ePoster #700 - ISHA Annual Scientific Meeting 2016

Hip Morphology And Outcomes Of Hip Arthroscopy In Soccer Athletes – A Comparison To A Cohort Of Non-Kicking Athletes

Danyal H. Nawabi, MD, FRCS(Orth), New York, NY UNITED STATES
Ryan M. Degen, MD, FRCSC, New York, NY UNITED STATES
Kara Fields, MS, New York, NY UNITED STATES
Catherine Wentzel, BS, New York, NY UNITED STATES
Olusanjo Adeoye, MD, New York, NY UNITED STATES
Bryan Talmadge Kelly, MD, New York, NY UNITED STATES

Hospital for Special Surgery, New York, New York, UNITED STATES

FDA Status Not Applicable

Summary: This study reviews the impingement patterns and clinical outcomes of a cohort of soccer athletes following arthroscopic treatment of FAI, compared with a non-kicking cohort of high-level athletes.

Background: Soccer requires repetitive forceful kicking and hip rotation and has been associated with avulsion injuries of the anterior inferior iliac spine (AIIS). While acute injuries are effectively treated nonoperatively, a subset of patients develops symptomatic subspine impingement secondary to malunion or traction apophysitis of the AIIS with caudal extension to, or beyond, the anterior acetabular margin.
Purpose: To describe the AIIS morphology and report the clinical outcomes after hip arthroscopy in high-level soccer athletes compared with a cohort of non-kicking athletes.
Study Design: Case series, level of evidence 4
Methods: Between January 2009 and June 2012, we retrospectively identified 26 soccer athletes (34 hips) and a control group of 87 non-kicking athletes (115 hips) from our prospective hip registry. All patients had minimum 2 years follow-up. Demographic information was collected and radiographic studies reviewed for several parameters, including AIIS morphology. Patient-reported outcome scores, including modified Harris Hip Score (mHHS), Hip Outcome Score-Activity of Daily Living (HOS-ADL) and Sport-specific Subscale (HOS-SSS), and International Hip Outcome Tool (iHOT-33), were administered preoperatively, at 6 months, 1, 2, and 3 years postoperatively.
Results: Demographics, including age (19.2±4.1 vs. 20.1±3.8 years) and gender distribution (53.8% vs. 51.7% male), were similar between the soccer and non-kicking athletes respectively (p>0.288). Eighty-four percent of soccer players demonstrated some abnormality of the AIIS extending to (Type II, 52%) or below the anterior acetabular rim (Type III, 32%), compared to 52% non-kicking athletes (p<0.001). At a mean follow-up of 35 months (range, 24-57 months) there was significant improvement in all outcome scores in both groups from pre- to post-op (p<0.001). After adjustment for age, sex, alpha angle, and pre-operative scores via multiple regression analyses, there were no statistically significant differences in outcome scores between groups (mHSS: 89±14.6 vs. 88.2±14.4, p=0.804 HOS-ADL: 94.1±9.1 vs. 92.2±11.1, p=0.431; HOS-SSS: 86±17.1 vs. 81.3±24.3, p=0.362) with the exception of iHOT-33 (81.7±19 vs. 70.3±23.6, p=0.027).
Conclusions: High-level soccer players have a significantly higher prevalence of subspine impingement compared to non-kicking athletes; however, post-operative clinical outcome scores between these groups are similar, with significant improvements at a mean of 35 months follow-up. Based on these findings, there should be a high index of suspicion for subspine impingement in soccer players with symptomatic FAI, with an expectation of excellent clinical outcomes, comparable to those of non-kicking athletes, if recognized and treated appropriately.