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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 pathology. In rotator cuff repair, the trajectory is relatively rapid, with approximately 60% of ultimate functional recovery achieved at 3 months and approximately 75% at 6 months [1]. Surgical repair of traumatic rotator cuff tears yields significant improvements in functional outcomes for all patients, though timing is critical; patients operated on within 3 weeks achieve the best outcomes, whereas those treated more than 4 months post-injury experience a drop in function [21].

Conversely, recovery from 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, evidence regarding long-term functional outcomes and failure rates beyond the 10-year mark remains limited [3]. In contrast, femoral osteotomy for osteonecrosis of the femoral head provides significant improvements in quality of life and functional capabilities, despite requiring an extended duration for physical recovery [7]. Endoscopic repair of gluteal tendon tears with comorbid labral tears and chondral lesions also demonstrates improved patient-reported functional outcomes at follow-up of at least 1 year postoperatively [6].

In joint arthroplasty and reconstruction, approach and rehabilitation protocols influence outcomes. The direct superior approach 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 results to traditional rehabilitation pathways [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]. Finally, postoperative rehabilitation is essential to maximize functional recovery and patient-reported outcomes in hand transplantation [5].

Anatomy & Pathophysiology

Osseous and Morphological Factors

An understanding of 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]. Hip injuries in young athletes are being diagnosed with increasing frequency due to advancements in technology and understanding of pathomechanics [32]. High rates of femoroacetabular impingement (FAI) morphologic characteristics are present in patients with hip instability [45]. Hip microinstability is a condition characterized by abnormal femoral head micromotion within the acetabulum, leading to cartilage damage and osteoarthritis, often associated with acetabular dysplasia or femoroacetabular impingement syndrome [59].

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 [62]. Intrinsic sarcomere changes contribute to the development of hip displacement in cerebral palsy [51]. 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 [56].

Kinematics and Surgical Outcomes

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 [36]. 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 [48]. After an ACL injury prevention program, 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 [39]. Regardless of hip morphology or concomitant procedures, all studies that reported postoperative outcomes demonstrated improved PROs following periacetabular osteotomy after failed hip arthroscopy [44].

Classification

Functional Recovery Trajectories: Functional recovery following rotator cuff repair shows approximately 60% of ultimate recovery at 3 months and approximately 75% recovery at 6 months [1]. 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]. 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]. 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].

Hip Arthroplasty Approaches and Outcomes: 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]. Patient-reported functional outcomes are improved at follow-up of at least 1 year postoperatively for endoscopic repair of gluteal tendon tears associated with labral tears and chondral lesions [6]. Patient-reported outcomes (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]. There is limited evidence on long-term functional outcomes and failure rates for hip preservation procedures beyond the 10-year mark [3].

Classification Systems for Specific Pathologies: The classification system for anterior cruciate ligament (ACL) tear location is reliable in assessing tear location in acute ACL injuries [43]. Diagnosis of patellofemoral pain uses reproduction of retropatellar pain during squatting and other functional activities, and proposes a classification system based on predominant impairments [52]. The classification system and treatment algorithm for surgical treatment of various greater trochanteric pain syndrome (GTPS) types leads to favorable patient-reported outcomes [46].

Other Considerations: Postoperative rehabilitation is essential to maximize functional recovery and patient-reported outcomes in hand transplantation [5]. 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 THA and TKA [11]. Treatment-based classification for low back pain focuses on identifying clusters of findings from history and clinical examination that predict a more favorable outcome with a specific treatment approach [37].

Clinical Presentation

Functional recovery trajectories vary significantly by procedure and injury type. 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]. For femoral osteotomy, significant improvements in quality of life and functional capabilities are achieved, though physical recovery requires an extended duration [7].

Prognostic patterns and timing of recovery differ across arthroplasty and preservation techniques. Most patients achieve clinically meaningful improvements in physical function after primary total hip arthroplasty much earlier than previously believed [9]. One-year follow-up has merit for assessing functional performance after primary total hip arthroplasty in subjects less than 65 years of age [20]. However, recovery of postural stability and functional capacity over one year after minimally invasive total hip arthroplasty fluctuated with no consistent improvement tendency [12]. Prognostic subgrouping reveals more diverse patterns in pain and function recovery over 1 year than classification by traditional diagnostic groups [16]. Limited evidence exists on long-term functional outcomes and failure rates for hip preservation procedures beyond the 10-year mark [3].

Surgical approach and specific pathologies influence functional outcomes and rehabilitation needs. The direct superior approach (DSA) promotes early recovery and better mid-term functional outcomes compared to the posterolateral approach in total hip arthroplasty [4]. 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]. Bilateral reverse total shoulder arthroplasty provides predictable pain relief and improved function [18]. Patient-reported outcome measures (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]. Postoperative rehabilitation is essential to maximize functional recovery and patient-reported outcomes in hand transplantation [5].

Neurological injury and specific patient populations present distinct clinical challenges. There is a relationship between the degree of neurological recovery and intraoperative nerve exploration abnormalities in patients with traumatic sciatic nerve injury from acetabular fractures [29]. Patients with partial neurological recovery from traumatic sciatic nerve injury take longer to recover [29]. Military service members report continued pain and functional limitations after surgery for femoroacetabular impingement syndrome despite improvements in patient-reported outcome measures [26]. 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].

Return to sport and psychological factors require nuanced assessment. 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 patient-reported outcome measures [28].

Investigations

The provided evidence base contains no data regarding specific diagnostic imaging modalities (Plain radiography, MRI, CT, Bone scan, Tomosynthesis), aspiration techniques, or laboratory markers. Consequently, subsections for Plain radiography:, MRI:, CT:, Bone scan:, Tomosynthesis:, Aspiration:, and Laboratory: are not populated with clinical findings or specific signs in this dataset.

Other Considerations: Functional recovery trajectories and outcomes vary significantly by procedure and pathology. Following rotator cuff repair, patients achieve approximately 60% of ultimate functional recovery at 3 months and 75% at 6 months [1]. 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]. For hip preservation procedures, evidence on long-term functional outcomes and failure rates beyond the 10-year mark is limited [3].

In total hip arthroplasty (THA), the direct superior approach (DSA) promotes early recovery and better mid-term functional outcomes compared to the posterolateral approach [4]. The direct anterior approach (DAA) demonstrates superior short-term functional gains and similar long-term outcomes compared with the posterolateral approach in elderly individuals with femoral neck fractures [13]. Both DAA and posterolateral approach (PA) yield good results at an average 5-year follow-up regarding survivorship, function, complications, and radiographic analysis [69]. Enhanced recovery programmes after THA result in reduced length of hospital stay without compromising functional outcome, providing equivalent functional outcomes to traditional rehabilitation pathways [8]. THA in adults with developmental dysplasia of the hip yields excellent overall survivorship and favorable clinical and radiographic outcomes [63].

Shoulder arthroplasty outcomes include sustained functional improvement from ream-and-run shoulder arthroplasty at a mean of 10 years postoperatively [14], while bilateral reverse total shoulder arthroplasty (RTSA) provides predictable pain relief and improved function [18]. Endoscopic repair of gluteal tendon tears with comorbid labral tears and chondral lesions improves patient-reported functional outcomes at follow-up of at least 1 year postoperatively [6]. 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].

Hip arthroscopy for symptomatic acetabular labral tears shows that patients with low functional improvement at 6 months continue to improve for up to 5 years [15]. In hand transplantation, postoperative rehabilitation is essential to maximize functional recovery and patient-reported outcomes [5]. Periarticular injection with a multimodal protocol decreases pain and improves functional recovery compared with conventional pain control modalities in total hip and knee arthroplasty [71].

Regarding pelvic and spine surgery, 3D-assisted operative treatment of pelvic ring injuries has not established improvement in clinical outcome in terms of fracture reduction and functional outcome [70]. Limited improvement in objectively-measured physical activity is observed from 6 weeks to 6 months after lumbar spine surgery, despite moderate to large function gains [68]. The effect of radiation therapy versus usual care for heterotopic ossification prophylaxis on functional outcomes remains unclear because surgery to perform heterotopic ossification excision is exceedingly rare [67]. Reoperations in developmental dysplasia of the hip treated at walking age may not be directly linked to radiographic and functional outcomes but are important from the patient's perspective and in terms of cost-effectiveness [73].

Treatment

Non-Operative

Nonoperative management serves as a primary or viable long-term strategy across several pathologies. For rotator cuff tears, early nonoperative treatment yields optimal outcomes [41], and it remains an effective, lasting option for many patients with chronic, full-thickness tears [47]. In femoroacetabular impingement (FAI) syndrome, nonoperative treatment is the first-line approach for most patients and should not be abandoned for early surgery [57]; it is effective in the majority of adolescent patients, with significant improvements in patient-reported outcomes persisting at a mean 5-year follow-up [49]. Hip arthroscopy for FAI is appropriate only after failure to improve following a full course of physical therapy [57]. For degenerative hip abductor lesions, particularly partial tears, nonoperative treatment may be a valid long-term option due to low risks of progression or fatty infiltration and clinical outcomes similar to operative treatment [66]. In ballet dancers with hip pain, focused physical therapy is first-line, with surgery reserved for those failing conservative measures [34].

Operative

Indications: Surgical intervention is indicated for traumatic rotator cuff tears to improve functional outcomes [21]. Early repair within 3 weeks yields the best results [21], whereas repair delayed more than 4 months after injury results in a drop in function [21]. For acetabular fractures, surgery is the standard, though recovery is often elongated beyond one year [2]. In lumbar spinal stenosis, surgery reduces pain and disability more effectively than nonoperative treatment, with benefits sustained over 2 years [31]. For osteonecrosis of the femoral head, femoral osteotomy is indicated to achieve significant improvements in quality of life and functional capabilities [7].

Surgical Approach / Technique: In total hip arthroplasty, the direct superior approach (DSA) promotes early recovery and better mid-term functional outcomes compared to the posterolateral approach [4]. For gluteal tendon tears causing greater trochanteric pain syndrome, endoscopic repair improves patient-reported functional outcomes at follow-up of at least 1 year [6]. In arthroscopic hip preservation surgery, both capsular repair and unrepaired capsulotomy result in statistically significant improvements in all patient-reported outcomes at a minimum of 2 years [65].

Rehabilitation and Adjuncts: Enhanced recovery programmes after total hip arthroplasty reduce length of hospital stay without compromising functional outcome and provide 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 these pathways for THA and TKA [11]. Continuous-flow cryo and cyclic compression therapy after hip fracture surgery aims to lower pain levels, morphine consumption, and blood loss while enhancing functional recovery [30]. Rehabilitation protocols for hip arthroscopy should be tailored to address specific surgical findings, procedures, patient characteristics, and athletic goals [38]. Physical therapy management of osteochondritis dissecans can incorporate a full spectrum of conservative, nonoperative, and postoperative care [42]. A novel multimodal non-opioid pain protocol was effective in managing postoperative pain following common orthopedic sports procedures [64].

Outcomes and Prognosis: Following rotator cuff repair, patients experience approximately 60% of ultimate functional recovery at 3 months and approximately 75% at 6 months [1]. Two-thirds of patients treated surgically for acetabular fractures display persistent clinically relevant long-term disability [2]. Short-term and intermediate-term results for hip preservation are favorable, but there is limited evidence on long-term functional outcomes and failure rates beyond the 10-year mark [3]. Postoperative rehabilitation is essential to maximize functional recovery and patient-reported outcomes following combined face and bilateral hand transplantation [5]. There is a severe lack of evidence on the athlete characteristics and clinical course of nonreturning athletes after hip arthroscopy for femoroacetabular impingement syndrome, and the rate of subsequent hip procedures for these patients 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]. Physical recovery following femoral osteotomy for osteonecrosis of the femoral head requires an extended duration [7]. Postoperative rehabilitation is essential to maximize functional recovery and patient-reported outcomes in hand transplantation [5].

Long-term functional outcomes also demonstrate variability in joint preservation and arthroplasty. Late functional improvements are still possible for up to 5 years after hip arthroscopy for symptomatic acetabular labral tears, even in patients with low improvement at 6 months [15]. Patient-reported functional outcomes were improved at follow-up of at least 1 year postoperatively for endoscopic repair of gluteal tendon tears with comorbid labral tears and chondral lesions [6]. However, recovery of postural stability and functional capacity over one year after minimally invasive total hip arthroplasty fluctuated with no consistent improvement tendency [12]. In non-surgical or conservative management contexts, 40% of patients with Achilles tendinopathy report ongoing pain even after five years of therapy [22].

Recovery

Light activity (weeks): Evidence does not specify a precise week range for light activity across the included procedures, though early recovery is noted with the direct superior approach in total hip arthroplasty [4] and short-term gains with the direct anterior approach (DAA) in femoral neck fracture arthroplasty [13]. For hand transplantation, postoperative rehabilitation is essential to maximize functional recovery [5].

Full activity (months): Functional trajectories vary significantly by procedure. Following rotator cuff repair, patients achieve approximately 60% of ultimate functional recovery at 3 months and 75% at 6 months [1]. In total hip arthroplasty for femoral neck fractures, the DAA demonstrates superior short-term functional gains compared with the posterolateral approach [13]. Most patients achieve clinically meaningful improvements in physical function earlier than previously believed after primary total hip arthroplasty [9]. For endoscopic repair of gluteal tendon tears, patient-reported functional outcomes are improved at follow-up of at least 1 year postoperatively [6].

Complete recovery / outcome plateau (months): Recovery timelines are often prolonged. The 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]. Physical recovery following femoral osteotomy for osteonecrosis of the femoral head requires an extended duration [7]. Recovery of postural stability and functional capacity over one year following minimally invasive total hip arthroplasty fluctuated with no consistent improvement tendency [12]. Late functional improvements are still possible beyond 6 months after hip arthroscopy for symptomatic acetabular labral tears, and patients with low functional improvement at 6 months continued improving for 5 years [15]. Functional improvement from ream-and-run shoulder arthroplasty is sustained at a mean of 10 years postoperatively [14].

Rehabilitation protocol: Management strategies depend on the pathology. For Achilles tendinopathy, the natural history is typically a long protracted course where management focuses on physiotherapy, and exercises improve function in the majority of patients [22]. Postoperative rehabilitation is essential to maximize functional recovery and patient-reported outcomes in hand transplantation [5].

Functional milestones: Significant improvements in quality of life and functional capabilities can be achieved following femoral osteotomy for osteonecrosis of the femoral head [7]. The direct superior approach (DSA) promotes early recovery and better mid-term functional outcomes in total hip arthroplasty compared with the posterolateral approach [4]. The DAA demonstrates similar long-term outcomes compared with the posterolateral approach in total hip arthroplasty for femoral neck fractures [13]. 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: Long-term outcomes data are limited for some procedures. There is limited evidence on long-term functional outcomes and failure rates beyond the 10-year mark for hip preservation procedures [3]. In Achilles tendinopathy, 40% of patients report ongoing pain even after five years of therapy [22]. For growth-sparing management of early-onset scoliosis, a realistic long-term goal is spine elongation and maintenance of pulmonary function at a level no less than the percentage of normal at initial presentation [72].

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)
  • [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)
  • [L5] First-line treatment consists of focused physical therapy, with surgical management reserved for patients who fail to improve with conservative measures. (10.5435/jaaos-d-22-00528)
  • [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)
  • [Commentary] Rehabilitation protocols should be tailored to address specific surgical findings, procedures, patient characteristics, and athletic goals. (10.1016/j.arthro.2019.10.015)
  • [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)
  • [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)
  • [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)

References

[1] Patients who have undergone rotator cuff repair experience around 75% functional recovery at 6 months after surgery. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-06019-z

[2] Evaluation of the trajectory of recovery following surgically treated acetabular fractures. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b1.bjj-2023-0499.r2

[3] The growth of hip preservation as a speciality. Knee Surgery, Sports Traumatology, Arthroscopy. 2023. DOI: 10.1007/s00167-023-07409-9

[4] Direct superior approach versus posterolateral approach in mid-term clinical outcomes of total hip arthroplasty: a prospective randomized controlled study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-024-08271-7

[5] Hand Therapy Regimen for Functional Recovery Following Combined Face and Bilateral Hand Transplantation. HAND. 2022. DOI: 10.1177/15589447221124250

[6] Labral Tears and Chondral Lesions Are Common Comorbidities Identified During Endoscopic Repair of Gluteal Tendon Tears for Greater Trochanteric Pain Syndrome: A Systematic Review. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.06.031

[7] A Five-Year Longitudinal Assessment of Quality of Life and Employment Status in Patients Who Have Osteonecrosis of the Femoral Head Undergoing Femoral Osteotomy: A Multicenter Study. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.06.066

[8] Enhanced recovery programmes after total hip arthroplasty can result in reduced length of hospital stay without compromising functional outcome. The Bone & Joint Journal. 2016. DOI: 10.1302/0301-620x.98b4.36243

[9] Time to Achieve the Minimal Clinically Important Difference in Primary Total Hip Arthroplasty: Comparison of Anterior and Posterior Surgical Approaches. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2024.04.038

[10] Painful Sequelae Following Limb Salvage: Etiology and Management. Journal of the American Academy of Orthopaedic Surgeons. 2011. DOI: 10.5435/00124635-201102001-00005

[11] Patient and surgical prognostic factors for inpatient functional recovery following THA and TKA: a prospective cohort study. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-01854-9

[12] Recovery of Posture Stability at Different Foot Placements in Patients Who Underwent Minimally Invasive Total Hip Arthroplasty: A One-Year Follow-Up Study. BioMed Research International. 2015. DOI: 10.1155/2015/463792

[13] Direct anterior approach enhances early recovery outcomes in total hip arthroplasty among elderly individuals with femoral neck fractures: a propensity-matched cohort study. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05941-7

[14] Functional Outcomes of the Ream-and-Run Shoulder Arthroplasty. Journal of Bone and Joint Surgery. 2017. DOI: 10.2106/jbjs.17.00201

[15] Six-Month Functional Scores Predict 5-Year Achievement of the Minimal Clinically Important Differences After Hip Arthroscopy for Symptomatic Acetabular Labral Tears. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251352195

[16] Recovery trajectories in common musculoskeletal complaints by diagnosis contra prognostic phenotypes. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04332-3

[17] FUNCTIONAL OUTCOMES OF ACETABULAR FRACTURES. The Journal of Bone and Joint Surgery-American Volume. 2003. DOI: 10.2106/00004623-200310000-00002

[18] Functional results of bilateral reverse total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.10.011

[19] Comparison of anterior and posterior approaches for hip resurfacing arthroplasty: a gait analysis study. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06457-w

[20] A randomized pilot study of a comprehensive postoperative exercise program compared with usual care following primary total hip arthroplasty in subjects less than 65 years of age: feasibility, selection of outcome measures and timing of assessment. BMC Musculoskeletal Disorders. 2014. DOI: 10.1186/1471-2474-15-192

[21] Early repair of traumatic rotator cuff tears improves functional outcomes. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.03.134

[22] Featured specialty lead: Mr Mike Carmont What is new about Achilles tendinopathy?. 2014.

[23] Can We Identify Why Athletes Fail to Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement Syndrome? A Systematic Review and Meta-analysis. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546520956292

[24] A Clinically Relevant Review of Hip Biomechanics. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2010.01.027

[26] Most Military Service Members Return to Activity Duty With Limitations After Surgery for Femoroacetabular Impingement Syndrome: A Systematic Review. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.05.011

[27] Editorial Commentary: Designing Patient‐Reported Outcome Measures That Have High Clinical Utility and Minimum Responder Burden: When Less Is More. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2022.11.028

[28] Editorial Commentary: Failure to Return to Sport, or Rather a Failure to Attempt a Return After Hip Arthroscopy Is Not Correlated With Poor Clinical Outcome: The Devil Is in the Details. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.01.015

[29] Incidence of traumatic sciatic nerve injury in patients with acetabular fractures and factors affecting recovery: a retrospective study. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-03515-z

[30] The efficacy of continuous-flow cryo and cyclic compression therapy after hip fracture surgery on postoperative pain: design of a prospective, open-label, parallel, multicenter, randomized controlled, clinical trial. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-1000-4

[31] Surgery Reduced Pain and Disability in Lumbar Spinal Stenosis Better Than Nonoperative Treatment. The Journal of Bone & Joint Surgery. 2007. DOI: 10.2106/jbjs.8908.ebo2

[32] Hip Pathology in the Adolescent Athlete. Journal of the American Academy of Orthopaedic Surgeons. 2013. DOI: 10.5435/jaaos-21-11-665

[34] Hip Pain in Ballet Dancers: Evaluation and Management. Journal of the American Academy of Orthopaedic Surgeons. 2022. DOI: 10.5435/jaaos-d-22-00528

[36] Variation in functional pelvic tilt in patients undergoing total hip arthroplasty. The Bone & Joint Journal. 2017. DOI: 10.1302/0301-620x.99b2.bjj-2016-0098.r1

[37] Clinical Prediction for Success of Interventions for Managing Low Back Pain. Clinics in Sports Medicine. 2008. DOI: 10.1016/j.csm.2008.03.002

[38] Editorial Commentary: Rehabilitation After Hip Arthroscopy—Bear in Mind the Bearing of Weight. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020. DOI: 10.1016/j.arthro.2019.10.015

[39] Hip biomechanics differ in responders and non-responders to an ACL injury prevention program. Knee Surgery, Sports Traumatology, Arthroscopy. 2018. DOI: 10.1007/s00167-018-5158-1

[41] Predictors of Pain and Functional Outcomes After the Nonoperative Treatment of Rotator Cuff Tears. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118788531

[42] Physical Therapy Management of Patients with Osteochondritis Dissecans. Clinics in Sports Medicine. 2014. DOI: 10.1016/j.csm.2014.01.001

[43] The Location of Anterior Cruciate Ligament Tears: A Prevalence Study Using Magnetic Resonance Imaging. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117709966

[44] Periacetabular osteotomy after failed hip arthroscopy demonstrates improved outcomes in a heterogenous patient population: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2022. DOI: 10.1007/s00167-022-07108-x

[45] Does Femoroacetabular Impingement Cause Hip Instability? A Systematic Review. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.07.021

[46] Intraoperative Classification System Yields Favorable Outcomes for Patients Treated Surgically for Greater Trochanteric Pain Syndrome. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.01.058

[47] What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.10.009

[48] Adverse effects of total hip arthroplasty on the hip abductor and adductor muscle lengths and moment arms during gait. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-01832-1

[49] Nonoperative Management of Femoroacetabular Impingement in Adolescents: Clinical Outcomes at a Mean of 5 Years: A Prospective Study. The American Journal of Sports Medicine. 2021. DOI: 10.1177/03635465211030512

[51] Relationship of muscle morphology to hip displacement in cerebral palsy: a pilot study investigating changes intrinsic to the sarcomere. Journal of Orthopaedic Surgery and Research. 2019. DOI: 10.1186/s13018-019-1239-1

[52] Patellofemoral Pain. Journal of Orthopaedic & Sports Physical Therapy. 2019. DOI: 10.2519/jospt.2019.0302

[56] Chapter 57 Pediatric Hip Disorders. 2020.

[57] Editorial Commentary: Nonoperative Management Is the First Line of Treatment for Hip Femoroacetabular Impingement in Adolescents: Children Are Not Little Adults!. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.05.009

[59] Chapter 12 Hip Microinstability. 2019.

[62] Function of the ligamentum teres during multi‐planar movement of the hip joint. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-2168-2

[63] Retrospective Review of Outcomes of Total Hip Arthroplasty in Developmental Dysplasia of the Hip in Adults. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.03.070

[64] Can We Eliminate Opioids After Common Orthopedic Sports Procedures? A Novel Multimodal Pain Protocol. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2020.12.065

[65] Influence of Capsular Repair Versus Unrepaired Capsulotomy on 2‐Year Clinical Outcomes After Arthroscopic Hip Preservation Surgery. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.10.014

[66] Natural History of Degenerative Hip Abductor Tendon Lesions. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465221135759

[67] A Multicenter, Modern Cohort, Study of Radiation Therapy Versus Usual Care for Heterotopic Ossification Prophylaxis After Fixation of Acetabular Fractures Through a Posterior Approach. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-00491

[68] Early postoperative physical activity and function: a descriptive case series study of 53 patients after lumbar spine surgery. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03816-y

[69] Prospective, Randomized Study of Direct Anterior Approach vs Posterolateral Approach Total Hip Arthroplasty: A Concise 5-Year Follow-Up Evaluation. The Journal of Arthroplasty. 2019. DOI: 10.1016/j.arth.2019.01.060

[70] Does 3D-Assisted Operative Treatment of Pelvic Ring Injuries Improve Patient Outcome?—A Systematic Review of the Literature. Journal of Personalized Medicine. 2021. DOI: 10.3390/jpm11090930

[71] Controlling Pain After Total Hip And Knee Arthroplasty Using a Multimodal Protocol With Local Periarticular Injections: A Prospective, Randomized Study. The Journal of Arthroplasty. 2007. DOI: 10.1016/j.arth.2006.12.027

[72] Functional and Radiographic Outcomes Following Growth-Sparing Management of Early-Onset Scoliosis. Journal of Bone and Joint Surgery. 2017. DOI: 10.2106/jbjs.16.00796

[73] Reoperations as an Outcome Indicator for Developmental Dysplasia of the Hip Treated at Walking Age. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.00486

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