Rehabilitation Following Hip Arthroscopy for Femoroacetabular Impingement and Labral Repair

Abstract Proper rehabilitation after hip arthroscopy for the treatment of femoroacetabular impingement involving femoroplasty, acetabuloplasty, and/or labral repair is essential for optimizing patient outcomes. Rehabilitation should emphasize initial protection of the repair and advance based on progression criteria within each phase. Lumbopelvic stability and restoring appropriate hip biomechanics and muscle firing patterns are key to successful return to activity and sport. The rehabilitation program should be goal‐oriented, not time‐based, with functional criteria defining each phase of recovery. Recovery may be broken down into four phases: maximum protection (0‐4 weeks), low impact (4‐12 weeks), linear phase (12‐16 weeks), and high impact (16+ weeks). The first phase, emphasizes maximum protection of an inflamed hip joint shortly after the index surgical procedure. The main criteria to progress to the second phase include no active effusion and functional passive hip range of motion with no pain. The low impact phase, or second phase, focuses on restoring balance and gait. Exercises are performed that allow progression to full weight bearing while avoiding iliopsoas activation. Criteria to progress from this phase include normalized gait pattern without assistive device; ability to ascend/descend 1 flight of stairs; soreness lasting no longer than 24 hours after activity; and a pain free, symmetrical squat to 75°. The third phase, the linear phase, aims to restore proprioception and proper running and landing mechanics. Progression from this phase involves isometric strength in the operative hip within 80% of the uninvolved side, no dynamic valgus with single limb balance or with lateral step down, and a normal jogging gait pattern. The final, high impact, phase progresses through a running/agility program. This involves initiation of sport specific training. Graduation from this phase happens when all sport specific training exercises are undertaken with no compensation and no pain, culminating with completion of return to sport testing. A goal‐oriented rehabilitation program is a key component of a successful hip arthroscopy surgery.