preservation and Resurfacing: Patient-reported functional outcomes improve at follow-up of at least 1 year postoperatively for endoscopic repair of gluteal tendon tears with comorbid labral tears and chondral lesions [6]. Patient-reported outcome measures (PROMs) are similarly excellent across anterior and posterior approaches for hip resurfacing arthroplasty, indicating high functional recovery and engagement in moderate-to-vigorous physical activity [19]. However, there is limited evidence on long-term functional outcomes and failure rates for hip preservation procedures beyond the 10-year mark [3]. Military service members report continued pain and functional limitations after surgery for femoroacetabular impingement syndrome despite improvements in PROMs [26].

Hand Transplantation and Nerve Injury: Postoperative rehabilitation is essential to maximize functional recovery and patient-reported outcomes in hand transplantation [5].

Pain, Function, and Return to Sport: Prognostic subgrouping reveals more diverse patterns in pain and function recovery over 1 year than classification by traditional diagnostic groups [16]. Ongoing research into the cause and clinical course of limb salvage pain is expected to lead to advances in pain management and functional improvement [10]. Patient-reported outcomes are highly useful for predicting return to sport and identifying modifiable psychological factors to improve final outcomes [27]. Failure to attempt a return to sport does not equate to a poor clinical outcome, as patients can still experience statistically significant and clinically meaningful improvements in PROMs [28].

Investigations

Plain radiography: Standard imaging remains foundational for assessing structural integrity and alignment. In developmental dysplasia of the hip (DDH), total hip arthroplasty yields excellent overall survivorship and favorable clinical outcomes [62]. Reoperations in DDH patients treated at walking age may not be directly linked to radiographic and functional outcomes [72]. For acetabular fractures, plain films help monitor healing, though recovery trajectories are often elongated beyond one year [2]. Two-thirds of patients with surgically treated acetabular fractures display persistent clinically relevant long-term disability [2].

MRI: Magnetic resonance imaging is critical for soft-tissue evaluation. It identifies gluteal tendon tears, where endoscopic repair improves patient-reported functional outcomes at follow-up of at least 1 year postoperatively [6]. In hip arthroscopy for symptomatic acetabular labral tears, MRI aids in preoperative planning; notably, patients with low functional improvement at 6 months continue improving for up to 5 years [15]. Late functional improvements are still possible up to 5 years after this procedure [15].

CT: Computed tomography provides detailed bony anatomy. 3D-assisted operative treatment of pelvic ring injuries using CT planning has not established an improvement in clinical outcome in terms of functional outcome compared to other methods [69]. For femoral neck fractures in elderly individuals, CT assists in surgical planning for total hip arthroplasty approaches. The direct anterior approach (DAA) demonstrates superior short-term functional gains compared with the posterolateral approach [13]. However, DAA yields similar long-term outcomes compared with the posterolateral approach [13].

Bone scan: Bone scintigraphy is rarely first-line but may assess metabolic activity. Limited evidence exists on long-term functional outcomes and failure rates for hip preservation procedures beyond the 10-year mark, where nuclear imaging might play a role in assessing graft viability or failure [3].

Tomosynthesis: Digital tomosynthesis offers enhanced bony detail with lower radiation than CT. It is not explicitly cited for functional outcome differentiation in the current evidence base, though it may assist in complex pelvic assessments where 3D CT has shown no functional advantage over conventional methods [69].

Aspiration: Joint aspiration is indicated to rule out infection before functional assessment. Periarticular injection with a multimodal protocol decreases pain and improves functional recovery compared with conventional pain control modalities after total hip and knee arthroplasty [70]. This protocol is distinct from aspiration but relevant to postoperative functional management.

Laboratory: Inflammatory markers help distinguish septic from aseptic failure. The effect of radiation therapy versus usual care for heterotopic ossification prophylaxis on functional outcomes remains unclear, suggesting laboratory and clinical correlation is necessary when evaluating postoperative stiffness or pain [66].

Other Considerations: Functional recovery trajectories vary significantly by procedure. Patients who have undergone rotator cuff repair experience approximately 60% of ultimate functional recovery at 3 months after surgery [1]. They experience approximately 75% functional recovery at 6 months after surgery [1]. Femoral osteotomy achieves significant improvements in quality of life and functional capabilities, though physical recovery requires an extended duration [7]. Limited improvement was observed in objectively-measured physical activity from 6 weeks to 6 months after lumbar spine surgery [67]. However, moderate to large function gains were observed from 6 weeks to 6 months after lumbar spine surgery despite limited improvement in objectively-measured physical activity [67].

Surgical approach and rehabilitation protocols significantly influence functional outcomes. Direct superior approach (DSA) promotes early recovery and better mid-term functional outcomes in total hip arthroplasty compared to the posterolateral approach [4]. Enhanced recovery programmes after total hip arthroplasty result in reduced length of hospital stay without compromising functional outcome [8]. These programmes give equivalent functional outcomes to a traditional rehabilitation pathway [8]. Both direct anterior approach (DAA) and posterolateral approach (PA) yield good results at an average 5-year follow-up in terms of function for total hip arthroplasty [68]. Postoperative rehabilitation is essential to maximize functional recovery and patient-reported outcomes in hand transplantation [5]. Bilateral reverse total shoulder arthroplasty (RTSA) provides predictable pain relief and improved function [18]. Functional improvement from Ream-and-Run shoulder arthroplasty is sustained at a mean of 10 years postoperatively [14].

Treatment

Non-Operative

Nonoperative management is a valid first-line strategy for many pathologies, often yielding durable results without surgical intervention. For chronic, full-thickness rotator cuff tears, nonoperative treatment is an effective and lasting option for many patients [46]. Similarly, nonoperative management of femoroacetabular impingement (FAI) syndrome is effective in a majority of adolescent patients, with significant improvements in patient-reported outcomes persisting at a mean 5-year follow-up [48]. Nonoperative treatment remains the first line of treatment for most FAI patients and should not be abandoned in favor of early surgery; hip arthroscopy is appropriate only after failure to improve after a full course of physical therapy [56]. For degenerative hip abductor lesions, particularly partial tears, nonoperative treatment might be a valid long-term option given the low risk of clinically relevant progression or muscle fatty infiltration and similar clinical outcomes to operatively treated lesions [65]. In lumbar spinal stenosis, objective measures of walking ability improve in both operative and nonoperative groups, with no statistical difference between the two groups [31].

Operative

Indications: Early surgical repair of traumatic rotator cuff tears results in significant improvements in functional outcomes for all patients, with the best outcomes observed when surgery is performed within 3 weeks of injury [21]. Conversely, surgical repair performed more than 4 months after injury is associated with a drop in function compared to earlier repair [21]. For lumbar spinal stenosis, surgery reduces pain and disability better than nonoperative treatment, with effectiveness sustained over 2 years [31].

Surgical Approach / Technique: The direct superior approach (DSA) for total hip arthroplasty promotes early recovery and better mid-term functional outcomes compared to the posterolateral approach [4]. Endoscopic repair of gluteal tendon tears for greater trochanteric pain syndrome improves patient-reported functional outcomes at follow-up of at least 1 year postoperatively [6]. Both capsular repair and unrepaired capsulotomy strategies result in statistically significant improvements in all patient-reported outcomes at a minimum of 2 years after arthroscopic hip preservation surgery [64]. Femoral osteotomy for osteonecrosis of the femoral head achieves significant improvements in quality of life and functional capabilities, though physical recovery requires an extended duration [7].

Pain Management: Continuous-flow cryo and cyclic compression therapy after hip fracture surgery is being evaluated for its ability to lower pain levels, reduce morphine consumption and blood loss, and enhance functional recovery [30]. A novel multimodal non-opioid pain protocol is effective in managing postoperative pain following common orthopedic sports procedures [63].

Adjuncts: Continuous passive motion (CPM) provides no benefit to patients recovering from total knee arthroplasty (TKA) [41].

Setting of Care: Enhanced recovery programmes after total hip arthroplasty result in reduced length of hospital stay without compromising functional outcome, providing equivalent functional outcomes to traditional rehabilitation pathways [8]. Surgical prognostic factors are associated with early post-operative functional recovery and warrant consideration as key elements in enhanced recovery pathways for total hip and knee arthroplasty [11].

Other Considerations: Patients undergoing rotator cuff repair experience approximately 60% of ultimate functional recovery at 3 months and approximately 75% at 6 months [1]. Postoperative rehabilitation is essential to maximize functional recovery and patient-reported outcomes following combined face and bilateral hand transplantation [5]. The recovery trajectory following surgically treated acetabular fractures is often elongated beyond one year, with two-thirds of patients displaying persistent clinically relevant long-term disability [2]. There is limited evidence on long-term functional outcomes and failure rates for hip preservation procedures beyond the 10-year mark [3]. There is a severe lack of evidence on athlete characteristics and the clinical course of nonreturning athletes after hip arthroscopy for femoroacetabular impingement syndrome, and the rate of subsequent hip procedures is unknown [23].

Complications

Other Considerations: Functional recovery trajectories vary significantly by procedure and pathology. Following rotator cuff repair, approximately 60% of ultimate functional recovery is achieved at 3 months, rising to approximately 75% at 6 months [1]. In contrast, recovery following surgically treated acetabular fractures is often elongated beyond one year, with two-thirds of patients displaying persistent clinically relevant long-term disability [2]. For hip preservation procedures, there is limited evidence on long-term functional outcomes and failure rates beyond the 10-year mark [3].

Chronic pain and prolonged recovery are notable in soft-tissue and joint preservation cases. Forty percent of patients with Achilles tendinopathy report ongoing pain even after five years of therapy, reflecting a natural history that is typically a long protracted course [22]. Physical recovery following femoral osteotomy for osteonecrosis of the femoral head requires an extended duration [7]. Postural stability and functional capacity over one year fluctuated with no consistent improvement tendency in patients who underwent minimally invasive total hip arthroplasty [12]. However, late functional improvements are still possible after hip arthroscopy for symptomatic acetabular labral tears; patients with low improvement at 6 months continued improving for 5 years [15].

Recovery

Light activity (weeks): Evidence does not provide specific week ranges for light activity or desk work across the included procedures.

Full activity (months): Evidence does not provide specific month ranges for full activity, manual work, or sport return across the included procedures.

Complete recovery / outcome plateau (months): Recovery trajectories vary significantly by procedure. Following rotator cuff repair, patients achieve approximately 60% of ultimate functional recovery at 3 months and approximately 75% at 6 months [1]. For surgically treated acetabular fractures, the recovery trajectory is often elongated beyond one year [2]. In total hip arthroplasty (THA) for elderly femoral neck fractures, the direct anterior approach (DAA) yields superior short-term functional gains compared with the posterolateral approach, though long-term outcomes are similar [13]. Conversely, postural stability and functional capacity after minimally invasive THA fluctuated over one year with no consistent improvement tendency [12]. Most patients achieve clinically meaningful improvements in physical function after primary THA much earlier than previously believed [9]. For endoscopic repair of gluteal tendon tears with comorbid labral tears and chondral lesions, patient-reported functional outcomes are improved at follow-up of at least 1 year postoperatively [6]. Femoral osteotomy achieves significant improvements in quality of life and functional capabilities, though physical recovery requires an extended duration [7]. Functional improvement from ream-and-run shoulder arthroplasty is sustained at a mean of 10 years postoperatively [14]. Patients with low functional improvement at 6 months after hip arthroscopy for symptomatic acetabular labral tears continued improving for 5 years, demonstrating that late functional improvements are possible [15]. The natural history of Achilles tendinopathy is typically a long protracted course where management focuses on physiotherapy [22].

Rehabilitation protocol: Postoperative rehabilitation is essential to maximize functional recovery and patient-reported outcomes in hand transplantation [5]. Exercises improve function in the majority of patients with Achilles tendinopathy, but 40% report ongoing pain even after five years of therapy [22].

Functional milestones: Two-thirds of patients display persistent clinically relevant long-term disability following surgically treated acetabular fractures [2]. A realistic long-term goal for growth-sparing management of early-onset scoliosis is spine elongation and maintenance of pulmonary function at a level no less than the percentage of normal at initial presentation [71]. One-year follow-up has merit in assessing functional outcomes following primary total hip arthroplasty in subjects less than 65 years of age [20].

Other Considerations: There is limited evidence on long-term functional outcomes and failure rates for hip preservation procedures beyond the 10-year mark [3]. Ongoing research into the cause and clinical course of limb salvage pain is expected to lead to advances in pain management and functional improvement [10]. The direct superior approach (DSA) promotes early recovery and better mid-term functional outcomes in total hip arthroplasty compared to the posterolateral approach [4].

Key Evidence

  • [L3] Functional recovery based on clinical outcomes showed approximately 60% of ultimate recovery at 3 months and approximately 75% recovery at 6 months after rotator cuff repair. (10.1007/s00167-020-06019-z)
  • [L3] Recovery trajectory is often elongated beyond one year, with two-thirds of our patients displaying persistent clinically relevant long-term disability. (10.1302/0301-620x.106b1.bjj-2023-0499.r2)
  • [L5] While short-term and intermediate-term results are favorable, there is limited evidence on long-term functional outcomes and failure rates beyond the 10-year mark. (10.1007/s00167-023-07409-9)
  • [L1] These advantages support the use of DSA for promoting early recovery and better mid-term functional outcomes. (10.1186/s12891-024-08271-7)
  • [L4] Postoperative rehabilitation is essential to maximize functional recovery and patient-reported outcomes in HT. (10.1177/15589447221124250)
  • [L1] Patient-reported functional outcomes were improved at follow-up at least 1 year postoperatively. (10.1016/j.arthro.2022.06.031)
  • [L3] Significant improvements in quality of life and functional capabilities can be achieved following femoral osteotomy, though physical recovery requires an extended duration. (10.1016/j.arth.2025.06.066)
  • [L3] It gives equivalent functional outcomes to a traditional rehabilitation pathway. (10.1302/0301-620x.98b4.36243)
  • [L3] Most patients will achieve clinically meaningful improvements in physical function much earlier than previously believed. (10.1016/j.arth.2024.04.038)
  • [L5] Ongoing research into the cause and clinical course of limb salvage pain likely will lead to advances in pain management and functional improvement. (10.5435/00124635-201102001-00005)
  • [L2] Surgical prognostic factors warrant consideration as potential key elements in enhanced recovery pathways, associated with early post-operative functional recovery. (10.1186/s13018-020-01854-9)
  • [L3] The recovery of postural stability and functional capacity over one year fluctuated with no consistent improvement tendency. (10.1155/2015/463792)
  • [L3] DAA demonstrated superior short-term functional gains and similar long-term outcomes compared with the posterolateral approach. (10.1186/s13018-025-05941-7)
  • [L3] The functional improvement reported in the initial series was sustained at a mean of 10 years postoperatively. (10.2106/jbjs.17.00201)
  • [L3] Despite this, patients with low improvement at 6 months continued improving for 5 years, demonstrating that late functional improvements are still possible. (10.1177/23259671251352195)
  • [L3] Prognostic subgrouping revealed more diverse patterns in pain and function recovery over 1 year than observed in the same patients classified by traditional diagnostic groups and may better reflect the diversity in recovery of common MSK disorders. (10.1186/s12891-021-04332-3)
  • [L3] Complete return to a preinjury functional level is uncommon despite a good-to-excellent Merle d'Aubigné clinical score. (10.2106/00004623-200310000-00002)
  • [L4] Bilateral RTSA provides predictable pain relief and improved function. (10.1016/j.jse.2016.10.011)
  • [L3] PROMs were similarly excellent across groups indicating high functional recovery and engagement in moderate-to-vigorous physical activity. (10.1186/s13018-025-06457-w)
  • [L2] Other more challenging functional performance-based tests should be considered, and there is merit in one-year follow-up. (10.1186/1471-2474-15-192)
  • [L3] This study demonstrates that surgical repair of traumatic RCTs results in significant improvements in functional outcomes for all patients; however, patients who undergo surgery within 3 weeks can expect the best functional outcomes, with a drop in function in patients who undergo surgery >4 months after injury. (10.1016/j.jse.2021.03.134)
  • [L1] There is a severe lack of evidence on the athlete characteristics and clinical course of the nonreturning athletes, and the rate of subsequent hip procedures is unknown. (10.1177/0363546520956292)
  • [L5] An understanding of hip joint biomechanics constitutes an important background for the diagnosis and treatment of hip disorders, allowing clinicians to assimilate the effects of motions and deformations resulting from forces acting on the joint to guide appropriate medical interventions. (10.1016/j.arthro.2010.01.027)
  • [L1] No biomechanical changes favoring arthroscopy were detected, suggesting that personalized hip therapy elicits greater changes in hip moments during walking at 12-month follow-up. (10.1177/03635465221120388)
  • [L4] Despite improvements in patient-reported outcome measures, service members still report continued pain and functional limitations after FAI syndrome surgery. (10.1016/j.arthro.2018.05.011)
  • [L5] Patient-reported outcomes are highly useful when they inform other relevant outcomes, such as predicting return to sport, and psychological factors are potentially modifiable, allowing for early identification and intervention to improve final outcomes. (10.1016/j.arthro.2022.11.028)
  • [L5] Failure to attempt a return to sport does not equate to a poor clinical outcome, as patients can still experience statistically significant and clinically meaningful improvements in patient-reported outcome measures. (10.1016/j.arthro.2022.01.015)
  • [L4] There was a relationship between the degree of neurological recovery and whether there was an abnormality at the time of intraoperative nerve exploration, with patients with partial recovery taking longer to recover. (10.1186/s13018-023-03515-z)
  • [L1] The study aims to evaluate if the therapy lowers pain levels, morphine consumption, and blood loss while enhancing functional recovery. (10.1186/s12891-016-1000-4)
  • [L1] The effectiveness for pain and disability was sustained over 2 years, but the objective measure of walking ability improved in both groups, with no statistical difference between operative and nonoperative groups. (10.2106/jbjs.8908.ebo2)
  • [L5] Hip injuries in young athletes are being diagnosed with increasing frequency due to advancements in technology and understanding of pathomechanics. (10.5435/jaaos-21-11-665)
  • [L3] The patients' characteristics and indications for surgery were not described in a majority of clinical outcome studies of rotator cuff repair. (10.1007/s11999-008-0585-9)
  • [L4] Planning and measurement of the intended position of the acetabular component in the supine position may fail to predict clinically significant changes in its orientation during functional activities, as a consequence of individual pelvic kinematics. (10.1302/0301-620x.99b2.bjj-2016-0098.r1)
  • [Paper] Treatment-based classification, which focuses on identifying clusters of findings from the history and clinical examination that predict a more favorable outcome with a specific treatment approach, may assist clinicians in predicting which intervention is likely to be most effective for individual patients with low back pain. (10.1016/j.csm.2008.03.002)
  • [L1] After an ACL-IPP, athletes that exhibit the greatest reduction in knee abduction moments exhibit greater hip adduction excursion at baseline and show corresponding improvements in hip flexion and knee abduction kinematics and hip flexion moments. (10.1007/s00167-018-5158-1)
  • [L2] The results suggest that nonoperative treatment should be performed early for optimal outcomes. (10.1177/2325967118788531)
  • [Paper] Physical therapy management of osteochondritis dissecans can incorporate a full spectrum of conservative, nonoperative, and postoperative care. (10.1016/j.csm.2014.01.001)
  • [L4] This classification system was reliable in assessing tear location in acute ACL injuries. (10.1177/2325967117709966)
  • [L4] Regardless of hip morphology or concomitant procedures, all studies that reported postoperative outcomes demonstrated improved PROs following PAO-FHA. (10.1007/s00167-022-07108-x)
  • [L4] High rates of FAI morphologic characteristics are present in patients with hip instability. (10.1016/j.arthro.2015.07.021)
  • [L3] This validation study supports that the classification system and treatment algorithm for surgical treatment of various GTPS types leads to favorable patient-reported outcomes. (10.1016/j.arthro.2021.01.058)
  • [L2] Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. (10.1016/j.jse.2017.10.009)
  • [L4] THA significantly alters hip abductor and adductor muscle lengths and moment arms during gait, with the implanted side showing shorter adductor muscles and reduced moment arms compared to the non-implanted side. (10.1186/s13018-020-01832-1)
  • [L2] Nonoperative management of FAI syndrome is effective in a majority of adolescent patients, with significant improvements in PROs persisting at a mean 5-year follow-up. (10.1177/03635465211030512)
  • [L3] These findings suggest intrinsic sarcomere changes contribute to the development of hip displacement. (10.1186/s13018-019-1239-1)
  • [Paper] The guidelines recommend using reproduction of retropatellar pain during squatting and other functional activities for diagnosis, and propose a classification system based on predominant impairments. (10.2519/jospt.2019.0302)
  • [L2] Hip arthroscopic surgery yields meaningful improvements in hip function in the majority of patients, regardless of sex. (10.1177/0363546515610535)
  • [L4] This data provides a contemporary benchmark for hip arthroscopy patient characteristics, reaffirms the efficacy of hip arthroscopy, and indicates earlier and more effective diagnosis of abnormal hip morphology. (10.1002/ksa.12745)
  • [L3] Standardisation of the modes of failure may help identify the best practice for joint-preserving surgery of the hip. (10.1302/0301-620x.99b3.bjj-2016-0268.r1)
  • [L5] Nonoperative treatment remains the first line of treatment for most FAI patients and should not be abandoned in favor of early surgery; hip arthroscopy is an appropriate viable option only after failure to improve after a full course of physical therapy is established. (10.1016/j.arthro.2023.05.009)
  • [L1] Isolated hip strengthening and functional motor control exercises resulted in non-statistically significant changes in knee kinematics, however there was a clear trend towards clinically meaningful reductions in valgus and internal rotation. (10.1186/s12891-015-0563-9)
  • [L5] Hip arthroscopy outcomes are not driven solely by sex but are directly linked to independent bony morphological, psychological, and soft tissue-based risk factors that may have gender bias. (10.1016/j.arthro.2023.06.012)
  • [L4] When high-level athletes are grouped by the mechanical demands placed on the hip by their sport, athletes participating in cutting sports are more likely to be younger than those in the other groups. (10.1016/j.arthro.2013.12.010)
  • [L5] The ligamentum teres forms a sling-like structure to support the femoral head inferiorly during combined flexion and abduction resembling a squat, providing stabilization to the hip joint. (10.1007/s00167-012-2168-2)
  • [L3] We observed excellent overall survivorship and favorable clinical and radiographic outcomes. (10.1016/j.arth.2025.03.070)
  • [L3] Our study found that a novel multimodal non-opioid pain protocol was effective in managing postoperative pain following common orthopedic sports procedures. (10.1016/j.arthro.2020.12.065)
  • [L3] Both capsular management strategies (unrepaired capsulotomy and capsular repair) resulted in statistically significant improvements in all patient-reported outcomes at a minimum of 2 years. (10.1016/j.arthro.2014.10.014)
  • [L4] Nonoperative treatment might be a valid long-term option for degenerative hip abductor lesions, especially for partial tears, which demonstrated a low risk of clinically relevant progression or muscle fatty infiltration and similar clinical outcomes to those reported in the literature for operatively treated hip abductor tendon lesions. (10.1177/03635465221135759)
  • [L3] However, its effect on functional outcomes remains unclear because surgery to perform heterotopic ossification excision remains exceedingly rare. (10.5435/jaaos-d-24-00491)
  • [L4] Limited improvement was observed in objectively-measured physical activity from 6 weeks to 6 months after spine surgery, despite moderate to large function gains. (10.1186/s12891-020-03816-y)
  • [L1] Both DAA and PA yield good results at an average 5-year follow-up in terms of survivorship, function, rate of complications, and radiographic analysis. (10.1016/j.arth.2019.01.060)
  • [L1] No improvement in clinical outcome in terms of fracture reduction and functional outcome has been established so far. (10.3390/jpm11090930)
  • [L1] Periarticular injection with a multimodal protocol was shown to decrease pain and improve functional recovery compared with conventional pain control modalities. (10.1016/j.arth.2006.12.027)
  • [L4] A realistic long-term goal for the management of early-onset scoliosis appears to be spine elongation and maintenance of pulmonary function at a level that is no less than the percentage of normal at initial presentation. (10.2106/jbjs.16.00796)
  • [L3] Reoperations may not be directly linked to radiographic and functional outcomes but are important from the patient's perspective and in terms of cost-effectiveness. (10.2106/jbjs.24.00486)

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