Results published in The American Journal of Sports Medicine showed increased progressive degenerative changes on MRI and radiographs at 5 years among young athletes with limited range of motion of the hip.
Rafael J. Sierra
Of 226 male and female athletes aged 12 to 18 years who presented for preparticipation sports physical examinations, Rafael J. Sierra, MD, and colleagues identified 13 participants with at least one hip having internal rotation of less than 10° with the hip flexed at 90° and compared these participants with 13 age- and sex-matched participants with internal rotation of greater than 10°. All were asymptomatic. All participants underwent hip examination, radiographic imaging with radiographs and non-arthrogram MRI, and hip function questionnaires at time of enrollment and at 5-year follow-up.
Increased degeneration at 5 years
Results showed 62% of patients in the limited range of motion group had abnormal MRI findings within the acetabular labrum or cartilage vs. 31% of patients in the control group at the time of study enrollment. Radial MRI sequences showed a mean alpha angle of 58° and 44° in the limited range of motion and control groups, respectively. Researchers noted a positive anterior impingement sign among 50% of participants in the limited range of motion group vs. 0% of participants in the control group.
According to results, 95% of participants in the limited range of motion group and 54% of participants in the control group had abnormal MRI findings at 5-year follow-up. New or progressive findings were documented in 15 hips of 20 hips in the limited range of motion group and in eight hips of 26 hips in the control group. Researchers noted a progression from Tönnis grade 0 to Tönnis grade 1 in 27% vs. 0% of participants in the limited range of motion and control groups, respectively. A positive anterior impingement sign was noted in 50% of the limited range of motion group vs. 4% of the control group, and 91% vs. 46% of participants in the limited range of motion group and control group, respectively, presented with a cam deformity. Researchers found decreased hip internal rotation, positive anterior impingement sign, decreased hip flexion, increased alpha angle and presence of a cam lesion at baseline were associated with an increased risk of degenerative changes at 5-year follow-up.
Implementation of a
hip screening protocol
Sierra noted young athletes should undergo a hip screening protocol prior to participating in sports to identify those with a decreased range of motion. Orthopedists should also have a thorough discussion with patients who present with decreased range of motion, pain or stiffness.
“Those patients with marked limitations in range of motion or pain with provocation maneuvers should undergo radiographic evaluation for impingement-type morphology,” Sierra told Healio.com/Orthopedics. “Patients should be counseled about participating in sports and early clinical signs associated with femoroacetabular impingement. We do not recommend prophylactic surgery.” – by Casey Tingle
Disclosures: Sierra reports he is a paid consultant for Zimmer Biomet and has received research support as a principal investigator from DePuy, Zimmer and Stryker. Please see the full study for a list of all other authors’ relevant financial disclosures.