Apophyseal Injuries

Avulsion injuries are common among skeletally immature athletes because of the inherent weakness across the open apophysis 1 . The incidence of avulsion fractures is increasing, especially among 14 to 17 year olds, as a result of the growth in competitive sports participation. Avulsion fractures results from indirect trauma caused by sudden, violent, or unbalanced muscle contraction, and are most commonly associated with sports such as soccer, rugby, ice hockey, gymnastics, and sprinting, that...

Labrum Anatomy

The hip joint is a ball and socket joint enveloped in dense capsular tissue. The Y-shaped triradiate cartilage acetabulum covers 170 of the femoral head 3 . The acetabular labrum is a fibrocartilaginous structure that outlines the ace-tabular socket. Labral attachment occurs at the periphery of the labrum to the capsule, and is anchored anteriorly and posteriorly at the acetabular transverse ligament. The posterior labrum has a sulcus that can be mistaken for pathology (Fig. 1). Its free margin...

JW Thomas Byrd MD

Nashville Sports Medicine & Orthopaedic Center, 2011 Church Street, Suite 100, Nashville, TN37203, USA he arthroscope has been instrumental in the growing understanding of hip joint injuries in athletes. Until recently, sports-related hip injuries have received little attention. There are three reasons for this. First, perhaps hip injuries are less common than other joints. Second, investigative skills for the hip have been less sophisticated, including clinical assessment and imaging...

Specific Indications For Hip Arthroscopy In Children And Adolescents

Intra-articular pathology is often associated with developmental dysplasia of the hip 1,37,39 . Hip dysplasia may present in adolescence or young adulthood as hip pain from a degenerative labral tear or chondral lesion (Fig. 7). Anterior labral tears may also occur as a result of anterior impingement from a post-slipped capital femoral epiphysis deformity or pistol-grip deformity 36,40-45 . Although favorable results have been reported from the arthroscopic management of intra-articular...

Associated Intraarticular Injuries

The most common associated lesions with labral tears in athletes are chondral injuries 2 . These injuries are usually adjacent to the labral pathology 2,11,12 . Chondral changes include chondromalacia, thinning of the cartilage, delamina-tion of the cartilage, chondral flap tears (Fig. 10), and full-thickness chondral Fig. 10. Posterior acetabular chondral flap tear. Fig. 10. Posterior acetabular chondral flap tear. Fig. 11. Grade IV chondral lesion adjacent to anterior labral tear. Fig. 11....

Intraarticular Central Compartment

The perineal post is heavily padded and lateralized against the medial thigh of the surgical hip. This aids in achieving the optimal traction vector (Fig. 2) and reduces direct pressure on the perineum, lessening the risk of neuro-praxia of the pudendal nerve. Neutral rotation achieves a constant rela- Fig. 2. The optimal vector for distraction is oblique relative to the axis of the body, and more closely coincides with the axis of the femoral neck than the femoral shaft. This oblique vector is...

Clinical Examination of the Athletic

Beall, MDbc, Hal D. Martin, DOd aUniversity of Oklahoma College of Medicine, PO Box 26901, BSEB 100, Box 396, Oklahoma City, OK 73190, USA bThe Physicians Group, 610 NW 14th Street, Oklahoma City, OK 73103, USA cUniversity of Oklahoma Health Sciences Center, 1100 N. Lindsay, Oklahoma City, OK 73104, USA Oklahoma Sports Science and Orthopedics, 6205 North Santa Fe Avenue, Suite 200, Oklahoma City, OK 73118, USA The hip assumes an essential role in most...

Hip Injuries

Philippon, MD The recent popularity of hip arthroscopy has led to a new focus on hip injuries in athletes for the sports medicine practitioner. Five to six percent of all adult athletic injuries and 24 of pediatric athletic injuries are hip-related injuries. Hip loading increases up to 5 -8 during athletic activity and may place the athlete at risk of injury during athletic participation. Hip pain in the recreational to elite athlete in both men and women can result...

Summary

Labral tears in athletes can lead to disabling hip pain and affect their athletic performance. Isolated athletic injury or repetitive traumatic activity can lead to labral tears however, underlying structural (femoroacetabular impingement) and developmental abnormalities predisposing athletes to labral pathology must also be addressed. Recent studies 11,12 have demonstrated lesions associated with acetabular labral tears, and that labral tears uncommonly occur as isolated injuries. Return to...

Indications And Contraindications

The indications for microfracture of the hip include focal and contained lesions, typically less than 2 to 4 cm in size. Some authors have noted that lesions less than 400 mm2 tend to respond better to microfracture than lesions 400 mm2 or greater 9 . Other indications include full thickness loss of articular cartilage in weight-bearing areas and unstable cartilage flaps overlying intact subchondral bone. Patients with degenerative joint disease of the hip may also be candidates for this...

1

Coronal T1 fat-saturated image of focal grade 3 cartilage defect of superior acetabulum (white arrow). and 77 to 89 for cartilage injury detection, respectively 4,62 . One of these studies showed an overreliance on secondary signs of osteoarthritis and chon-drosis (ie, increased signal intensity of subchondral marrow and osteophytes) resulted in false positive interpretation. These authors also had more difficulty assessing acetabular sided cartilage lesions. However, a more recent...

Hip Arthroscopy In Children And Adolescents

Described originally by Burman in 1931 2 , arthroscopy of the hip has more recently become an established procedure 3-7 . Arthroscopic surgery of the hip may offer potential advantages over traditional open arthrotomy and surgical dislocation in terms of limited invasiveness and diminished morbidity. The most recognized indications for hip arthroscopy are for the management of labral tears 8-13 and loose bodies 9,14 however, hip arthroscopy has been described for a variety of other hip...

Labral Tears

The etiology for labral tears can be from traumatic and degenerative causes, structural abnormalities from femoroacetabular impingement (cam and pincer Fig. 2. Limited blood supply to the labrum at the labrocapsular junction. Arthroscopic view of a hyperemic labrum. Fig. 2. Limited blood supply to the labrum at the labrocapsular junction. Arthroscopic view of a hyperemic labrum. Fig. 3. Arthroscopic view showing degenerative changes within the labrum. Fig. 3. Arthroscopic view showing...

Marc J Philippon MDab Mara L Schenker BSa

ASteadman-Hawhins Research Foundation, 181 W. Meadow Drive, Suite 1000, Vail, CO 81657, USA Steadman-Hawhins Clinic, 181 W. Meadow Drive, Suite 1000, Vail, CO 81657, USA Our previously reported technique of labral repair has shown promising clinical outcomes 1,2 . However, the surgical technique is technically demanding and provides less than optimal visualization for anchor placement. As a result, the senior author (MJ.P.) has developed a new technique using the lateral portal. This technique...

Neuromuscular Hip Biomechanics and Pathology in the Athlete

Schenker, BSa, Hal D. Martin, DOb, Doug Hogoboom, BSa, Marc J. Philippon, MDa aBiomechanics Research Laboratory, Steadman-Hawkins Research Foundation, 181 West Meadow Drive, Suite 1000, Vail, CO 81657, USA hOklahoma Sports Science and Orthopedics, 6205 N. Santa Fe, Suite 200, Oklahoma City, OK 73118, USA Dynamic movement occurs at the hip joint and is characterized and constrained by the anatomy of the region, including osseous, ligamen-tous, and...

Atraumatic Instability

Due to a lack of a discrete acute event, the etiology of hip pain in the absence of trauma may be more difficult to determine. Furthermore, the differential diagnosis of hip pain is quite broad (Table 1). Based on the history and physical examination, various categories can be eliminated and the differential diagnosis further narrowed. The history should assess the timing of the onset of symptoms, the qualitative nature of the discomfort (pain, clicking catching, instability, stiffness,...

Traumatic Hip Instability

The diagnosis of a traumatic hip injury is obvious in severe cases of dislocation. However, more subtle traumatic subluxation of the hip can occur with seemingly minimal trauma. The clinician should have a high index of suspicion for intraarticular injury even after minor trauma. A careful physical examination should be performed to differentiate intraarticular versus extraarticular pathology. Patients may also have concommitent soft tissue injuries such as chondral injuries, labral tears, and...

Radiographic and MR Imaging of the Athletic

Synovial Herniation Pit Femoral Head

Armfield, MDa'b'*, Jeffrey D. Towers, MDab, Douglas D. Robertson, MD, PhDa'b'c Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA b'Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA cDepartment of Bioengineering, School of Engineering, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA Magnetic resonance imaging (MRI) and radiography...