Recreational Sports and Intra-articular Hip Injuries in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement

Abstract

Purpose We aimed to determine the relationship between recreational sports and intra-articular hip injuries in an active population that had undergone hip arthroscopy for femoroacetabular impingement syndrome. Methods A retrospective review was performed of prospectively collected data from patients undergoing hip arthroscopy between January 2015 and December 2016. Inclusion criteria included patients between 18 and 50 years of age who had participated in recreational sports prior to surgery and had a minimum of a 2-year follow-up. Labral injury was evaluated using the Multicenter Arthroscopic Hip Outcome Research Network classification, and rim chondral injuries were evaluated using the Acetabular Labral Articular Disruptions system. Ligamentum teres tear and psoas impingement were also recorded. Sports were classified as rotational running (soccer, basketball, handball), flexibility (martial arts, dance), asymmetric-overhead (racquet), or endurance (running, swimming, cycling). Primary univariate analysis of sports’ independent associations, demographic characteristics, intra-articular hip injuries, and outcomes was performed. Results Patients included 185 people with a mean age of 36.7 years. Patients participating in rotational running sports and flexibility sports had a significantly greater proportion of rim chondral injuries than those participating in endurance sports or asymmetric overhead sports ( P = 0.02). Ligamentum teres tears were significantly associated with flexibility sports ( P < 0.001). A total of 84.7%, 67.7%, 67.2%, and 71.2% of patients met minimal clinically important difference levels for the modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS) 10 questionnaire with activities of daily living (HOS-ADL), the sports subscale (HOS-SSS), and the International Hip Outcome Tool (iHOT-12), respectively; 94.9%, 66.2% and 62.7% met the patient acceptable symptom state for mHHS, HOS-ADL, and HOS-SSS, respectively; 86.7%, 48.5%, 47.8%, and 32.4% found substantial clinical benefit for mHHS, HOS-ADL, HOS-SSS, and iHOT-12, respectively. Conclusions Rotational running sports were significantly associated with rim chondral injuries. Flexibility sports were significantly associated with rim chondral injuries and ligamentum teres tears. Athletes participating in these sports are more likely to have intra-articular hip injuries than those in the other sports categories. Level of Evidence Level IV, prognostic case series.

Pathologic Findings on Hip Arthroscopy in High-Level Athletes Competing in Flexibility Sports

“…Hip arthroscopy has been proven to be successful in these young, highly motivated patients, and populations of athletes undergoing this procedure have demonstrated excellent clinical outcomes and high rates of return to sports (RTS). 7,14,41,42,43,50,67,68 As is the case in patients from the general population, athletes represent a diverse patient cohort. To account for this, Nawabi et al 54 subclassified sports into 6 categories based on the mechanical loads placed on the hip: cutting, contact, impingement, asymmetric/overhead, endurance, and flexibility.…”

“…Hip arthroscopy has been proven to be successful in these young, highly motivated patients, and populations of athletes undergoing this procedure have demonstrated excellent clinical outcomes and high rates of return to sports (RTS). 7,14,41,42,43,50,67,68…”

Hip Pain Increases With Age and Experience Level in Adult Karate Athletes: A Statewide Survey Study

“…Their study investigated Tae Kwon Do and Hapkido athletes only, which demonstrated that 64% of symptomatic martial artists had cam-type FAI. Mas Martinez et al 23 concluded in their study that flexibility sports (martial arts) were significantly associated with rim chondral injuries and ligamentum teres tears. Mariconda et al 24 noted significant positive association between having an alpha angle of more than 60 (suggesting cam-type FAI) and the presence of groin pain (P ¼ .002) among skilled capoeira players.…”

“…While many studies exist that look at injury rates during martial arts’ competition, there are few studies that have reported the prevalence of FAI or labral tears in a specific subset of the martial arts community as a whole. 1 , 2 , 3 , 4 , 6 , 23 , 24 Given our knowledge of the prevalence of FAI and labral tears in the general and athletic population, it is important to investigate the prevalence of such injuries in karate athletes who devote a significant amount of their training to high-intensity hip movement. Outcomes from a prevalence study could lead to better understanding of populations at risk and injury mechanism in this population.…”

What the papers say

“…Martinez et al [ 5 ] aimed to determine the relationship between recreational sports and intra-articular hip injuries in an active population that had undergone hip arthroscopy for FAI syndrome. They performed a retrospective review of prospectively collected data from patients undergoing hip arthroscopy.…”