Athletic Injuries Involving the Hip (original) (raw)
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Orthopaedic sports injuries in youth: the hip
Annals of Joint, 2018
Hip injuries in the pediatric athlete have become more common as overall participation in organized, competitive youth sports has increased over the past decades (1,2). Improved diagnostic imaging studies and utilization of hip arthroscopy in the pediatric setting have also led to the increased diagnosis of hip injuries (3). These hip disorders can be classified as either acute injuries or chronic, overuse injuries. This chapter will focus on the most common acute and chronic injuries to the hip in the pediatric patient. Apophyseal avulsion fractures Epidemiology Apophyseal avulsion fractures are generally atraumatic and occur when there is a sudden eccentric contraction or passive stretch of muscle such as in exercises involving sprinting, jumping, and/or kicking. The Sharpey's fibers attaching from the muscle/tendon unit onto the epiphysis are stronger than the cells in the physis, resulting in failure through the zone of hypertrophy of the physis (4). These injuries can occur at any major muscle attachment site. The most common areas in the hip and pelvis are the anterior superior iliac spine (ASIS), anterior inferior iliac spine (AIIS), ischial tuberosity, lesser trochanter, and iliac crest. Reports vary on the incidence of each type of avulsion fracture (Figure 1) (5,6). Schuett et al. most recently reported on 228 patients with apophyseal avulsion fractures, with 49% of avulsions occurring at the AIIS and 30% occurring at the ASIS (7). In contrast, Metzmaker et al. found that ASIS avulsion fractures (40%) were the
Hip and groin pain in adolescents
Pediatric Radiology, 2010
A variety of disorders may result in hip or groin pain, particularly in adolescents who partake in sports. Both intra-articular and extra-articular pathologies should be considered. We will review a select group of abnormalities that are gaining recognition in this age group.
Activity related hip pain in a young adult
Journal of Arthroscopy and Joint Surgery, 2015
Two most common causes of non-inflammatory hip disease in the adolescent and young adult patient population are FAI or hip dysplasia. This article describes the clinical presentation of a patient with femoroacetabular impingement (FAI). It explains presentation and pathophysiology, and goes on to discuss important radiological parameters to diagnose FAI. In the end, treatment strategy of FAI is summarised.
Hip pain in young adults and the role of hip arthroscopy
Orthopaedics and Trauma, 2009
The spectrum of hip pathologies has broadened significantly over the past five years through improved imaging techniques and hip arthroscopy. Hip arthroscopy will increasingly provide new treatment options for the plethora of hip pathologies. Femoroacetabular impingement, a condition relatively unknown until its introduction by Ganz, is now thought to be the most common cause of hip pain in the young adult with an incidence around 10-15% of the population. FAI is responsible for labral tears and chondral injuries and there is growing evidence that it is precursor of osteoarthritis. Although there are few studies assessing open and arthroscopic treatment of FAI, the early results are promising. Labral tears may be associated with dysplasia and instability, and can be degenerative or post-traumatic. With regards to articular degeneration: hip arthroscopy appears to have its benefits in treating localized articular cartilage lesions; although its role for more diffuse osteoarthritis is still limited. There is no doubt that the hip arthroscopist will become a valuable addition to each orthopaedic department.
Prevalence of Hip or Groin Pain in Adolescents: A Systematic Review and Meta‐Analysis
Pain Practice, 2020
Musculoskeletal pain is a common cause of pain in adolescence and can be an important predictor of future pain. The prevalence of hip or groin pain that could potentially affect different adolescent populations has not yet been systematically reviewed. This systematic review aimed to determine the prevalence of hip or groin pain in this population. Five electronic databases were searched until January 2019 for eligible studies that included males and females 13 to 19 years of age. Study selection, data extraction, and risk of bias assessments were completed by 2 independent researchers. Based on inclusion criteria, 8 population‐based, 8 clinical, and 4 sports populations were included. Studies were conducted in Europe, North America, and Australia. The prevalence was dichotomized into “0 to 3 months” and “3 months and above.” Meta‐analyses were performed to estimate the prevalence from 0 to 3 months, and individual estimates were reported for studies of 3 months and above. The overa...
The Young Adult With Hip Pain: Diagnosis and Medical Treatment, Circa 2004
Clinical Orthopaedics and Related Research, 2004
Hip pain in young adults (18-35 years old) often is characterized by nonspecific symptoms, normal imaging studies, and vague findings from the history and physical examination. In younger patients, pain is more likely to be caused by congenital hip dysplasia, athletic injuries, trauma, spondyloarthropathy, and by conditions that first appear during this stage of life, such as rheumatoid arthritis, osteoarthritis, intravenous drug use, alcoholism, or corticosteroid use. The history and physical examination may narrow the diagnosis to intraarticular, extraarticular, or referred sources of pain. Plain radiography and magnetic resonance imaging are the preferred initial imaging procedures. Analyses of the blood, urine, and synovial fluid can be helpful in diagnosing inflammation, infection, and systematic rheumatic disease. Fractures, infection, and ischemic necrosis should be ruled out early because they require immediate treatment to prevent damage to the joint. Hip trauma at a young age increases the risk of osteoarthritis with advancing age, and, unlike most older adults, young adults receiving total hip replacement can expect revision surgery. Medical treatment often involves patient education, physical therapy, and pharmacotherapy. Acetaminophen, nonsteroidal antiinflammatory drugs, and opioids for pain and antibiotics for infection are the most often prescribed drugs for this population.
Clinical Orthopaedics and Related Research®, 2013
Background The literature contains few studies of open treatment with an open surgical hip dislocation approach for treatment of femoroacetabular impingement (FAI) in adolescents. The average age and associated disorders in adolescents with FAI reveal a critical need to study younger patients whose hip disorder has not had time to progress. Questions We assessed (1) how validated measures of patient-oriented assessment of hip function and quality of life change after surgical hip dislocation; (2) whether any patient-related or technique variables correlated with changes in the outcome scores; and (3) what the complications of treatment are and how many reoperations we performed on these patients. Methods We retrospectively reviewed a consecutive series of 71 hips in adolescents younger than 21 years who underwent surgical hip dislocation for FAI. The final cohort consisted of 44 patients (52 hips) with a mean age of 16 years. We analyzed changes in outcome variables after surgical hip dislocation and recorded reoperations during the study period. Results The minimum followup was 12 months (average, 27 months; range, 12-60 months). Modified Harris hip scores increased from a mean of 57.7 preoperatively to a mean of 85.8 postoperatively. Mean SF-12 scores increased from 42.3 to 50.6. Mean preoperative hip flexion increased from 97.5°to 106.2°. Mean internal rotation of the affected hip at 90°flexion increased from 18.19°to 34°. Conclusions Early results revealed improvements in hip function, patient quality of life, and ROM after surgical hip dislocation for the majority of this group of adolescents with FAI. However, 10% of the patients did not improve, and an additional 15% improved but still did not consider their hips good or excellent. This points toward the need for further studies in this population of patients. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
Hip Arthroscopy Improves Symptoms Associated with FAI in Selected Adolescent Athletes
Clinical Orthopaedics and Related Research®, 2012
Background Femoroacetabular impingement (FAI) is increasingly diagnosed in young and middle-aged patients. Although arthroscopic procedures are becoming frequently used in the treatment of FAI, there are little data regarding rates of complications or the ability of hip arthroscopy to improve hip function specifically in the adolescent athlete population. Because arthroscopic treatment is being used in the treatment of FAI, it is vital to know what, if any, improvements in hip function can be expected and the potential complications. Questions/purposes We asked (1) whether validated measures of hip function improve after arthroscopic treatment of FAI in adolescent athletes, and (2) what complications might be expected during and after arthroscopic treatment of FAI in these patients. Methods We retrospectively reviewed the records of 27 hips in 21 patients 19 years of age or younger who underwent arthroscopic treatment for FAI between 2007 and 2008. From the records we extracted demographic data, operative details, complications, and preoperative and postoperative modified Harris hip scores (HHS) and the Hip Outcome Score (HOS). The minimum followup was 1 year (average, 1.5 years; range, 1-2.5 years). Results Modified HHS improved by an average of 21 points, the activities of daily living subset of the HOS improved by an average of 16 points, and the sports outcome subset of the HOS improved by an average of 32 points. All patients' self-reported ability to engage in their preoperative level of athletic competition improved. In 24 hips that underwent cam decompression, the mean alpha-angle improved from 64°± 16°to 40°± 5.3°postoperatively. Conclusions We found short-term improvements in HOS and HHS with no complications for arthroscopic treatment of FAI in our cohort of adolescent athletes. We believe arthroscopic treatment of FAI by an experienced hip arthroscopist should be considered in selected patients when treating athletically active adolescents for whom nonoperative management fails. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.