Utilization of the Functional Lower Extremity Evaluation (FLEE) in Return-to-Sport Rehabilitation Protocol Following Hip Arthroscopy in Collegiate Athletes: A Case Series.
Yazdan Raji, Rebecca E Luft, Kinsley J Pierre and 2 others
PMID 42694058WHAT IT FOUND
Four college athletes who had hip surgery returned to sport at about 5.75 months with no reinjury over four years.
This is a descriptive case series with no comparison group. It cannot show the functional test or the rehab protocol caused the good outcome.
Key findings
01All four athletes achieved return to sport at a mean of 5.75 ± 1.44 months, with percent limb symmetry across FLEE components ranging from 97.95% to 110.04%, and no re-injuries or re-operations were recorded over a mean follow-up of 52.89 months.
02No formal hypothesis testing or inferential statistical analyses were performed because of the small sample size; all results are descriptive.
03The multi-phase progressive rehabilitation protocol used by all four athletes was developed by the senior author in conjunction with the institutional physical therapy team, meaning the protocol being described was designed by the lead investigator.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only four athletes from a single university; findings cannot be generalised to other populations, sports, or levels of competition. No pre-injury or pre-surgical FLEE baseline was recorded, so there is no within-subject comparison to show what the rehabilitation actually changed. No control or comparison group; it is impossible to attribute the good outcomes to the FLEE, to the rehab protocol, to the athletes' own recovery, or to any combination of these. No formal statistical testing was performed; all results are descriptive means and ranges. The sample is demographically narrow: one female, all right-leg dominant, only three sports represented. The senior author designed the rehabilitation protocol being evaluated, which introduces a conflict of interest in the interpretation of the results. Retrospective design means data quality depends on what was recorded in the chart at the time; missing or inconsistent entries could not be corrected.
Declared interests
The senior author, Marc R. Safran, MD, reports consulting fees from Medacta, Anika Therapeutics, and Smith & Nephew; royalties from Smith & Nephew, DJO, Stryker, Elsevier, Lippincott, Top Shelf, Vive Health, Subchondral Solutions, Marrow Access Technologies, and Medacta; research support from Smith & Nephew; and membership on journal editorial boards (AJSM, JISAKOS, JHPS). The first author, Yazdan Raji, MD, reports paid speaker fees from Arthrex, Inc. (stated as unrelated to this study) and membership on the AAOS Sports Medicine Examination Committee and the AOSSM Marketing & Communications Committee. The senior author also designed the rehabilitation protocol under evaluation. The remaining co-authors report no financial conflicts.
The easy way to misread this
Do not read the absence of reinjury in four athletes over four years as evidence that the FLEE-guided protocol prevents reinjury or is superior to other return-to-sport criteria. There was no comparison group, no baseline FLEE score to show what the rehabilitation changed, and no statistical testing; the authors themselves state that prospective, multicentre trials with larger cohorts are needed to confirm these findings. Equally, the phrase 'improvements in all FLEE components' in the results refers to the athletes' scores at a single post-operative time point, not to a measured change from a pre-injury baseline, which was never recorded.