ePoster #712 - ISHA Annual Scientific Meeting 2016

Gender Patterns in Sports Participation Among Athletes Undergoing Arthroscopic Hip Preserving Surgery: Does the ACL Teach Us Anything?

John Christoforetti, MD, Pittsburgh, PA UNITED STATES
Andrew B. Wolff, MD, Washington, DC UNITED STATES
Shane J. Nho, MD, MS, Chicago, IL UNITED STATES
John P. Salvo, MD, Marlton, NJ UNITED STATES
Dean K. Matsuda, MD, Los Angeles, CA UNITED STATES
Allston J. Stubbs, MD, MBA, Winston Salem, NC UNITED STATES
Ryan McGovern, ATC, Pittsburgh, PA UNITED STATES
Benjamin Kivlan, PhD, Pittsburgh, PA UNITED STATES
Dominic Carreira, MD, Fort Lauderdale, FL UNITED STATES

Allegheny Clinic, Pittsburgh, PA, UNITED STATES

FDA Status Not Applicable

Summary: A large multicenter cross sectional cohort study of athletes requiring hip arthroscopy shows gender based sports participation patterns divergent from that typical for ACL injury.

Injury prevention efforts for anterior cruciate ligament injury requiring surgical treatment establish risk stratification for injury based upon the amount of contact and lateral motion risk during particular sports activities. Sports with highest amounts of lateral cutting motions and contact risk (Level I) are highest risk while non-contact, linear motion sports are lowest risk (Level III). In addition, female athletes have been identified as suffering injury at higher rates than males during at-risk sports participation. No such information exists in the area of intraarticular athletic hip injuries that lead to surgical treatment. A multi-center registry database of prospectively collected hip arthroscopic surgery cases was used to perform a cross-sectional cohort study to determine the compatibility of stratification of injury prevalence by sport level. Our hypothesis is that athletic hip injury leading to arthroscopy for intraarticular pathology will demonstrate significant correlation with gender and sport type.

Methods: A multi-center hip arthroscopy study group comprised of Board Certified surgeon members in the United States with greater than 300 cases completed prior to enrollment and with annual case volumes greater than 100 cases per year was created (MASH StudyGroup). Institutional Review Board approval for pre-hoc collection and storage of agreed upon de-identified clinical data points was granted at each center. The de-identified data set was retrospectively reviewed and analyzed. All male and female athletes who elected to have hip preservation surgery due to hip pain that prevented participation in sports were identified and grouped based upon risk category for ACL injury (Level 1-3). A Chi Square Analysis with an a priori alpha set at p<0.05 was performed to determine the relationship of gender and classification of sport activity to hip arthroscopy.
Results: 830 subjects were available for analysis. Whole population distribution of sports: level 1 (25.5%), 2 (27.2%), 3 (47.2%). There were 467 female athletes (56.3%) and 362 male athletes (43.7%) that received hip preservation surgery. A chi-square test showed a significant effect of gender and sport classification for athletes electing hip preservation surgery, X2 (2, N = 829) = 23.37, p<0.001. There were more male athletes (32.6%) participating in Level 1 sports (jumping, cutting, pivoting) that underwent hip arthroscopy than female athletes (20.1%). Conversely, more female athletes (32.6%) than male athletes (20.4%) participated in Level 2 sports (lateral movements, less pivoting). Level 3 sports (straight ahead activities) were equally represented by male (47%) and female (47.3%) athletes.
This large, multi-center cohort of patients requiring arthroscopic hip preserving surgery supports that patients in level 1 sports requiring surgery were statistically significantly more likely to be male while those participating in level 2 sports were more likely to be female. Level three sports were equally represented by gender. This gender trend is opposite for that established in ACL injury (where level 1 sports injuries are predominately female) and can aid future investigations with pre-hoc planning for study of hip injury prevention.