Athletic Hip Injuries and Capsular Laxity

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Intra-articular hip injuries are becoming increasingly recognized as a significant cause of pain and decreased performance in the athlete. The introduction of arthroscopic techniques for the treatment of athletic hip injuries, including capsular laxity, has allowed many athletes to return to their high levels of performance. The mechanisms of intra-articular athletic hip injuries, however, have not been well defined. As a result, the establishment of optimal post-arthroscopic rehabilitation protocols and return-to-play guidelines has been difficult. However, based on extensive clinical observation, certain hip injury patterns have been documented for sports in which intra-articular hip pathology are common findings.

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Clinical Diagnosis

Hip injuries in the athlete often are diagnosed as extra-articular muscle strains or soft tissue contusions. However, within the past decade, various intra-articular pathologies have been identified and treated arthroscopically in the athlete (Table 1).3 To appropriately direct treatment, a full history and clinical and radiological workup is required in all athletes to differentiate the site of pathology.

Pain is the most commonly reported symptom in athletes with hip injuries.3 It is a

Anatomy

The joint capsule and the ligaments provide a thick sleeve surrounding the hip. The iliofemoral ligament dominates the anterior capsule. It is approximately 12- to 14-mm thick and is shaped like an inverted “Y.” This ligament provides resistance to hip extension beyond neutral and resists external rotation. The pubofemoral ligament reinforces the inferior and anterior capsule. It resists extension and abduction. The posterior surface of the capsule is reinforced by the ischiofemoral ligament in

Capsular Laxity

Instability in the hip joint is rarely an issue. Because of the deep recess of the acetabular socket and the strong ligamentous support, the hip joint is inherently stable. However, any deviation from “normal” osseous anatomy places excessive force on the adjacent soft tissues during movement.

Hip instability can be of traumatic or atraumatic origin and often is difficult to diagnose. Traumatic instability is the result of dislocation or subluxation of the femoral head.6 Most athletic hip

Hip Arthroscopy in Athletes

Injuries requiring hip arthroscopy cover a wide range of sports and hip pathologies (Table 2).3 Athletes subject their hip joints to extraphysiological forces that can approach 5 times their body weight. Athletic activities, such as running and jumping, twisting, and quickly cutting across the field, can lead to a variety of acute and chronic hip pathologies.

Discussion

Elite athletes are subjected to extreme forces and ranges of motion in their everyday sport activity. The hip joint is highly affected by the additional stresses, and the athlete is prone to developing hip injuries. Injury mechanisms may be acute and traumatic, or repetitive from overuse. Hip injuries in athletes that do not resolve over the course of a 4-6 week time period should prompt further investigation into possible intra-articular damage.

In the relatively short time period that hip

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