The Outcome of Hip Arthroscopy in Australian Football League Players: A Review of 27 Hips

doi:10.1016/j.arthro.2009.10.010

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 26, Issue 6, June 2010, Pages 743-749

https://doi.org/10.1016/j.arthro.2009.10.010 Get rights and content

Purpose

The purpose of this study was to investigate on hip pathology found at hip arthroscopy in Australian Football League (AFL) players and describe our current treatments and outcomes.

Methods

From 2003 to 2008, 24 consecutive AFL players (27 hips) had arthroscopic hip surgery by use of the lateral position. Patients were assessed preoperatively and postoperatively with the modified Harris Hip Score (MHHS) and Nonarthritic Hip Score (NAHS) and postoperatively with a satisfaction survey.

Results

All hips were available for review. The mean duration of follow up was 22 months (range, 6 to 60 months). The mean age was 22 years (range, 16 to 29 years). The mean body mass index was 24 points (range, 21 to 26 points). The mean traction time was 21 minutes (range, 11 to 60 minutes). The most common pathology was a rim lesion, affecting 93% of cases. Microfracture was performed in 22%. Synovitis was found in 70%, and this was most commonly associated with a rim lesion. Labral pathology was present in 33%, the most common of which was labral separation. On the femoral side, 81% had cam impingement and underwent a femoral neck ostectomy. Rim lesions and labral pathology were the most commonly associated lesions. Also seen were loose os acetabuli in 7% and loose bodies in 7%. The former were associated with labral tears and required repair. The MHHS and NAHS improved in all patients postoperatively, and they maintained their improvement from 1 year up to 4 years. In all but 1 case, the players returned to playing at the AFL level and were satisfied with their outcome.

Conclusions

Using hip arthroscopy, we have observed high satisfaction levels and return to preinjury levels of play in all but 1 case. Postoperative hip scores (MHHS and NAHS) have improved significantly, and this improvement has been maintained for up to 4 years.

Level of Evidence

Level IV, therapeutic case series.

Section snippets

Methods

From 2003 to 2008, 24 consecutive AFL players (27 hips) were identified from our database who had arthroscopic hip surgery. The patients were referred for an opinion and management by their club medical officers and physiotherapists. All referred AFL players were included. All had been identified as having probable intra-articular hip pathology as the underlying cause of their groin pain before referral. In this series there were no more serious injuries, such as hip dislocation, and no players

Results

All hips were available for review. The mean duration of follow up was 22 months (range, 6 to 60 months). Of the hips, 5 reached a minimum follow-up of 6 to 12 months, whereas 9 hips had more than 1 year, 4 hips had more than 2 years, 5 hips had more than 3 years, 3 hips had more than 4 years, and 1 hip had more than 5 years. There were 17 left hips and 10 right hips affected. The mean body mass index was 24 points (range, 21 to 26 points). Radiology showed 22 cam lesions, 3 pincer lesions, and

Discussion

In our study we have observed a spectrum of intra-articular hip pathology affecting the AFL players. Intra-articular disorders in the elite athlete can be disabling and potentially career threatening. We found that the most common lesion present was a rim lesion, affecting 93% of cases. The majority had the presence of cartilage loss particularly in the anterosuperior aspect of the acetabulum. Cartilage loss was defined as the presence of full-thickness cartilage loss typically at the

Conclusions

In our study all AFL players were significantly limited or unable to play elite-level AFL football before surgery. However, after hip arthroscopy to treat FAI in professional AFL players, we have observed high satisfaction levels. Of 24 AFL players treated for FAI, 23 were able to return to AFL-level play. None has required revision surgery at a mean follow up of 22 months.

Acknowledgment

The authors thank Gail Goodwin, Helen O'Brien, Tom Goodwin, Denise Chapman, Jess O'Donnell, and Cara O'Donnell for their help with the preparation of the manuscript.

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Cited by (104)

Acetabular Rim Ossification Variants Are Found in Almost 20% of Patients Presenting With Hip Pain
2023, Arthroscopy, Sports Medicine, and Rehabilitation
To determine the prevalence of 4 different types of acetabular rim ossifications, including partial labral ossification or punctate calcification, true os acetabuli, acetabular rim stress fracture, and complete labral ossification, and to determine whether different types of periacetabular ossifications are linked to demographic or radiological factors.
We retrospectively reviewed the medial records of patients presenting for hip-related complaints at 2 sports medicine practices from September 2007 to December 2009. An anteroposterior radiograph of both hips and a lateral radiograph of each hip was obtained for all patients and reviewed for findings of cam and pincer femoroacetabular impingement, degenerative changes (Tönnis grade), and periacetabular calcifications for both hips. These parameters were also evaluated with respect to symptoms, sex, and age.
Four hundred ninety-one consecutive patients (982 hips) presented to 2 orthopaedic surgeons at 2 centers for “hip”-related complaints. There were 223 males and 268 females (age 39 ± 14 years). The overall prevalence of periacetabular calcifications in hips was 17.6%, with 56.6% of calcifications in the symptomatic hip and 43.4% in the contralateral hip. Four basic patterns of calcification were identified: punctuate calcifications within the labrum (8.0% hips), large rounded calcifications (os acetabuli) (4.2% hip), large fragments with a vertical line of the superior-lateral acetabular rim, consistent with healed or non-healed stress fracture (2.0% hips), and complete ossification of the labrum (3.4% hips). Overall, male sex (P = .002), increased lateral center-edge angle (P = .046), and higher Tönnis grade (P < .001) statistically predicted the presence of periacetabular ossification. Punctate calcifications were more prevalent in males (P = .002). Higher Tönnis grade (P = .029) and increased alpha angle (P = .046) were more prevalent with os acetabuli. Younger age (P = .001), male sex (P = .048), increased alpha angle (P = .012), and increased lateral center-edge angle (P < .001) were more prevalent in acetabular rim fractures. No factors were statistically significant at predicting the presence of an ossified labrum.
Periacetabular calcifications are not uncommon. Four particular patterns of calcification are identified: punctate labral calcifications (8%), larger rounded calcifications (i.e., os acetabuli) (4.2%), acetabular rim stress fractures (2%), and complete ossification of the labrum (3.4%) for a combined prevalence of 17.6% in patients presenting to an orthopaedic surgeon with “hip”-related complaints. Nearly half were in the asymptomatic hip. Male sex had a higher prevalence of periacetabular calcifications. An increased lateral center edge angle and higher Tönnis grade also had a higher prevalence of periacetabular calcifications. Younger male patients are more likely to have acetabular rim stress fractures. Patients with an increased alpha angle have a higher prevalence of os acetabuli and rim stress fractures.
This study aims to identify, quantify, and categorize periacetabular calcifications about the hip. Their clinical relationships and relevance have been discussed, but no study has distinctly categorized the various types and their prevalence. This study provides a framework for identification and categorization.
Return to sport after arthroscopic surgery for femoroacetabular impingement
2023, Surgeon
Femoroacetabular impingement (FAI) is common among the active and young population. The present study analysed the rate of return to sport, related influencing factors, and the sport activity level according to the Hip Outcome Score - Sport-Specific Subscale (HOS-SSS).
The literature search was performed in December 2020. All clinical trials investigating HOS-SSS and/or return to sport after arthroscopic treatment for FAI were considered for inclusion. The outcomes of interest were to analyse the rate of return to sport and the sport activity level according to the HOS-SSS in patients who underwent arthroscopic osteoplasty for FAI.
Data from 41 studies (4063 procedures) were retrieved. A total of 88.75% (581 of 655) of patients returned to sports within a mean of 37.4 ± 16.5 months. The HOS-SSS score improved from 45.0 ± 10.6 to 73.1 ± 9.5 (P < 0.0001) at last follow-up. The following baseline characteristics evidenced positive association with post-operative activity level: lighter weight (P = 0.01), younger age (P = 0.001), Tönnis angle grade I (P = 0.009), greater HHS (P = 0.01), NAHS (P < 0.0001) and HOS-ADL (P = 0.01).
Arthroscopic treatment for FAI resulted in excellent results in terms of return to sport. Moreover, lighter weight and younger age, greater HHS, NAHS, HOS-ADL at baseline were positively associated with post-operative sport activity level.
IV, systematic review.
Arthroscopic Suture Fixation of Os Acetabuli With Absorbable Suture Anchors—A Double-Pulley Technique
2022, Arthroscopy Techniques
Os acetabuli is a bone fragment with unknown origin and isolated at the acetabular rim that may be associated with cam-type femoroacetabular impingement. If this bone fragment is too large and threatens the stability of the hip joint after resection, fixation would be recommended. However, conventional rigid fixation with metal screws has some disadvantages. We describe an arthroscopic suture fixation of the Os acetabulum with absorbable anchors penetrating the bone fragment and secured by tying knots in a double-pulley fashion simultaneously. This technique provides a new feasible solution for the fixation of Os acetabuli, avoiding any metal implants and potential damage to the joint.
Increased range of motion but otherwise similar clinical outcome of arthroscopy over open osteoplasty for femoroacetabular impingement at midterm follow-up: A systematic review
2022, Surgeon
A systematic review was conducted comparing patient reported outcomes measures (PROMs), functional scores, and the rate of complications between arthroscopic and open treatment for femoroacetabular impingement (FAI) at mid-term follow-up.
This systematic review was performed according to the PRISMA guidelines. The literature search was performed in October 2020. All clinical trials treating FAI using open osteoplasty or arthroscopic surgery were considered for inclusion. Only articles reporting >12 months follow-up were included.
Data from 97 articles (9981 procedures) were collected. At a mean 19.2 months follow-up there was no difference between the two cohorts. At a mean follow-up of 38 months, the external rotation was increased in the arthroscopic group (P < 0.0001). The modified Harris Hip Score scored greater in favour of the open osteoplasty group (P = 0.04), as did the Hip Outcome Score - Activities of Daily Living subscale (P = 0.01). At a mean 45.1 months the arthroscopic group presented greater external rotation (P < 0.0001) and SF-12 Mental (P = 0.04). The modified Harris Hip Score was greater in favour of the open osteoplasty group (P = 0.03), as was the HOS-ADL (P = 0.01). Regarding complications, the arthroscopic group experienced lower rates of subsequent revisions (P < 0.0001).
Based on the significant reduction of revisions-rate and significant increase in range of motion, arthroscopy treatment for the management of FAI may be recommended.
Return to Play in Amateur Soccer Players Undergoing Hip Arthroscopy: Short- to Mid-Term Follow-Up
2020, Arthroscopy - Journal of Arthroscopic and Related Surgery
To describe patient-reported outcomes (PROs) and return to play at any level in amateur soccer players undergoing hip arthroscopy for femoroacetabular impingement syndrome at short- to mid-term follow-up.
Data were prospectively collected and retrospectively reviewed for patients who underwent hip arthroscopy between March 2009 and June 2014. Patients who participated in amateur soccer within 1 year prior to surgery and intended to return to their sport after hip arthroscopy for femoroacetabular impingement syndrome were considered for inclusion in our study. Patients were excluded if they had a preoperative Tönnis osteoarthritis grade of 2 or greater, previous ipsilateral hip conditions or hip surgical procedures, or Workers’ Compensation status. The patients from the initial group who had preoperative and minimum 2-year postoperative measures for the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score–Sports Specific Subscale, and visual analog scale for pain were included in our final group. In addition to PROs, data regarding the patients’ return to soccer, surgical complications, and secondary surgical procedures were collected.
A total of 41 patients were eligible for inclusion in our study, of whom 34 (82.9%) had a mean follow-up period of 47.4 months. Five patients were not eligible because they did not intend to return to soccer. There were 15 male hips (44.1%) and 19 female hips (55.9%). The mean age at surgery was 20.8 ± 7.4 years. All PROs and the visual analog scale score improved significantly from preoperatively to latest follow-up. Of the 34 patients, 27 (79.4%) returned to soccer. Of the patients who returned to soccer, 19 (70.4%) were competing at the same level or a higher level compared with their highest level within 1 year of surgery. Regardless of competitive level, 21 patients (77.8%) reported that their athletic ability was the same as or higher than it was within 1 year of surgery.
Hip arthroscopy was associated with significant improvements in PROs for amateur soccer players. There was a high level of return to soccer and a high proportion of patients whose competitive level was similar or improved. As such, hip arthroscopy is a good option for soccer players, in the absence of underlying osteoarthritis, presenting with hip pathology.
Level IV, case series.
Hip Injuries in the Contact Athlete
2019, Operative Techniques in Sports Medicine
Citation Excerpt :
The traditional treatment of intra-articular hip injuries using an open approach has been largely replaced with arthroscopic management, a minimally invasive approach allowing full visualization and treatment of multiple intra-articular injuries.51 When compared to open management, hip arthroscopy has been shown to result in decreased recovery times with quicker return to sport9,51-54 and high rates of patient satisfaction.4,45 In the setting of isolated, traumatic labral tears without concurrent chondral injury or impingement, athletes may be successfully treated with arthroscopic debridement alone vs repair or reconstruction in the setting of large irreparable tears.55,56
Despite being relatively uncommon when compared to injuries to the ankle and knee, hip injuries in the contact athlete account for 5%-6% of all athletic-related injuries with increasing prevalence over the last decade. Athletic hip injuries represent a spectrum of often overlapping intra- and extra-articular disorders with the potential to cause significant disability and time lost from sport. Advancements in imaging modalities, arthroscopic instrumentation, and surgical techniques have improved diagnostic capabilities and treatment outcomes of athletic hip injuries. Furthermore, increased screening and better recognition of the role of femoroacetabular impingement on the development of intra-articular hip pathology and instability has provided physicians with a treatable risk factor deterring further hip disorders. This chapter provides physicians with a brief overview of commonly encounter hip injuries in the contact athlete, namely: muscle strains, contusion, labral injuries, and hip instability secondary to dislocation or subluxation in the setting of femoroacetabular impingement, as well as the previously described “sports hip triad.”

View all citing articles on Scopus

: The authors report no conflict of interest.

Note: To access the video accompanying this report, visit the June issue of Arthroscopy at www.arthroscopyjournal.org.

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Original Article With Video IllustrationThe Outcome of Hip Arthroscopy in Australian Football League Players: A Review of 27 Hips

Purpose

Methods

Results

Conclusions

Level of Evidence

Section snippets

Methods

Results

Discussion

Conclusions

Acknowledgment

Clin Sports Med

J Arthroplasty

Arthroscopy

Arthroscopy

Australian Football League Injury Report 2008

UEFA Champions League study: A prospective study of injuries in professional football during the 2001-2002 season

Br J Sports Med

Groin injuries in athletes

Br J Sports Med

Epidemiology of injuries in English professional rugby union: Part 1 match injuries

Br J Sports Med

Hip arthroscopy in athletes

Instr Course Lect

Hip arthroscopy in athletes

Clin Sports Med

The diagnosis of longstanding groin pain: A prospective clinical cohort study

Br J Sports Med

Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up

J Bone Joint Surg Br

Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement

Clin Orthop Relat Res

Early outcome of hip arthroscopy for femoroacetabular impingementThe role of femoral osteoplasty in symptomatic improvement

J Bone Joint Surg Br

The role of hip arthroscopy: Useful adjunct or devil's tool?

Orthopedics

The role of hip arthroscopy in the elite athlete

Clin Orthop Relat Res

Original Article With Video Illustration
The Outcome of Hip Arthroscopy in Australian Football League Players: A Review of 27 Hips