Editorial Commentary: Return to Sport Is Not the Finish Line: Raising the Bar for Long-Term Outcomes After Hip Arthroscopy in Athletes.

Abstract

In athletes with femoroacetabular impingement syndrome (FAIS), return-to-sport (RTS) rates are generally high at short- to mid-term follow-up after hip arthroscopy. However, there is significant heterogeneity and lack of standardization of RTS definitions across the literature, limiting meaningful comparison across studies. At long-term follow-up, patterns of sports participation, performance expectations, and physical capacity evolve, and traditional binary RTS definitions may not adequately capture the quality or durability of athletic participation. Recent evidence suggests that although more than 80% of athletes may continue to participate in sport at long-term follow-up after hip arthroscopy, participation occurs across a spectrum ranging from unlimited pain-free activity to modified participation or continued play despite persistent symptoms. Persistent hip pain, followed by new injuries to a separate body region or lifestyle changes, remains the primary reason for inability to sustain long-term sport participation. In contrast, continued sports participation, particularly at a pain-free level, represents a key determinant of patient satisfaction and is closely associated with achieving a patient acceptable symptom state at long-term follow-up. Ultimately, RTS as a binary outcome may overestimate true recovery and fail to reflect clinically meaningful long-term outcomes in this population. Using more precise RTS definitions that evaluate continued participation and integrate level of competition with sport- and sex-specific considerations are essential to better define long-term success following hip arthroscopy in athletes.