Mansell military FAI trial

Arthroscopic Surgery or Physical Therapy for Patients With Femoroacetabular Impingement Syndrome: A Randomized Controlled Trial With 2-Year Follow-up.

Mansell NS, Rhon DI, Meyer J, et al. The American journal of sports medicine 2018 · PMID 29443538 · doi:10.1177/0363546517751912

Question

In a military population with FAI syndrome, does arthroscopic surgery outperform physical therapy at 2 years?

Design

Single-centre RCT in a US military healthcare setting with 2-year follow-up.

Patients

US military personnel and beneficiaries with clinically and radiologically diagnosed FAI syndrome.

Intervention

Hip arthroscopy

Comparison

Structured physical therapy programme

Primary outcome

Hip Outcome Score (activities of daily living and sport subscales) over 2 years

Key result

Both groups improved, but there was no significant difference between surgery and physical therapy at 2 years; many patients allocated to physical therapy crossed over to surgery, limiting interpretation.

Limitations

Small sample, specific military population and substantial crossover dilute the intention-to-treat comparison.

Impact on practice

Often cited as the contrasting trial to UK FASHIoN and FAIT, reminding clinicians that not all patients benefit from surgery and that a trial of rehabilitation is reasonable first.