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Characterization of symptomatic hip impingement in butterfly ice hockey goalies.
Arthroscopy 2015; 31(4):635-42A

Abstract

PURPOSE

This study aimed to characterize the radiographic deformity observed in a consecutive series of butterfly goalies with symptomatic mechanical hip pain and to use computer-based software analysis to identify the location of impingement and terminal range of motion. We also compared these analyses to a matched group of positional hockey players with symptomatic femoroacetabular impingement (FAI).

METHODS

A consecutive series of 68 hips in 44 butterfly-style hockey goalies and a matched group of 34 hips in 26 positional hockey players who underwent arthroscopic correction for symptomatic FAI were retrospectively analyzed. Each patient underwent preoperative anteroposterior (AP) and modified Dunn lateral radiographs and computed tomography (CT) of the affected hips. Common FAI measurements were assessed on plain radiographs. Patient-specific, CT-based 3-dimensional (3D) models of the hip joint were developed, and the femoral version, alpha angles at each radial clock face position, and femoral head coverage were calculated. Maximum hip flexion, abduction, internal rotation in 90° flexion (IRF), flexion/adduction/internal rotation (FADIR), and butterfly position were determined, and the areas of bony collision were defined.

RESULTS

Butterfly goalies had an elevated mean alpha angle on both AP (61.3°) and lateral radiographs (63.4°) and a diminished beta angle (26.0°). The mean lateral center-edge angle (LCEA) measured 27.3° and acetabular inclination was 6.1°. A crossover sign was present in 59% of the hips. The maximum alpha angle on the radial reformatted computed tomographic scan was significantly higher among the butterfly goalies (80.9° v 68.6°; P < .0001) and was located in a more lateral position (1:00 o'clock v. 1:45 o'clock; P < .0001) compared with positional players.

CONCLUSIONS

Symptomatic butterfly hockey goalies have a high prevalence of FAI, characterized by a unique femoral cam-type deformity and noted by an elevated alpha angle and loss of offset, which is greater in magnitude and more lateral when compared with that in positional hockey players. Associated acetabular dysplasia is also common among hockey goalies.

LEVEL OF EVIDENCE

Level IV, prognostic case series.

Authors+Show Affiliations

Sports Medicine and Shoulder Service, University of Michigan, Ann Arbor, Michigan, U.S.A.Sports Medicine and Shoulder Service, University of Michigan, Ann Arbor, Michigan, U.S.A.. Electronic address: abedi@umich.edu.Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota, U.S.A.Sports Medicine and Shoulder Service, University of Michigan, Ann Arbor, Michigan, U.S.A.Hospital for Special Surgery, New York, New York, U.S.A.Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota, U.S.A.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25498869

Citation

Ross, James R., et al. "Characterization of Symptomatic Hip Impingement in Butterfly Ice Hockey Goalies." Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, vol. 31, no. 4, 2015, pp. 635-42.
Ross JR, Bedi A, Stone RM, et al. Characterization of symptomatic hip impingement in butterfly ice hockey goalies. Arthroscopy. 2015;31(4):635-42.
Ross, J. R., Bedi, A., Stone, R. M., Sibilsky Enselman, E., Kelly, B. T., & Larson, C. M. (2015). Characterization of symptomatic hip impingement in butterfly ice hockey goalies. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 31(4), pp. 635-42. doi:10.1016/j.arthro.2014.10.010.
Ross JR, et al. Characterization of Symptomatic Hip Impingement in Butterfly Ice Hockey Goalies. Arthroscopy. 2015;31(4):635-42. PubMed PMID: 25498869.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characterization of symptomatic hip impingement in butterfly ice hockey goalies. AU - Ross,James R, AU - Bedi,Asheesh, AU - Stone,Rebecca M, AU - Sibilsky Enselman,Elizabeth, AU - Kelly,Bryan T, AU - Larson,Christopher M, Y1 - 2014/12/10/ PY - 2014/03/07/received PY - 2014/10/06/revised PY - 2014/10/23/accepted PY - 2014/12/16/entrez PY - 2014/12/17/pubmed PY - 2015/11/18/medline SP - 635 EP - 42 JF - Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association JO - Arthroscopy VL - 31 IS - 4 N2 - PURPOSE: This study aimed to characterize the radiographic deformity observed in a consecutive series of butterfly goalies with symptomatic mechanical hip pain and to use computer-based software analysis to identify the location of impingement and terminal range of motion. We also compared these analyses to a matched group of positional hockey players with symptomatic femoroacetabular impingement (FAI). METHODS: A consecutive series of 68 hips in 44 butterfly-style hockey goalies and a matched group of 34 hips in 26 positional hockey players who underwent arthroscopic correction for symptomatic FAI were retrospectively analyzed. Each patient underwent preoperative anteroposterior (AP) and modified Dunn lateral radiographs and computed tomography (CT) of the affected hips. Common FAI measurements were assessed on plain radiographs. Patient-specific, CT-based 3-dimensional (3D) models of the hip joint were developed, and the femoral version, alpha angles at each radial clock face position, and femoral head coverage were calculated. Maximum hip flexion, abduction, internal rotation in 90° flexion (IRF), flexion/adduction/internal rotation (FADIR), and butterfly position were determined, and the areas of bony collision were defined. RESULTS: Butterfly goalies had an elevated mean alpha angle on both AP (61.3°) and lateral radiographs (63.4°) and a diminished beta angle (26.0°). The mean lateral center-edge angle (LCEA) measured 27.3° and acetabular inclination was 6.1°. A crossover sign was present in 59% of the hips. The maximum alpha angle on the radial reformatted computed tomographic scan was significantly higher among the butterfly goalies (80.9° v 68.6°; P < .0001) and was located in a more lateral position (1:00 o'clock v. 1:45 o'clock; P < .0001) compared with positional players. CONCLUSIONS: Symptomatic butterfly hockey goalies have a high prevalence of FAI, characterized by a unique femoral cam-type deformity and noted by an elevated alpha angle and loss of offset, which is greater in magnitude and more lateral when compared with that in positional hockey players. Associated acetabular dysplasia is also common among hockey goalies. LEVEL OF EVIDENCE: Level IV, prognostic case series. SN - 1526-3231 UR - https://www.unboundmedicine.com/medline/citation/25498869/Characterization_of_symptomatic_hip_impingement_in_butterfly_ice_hockey_goalies_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-8063(14)00859-7 DB - PRIME DP - Unbound Medicine ER -