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Radiographic Hip Anatomy Correlates With Range of Motion and Symptoms in National Hockey League Players.
Am J Sports Med 2017; 45(7):1633-1639AJ

Abstract

BACKGROUND

Hip disorders in athletes have been increasingly recognized.

PURPOSE

To characterize radiographic hip anatomy for National Hockey League (NHL) players and correlate it with hip range of motion and hip symptoms and/or surgery.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

Fifty-nine professional hockey players (118 hips) with 1 NHL organization (mean age, 24.2 years; range, 18-36) prospectively underwent history and physician examination by 2 independent orthopaedic surgeons. Current or previous groin and/or hip pain or surgery was noted. Anteroposterior (AP) pelvis and bilateral Dunn lateral radiographs were obtained for all players with assessment of hip morphology by 2 blinded independent orthopaedic surgeons.

RESULTS

Good to very good reliability of radiographic assessments was noted (intraclass correlation coefficients = 0.749-0.958). Sixty-four percent of athletes had a positive crossover sign, while 86% and 60% had a positive posterior wall sign and a prominent ischial spine sign, respectively. Twenty-one percent of hips demonstrated dysplastic acetabular features (lateral center edge angle <25°). Eighty-five percent and 89% of hips demonstrated cam-type morphology based on alpha angle (>50° Dunn lateral) and head-neck offset, respectively. Good to very good reliability was noted for ROM assessments (intraclass correlation coefficient >0.69). Mean hip flexion was 107.4º ± 6.7º, and mean hip internal rotation was 26.1º ± 6.6º. Thirty-one percent of hips had a history of hip-related pain and/or surgery. Higher AP, Dunn lateral, and maximal alpha angles correlated with decreased hip internal rotation (P = .004). Greater AP alpha angle correlated with decreased hip extension/abduction (P = .025), and greater Dunn lateral and maximal alpha angle correlated with decreased hip flexion/abduction (P = .001). A positive posterior wall sign correlated with increased straight hip abduction, while other radiographic acetabular parameters were not predictive of range of motion. Only decreased hip external rotation and total arc of motion correlated with an increased risk for current or prior hip symptoms or surgery (P < .001).

CONCLUSION

Hip anatomy in NHL players is characterized by highly prevalent cam-type morphology (>85%) and acetabular retroversion (>60%). In addition, acetabular dysplasia (21%) was relatively common. Greater cam-type morphology correlated with decreased hip range of motion, and a positive crossover sign correlated with increased hip abduction. Decreased hip external rotation and total arc of motion were predictive of hip-related pain and/or surgery.

Authors+Show Affiliations

Minnesota Orthopedic Sports Medicine Institute, Twin Cities Orthopedics, Edina, Minnesota, USA.Boca Care Orthopedics, Boca Raton Regional Hospital, Boca Raton, Florida, USA. College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA.Department of Orthopaedic Surgery-MedSport, University of Michigan Medical School, Ann Arbor, Michigan, USA.Minnesota Wild Hockey Club, National Hockey League, St Paul, Minnesota, USA.Fairview/MOSMI Orthopedic Fellowship Program, Minneapolis, Minnesota, USA.Minnesota Orthopedic Sports Medicine Institute, Twin Cities Orthopedics, Edina, Minnesota, USA.Minnesota Orthopedic Sports Medicine Institute, Twin Cities Orthopedics, Edina, Minnesota, USA.Department of Orthopaedic Surgery-MedSport, University of Michigan Medical School, Ann Arbor, Michigan, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28298064

Citation

Larson, Christopher M., et al. "Radiographic Hip Anatomy Correlates With Range of Motion and Symptoms in National Hockey League Players." The American Journal of Sports Medicine, vol. 45, no. 7, 2017, pp. 1633-1639.
Larson CM, Ross JR, Kuhn AW, et al. Radiographic Hip Anatomy Correlates With Range of Motion and Symptoms in National Hockey League Players. Am J Sports Med. 2017;45(7):1633-1639.
Larson, C. M., Ross, J. R., Kuhn, A. W., Fuller, D., Rowley, D. M., Giveans, M. R., ... Bedi, A. (2017). Radiographic Hip Anatomy Correlates With Range of Motion and Symptoms in National Hockey League Players. The American Journal of Sports Medicine, 45(7), pp. 1633-1639. doi:10.1177/0363546517692542.
Larson CM, et al. Radiographic Hip Anatomy Correlates With Range of Motion and Symptoms in National Hockey League Players. Am J Sports Med. 2017;45(7):1633-1639. PubMed PMID: 28298064.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Radiographic Hip Anatomy Correlates With Range of Motion and Symptoms in National Hockey League Players. AU - Larson,Christopher M, AU - Ross,James R, AU - Kuhn,Andrew W, AU - Fuller,Donnie, AU - Rowley,David M, AU - Giveans,M Russell, AU - Stone,Rebecca M, AU - Bedi,Asheesh, Y1 - 2017/02/01/ PY - 2017/3/17/pubmed PY - 2017/10/11/medline PY - 2017/3/17/entrez KW - adductor KW - anatomy KW - femoroacetabular impingement KW - groin KW - hip KW - ice hockey KW - radiographs KW - range of motion KW - symptoms SP - 1633 EP - 1639 JF - The American journal of sports medicine JO - Am J Sports Med VL - 45 IS - 7 N2 - BACKGROUND: Hip disorders in athletes have been increasingly recognized. PURPOSE: To characterize radiographic hip anatomy for National Hockey League (NHL) players and correlate it with hip range of motion and hip symptoms and/or surgery. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Fifty-nine professional hockey players (118 hips) with 1 NHL organization (mean age, 24.2 years; range, 18-36) prospectively underwent history and physician examination by 2 independent orthopaedic surgeons. Current or previous groin and/or hip pain or surgery was noted. Anteroposterior (AP) pelvis and bilateral Dunn lateral radiographs were obtained for all players with assessment of hip morphology by 2 blinded independent orthopaedic surgeons. RESULTS: Good to very good reliability of radiographic assessments was noted (intraclass correlation coefficients = 0.749-0.958). Sixty-four percent of athletes had a positive crossover sign, while 86% and 60% had a positive posterior wall sign and a prominent ischial spine sign, respectively. Twenty-one percent of hips demonstrated dysplastic acetabular features (lateral center edge angle <25°). Eighty-five percent and 89% of hips demonstrated cam-type morphology based on alpha angle (>50° Dunn lateral) and head-neck offset, respectively. Good to very good reliability was noted for ROM assessments (intraclass correlation coefficient >0.69). Mean hip flexion was 107.4º ± 6.7º, and mean hip internal rotation was 26.1º ± 6.6º. Thirty-one percent of hips had a history of hip-related pain and/or surgery. Higher AP, Dunn lateral, and maximal alpha angles correlated with decreased hip internal rotation (P = .004). Greater AP alpha angle correlated with decreased hip extension/abduction (P = .025), and greater Dunn lateral and maximal alpha angle correlated with decreased hip flexion/abduction (P = .001). A positive posterior wall sign correlated with increased straight hip abduction, while other radiographic acetabular parameters were not predictive of range of motion. Only decreased hip external rotation and total arc of motion correlated with an increased risk for current or prior hip symptoms or surgery (P < .001). CONCLUSION: Hip anatomy in NHL players is characterized by highly prevalent cam-type morphology (>85%) and acetabular retroversion (>60%). In addition, acetabular dysplasia (21%) was relatively common. Greater cam-type morphology correlated with decreased hip range of motion, and a positive crossover sign correlated with increased hip abduction. Decreased hip external rotation and total arc of motion were predictive of hip-related pain and/or surgery. SN - 1552-3365 UR - https://www.unboundmedicine.com/medline/citation/28298064/Radiographic_Hip_Anatomy_Correlates_With_Range_of_Motion_and_Symptoms_in_National_Hockey_League_Players_ L2 - http://journals.sagepub.com/doi/full/10.1177/0363546517692542?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -