Sport-Specific Loading in Femoroacetabular Impingement (FAI): Development, Treatment, and Return to Sport

Abstract

Femoroacetabular impingement (FAI), particularly cam-type morphology, is increasingly recognized as a major cause of hip pain and functional limitation in young athletes. Growing evidence suggests that repetitive sport-specific mechanical loading during skeletal maturation contributes to the development of cam deformity and may influence postoperative outcomes after hip arthroscopy. High-impact sports involving repetitive hip flexion, internal rotation, axial loading, and rapid directional changes-especially ice hockey, soccer, and basketball-demonstrate a significantly increased prevalence of cam morphology compared with non-athletic populations. Current findings support a mechanobiological model in which repetitive loading during adolescence induces adaptive remodeling of the proximal femur, potentially progressing from physiological adaptation to pathological impingement. Although both physiotherapy and arthroscopic treatment improve symptoms and hip function, hip arthroscopy generally provides superior short-term improvements in patient-reported outcomes. Return-to-sport rates following arthroscopy are consistently high, commonly ranging from 80% to 90%; however, successful return to competition does not necessarily correspond to restoration of pre-injury performance levels. Postoperative recovery appears to vary according to biomechanical demands, age, revision surgery, duration of symptoms, and the severity of intra-articular damage. Arthroscopic treatment provides superior short-term improvements in patient-reported outcomes compared with conservative management. Nevertheless, physiotherapy remains a reasonable first-line approach, particularly in less severe cases, and does not appear to adversely influence the outcomes of subsequent surgical intervention.