Abstract
BACKGROUND: The Hip-Return to Sport after Injury (Hip-RSI) score emphasizes the importance of psychological factors in return to sport (RTS) after arthroscopic treatment of femoroacetabular impingement. PURPOSE/HYPOTHESIS: The goal of this study was to evaluate the reproducibility and validity of the Hip-RSI score for the assessment of the psychological readiness to RTS after surgical repair of a proximal hamstring avulsion in active patients, and the ability of the score to predict the return to preinjury sport at 9 months postoperatively. It was hypothesized that the Hip-RSI score is a reliable and valid tool for effectively assessing psychological readiness and predicting return to preinjury sport at 9 months after surgery. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Patients who underwent primary surgical repair of a proximal hamstring avulsion between June 2022 and November 2023 were included in this prospective cohort study. All patients completed the Hip-RSI score at 4 and 9 months postoperatively. The Hip-RSI score was compared with the Parisian Hamstring Avulsion Score (PHAS) for validation using the Pearson correlation coefficient. The discriminant and predictive abilities of the Hip-RSI score were also estimated. A test-retest method was used to assess the reliability of the scores, and internal consistency was evaluated using the Cronbach alpha coefficient. RESULTS: A total of 84 patients (38 women and 46 men), with a mean age of 48.7 ± 12.7 years (range, 21-85 years), were included in the study. The Hip-RSI score was strongly correlated with the PHAS score (r = 0.55 [95% CI, 0.37-0.68]). The intraclass correlation coefficient was 0.89 (95% CI, 0.75-0.96), indicating good reliability of the score over time. The discriminant ability of the Hip-RSI score was good, as it was significantly higher in the RTS group than in patients who did not return to their preinjury sport. Furthermore, the predictive ability to identify patients who would return to their preinjury sport at 9 months postoperatively was acceptable (area under the curve = 0.76). At an optimal cutoff value of 51.7, the Hip-RSI score at 4 months had a sensitivity of 69% and a specificity of 77%, with a moderate Youden index of 0.46. The internal consistency suggested redundancy among the score items (alpha coefficient = .97). CONCLUSION: The Hip-RSI score is a valid, reproducible tool to assess the psychological readiness to RTS in active patients who undergo surgical repair of a proximal hamstring avulsion. This score, with a cutoff of 51.7 at 4 months postoperatively, demonstrated a moderate ability to predict which patients would return to sport, with a sensitivity of 69% and a specificity of 77%.