Course

Hip

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12 Lessons

Hip and groin pain are relatively common complaints among football players of all levels. This chapter will focus on hip joint pathologies (the different entities of sports-related groin pain will be covered in their own module).

Femoroacetabular impingement (FAI) is now recognised as a disorder that can lead to progressive labral and chondral injury in the hip. It commonly occurs in athletes and is thought to contribute to CAM formation in football players. FAI can lead to groin and hip pain. Diagnosing this condition promptly may prevent early degeneration of the hip in kicking athletes.

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Learning outcomes

After completing this module you should be able to:

  • understand the different causes of hip joint pathology as well as the evidence regarding their aetiology;
  • take an appropriate clinical history from an athlete presenting with him and groin pain;
  • be able to identify a player with a hip joint problem by conducting a comprehensive clinical examination;
  • be able to order and interpret X-ray studies of the hip and understand the indications for other imaging modalities;
  • be able to initiate a non-surgical rehabilitation programme to treat hip pain;
  • understand the indications for an orthopaedic opinion and the different surgical procedures available to treat FAI and hip labral pathology;
  • have an awareness of how hip joint pathology may be prevented, including the possible importance of controlled loading during adolescence.

Tasks

  • Read the relevant section in the FIFA Medical Manual and other required reading.
  • Review the suggested reading
  • View, or listen to, any relevant multimedia content
  • Complete the course quiz

Required reading

FIFA Football Medicine Manual, 2nd Edition

Chapter 3.4 (pages 182-187)

Suggested reading

Brukner and Khan’s
Clinical Sports Medicine, 4th Edition
Chapter 28 (pages 510-544)

References

  1. Kemp JL, FAU CN, Makdissi M FAU – Schache, Anthony,G., FAU SA, Machotka ZF, Crossley K. Hip arthroscopy for intra-articular pathology: A systematic review of outcomes with and without femoral osteoplasty. British journal of sports medicine JID – 0432520. 0917.
  2. Ganz R, Parvizi JF, Beck MF, Leunig MF, Notzli H FAU – Siebenrock, Klaus,A., Siebenrock KA. Femoroacetabular impingement: A cause for osteoarthritis of the hip. Clinical orthopaedics and related research JID – 0075674. 0106(0009-921; 0009-921).
  3. Siebenrock KA, Ferner F FAU – Noble,,P.C., FAU NP, FAU SR, Werlen S FAU – Mamisch,,T.C., Mamisch TC. The cam-type deformity of the proximal femur arises in childhood in response to vigorous sporting activity. Clinical orthopaedics and related research JID – 0075674. 1130(0009-921).
  4. Allen D, FAU BP, Ramadan OF, Doucette S. Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement. The Journal of bone and joint surgery.British volume JID – 0375355. 0601(0301-620; 0301-620).
  5. Clohisy JC, FAU KE, FAU HD, FAU LJ, Harris-Hayes MF, Prather H. Clinical presentation of patients with symptomatic anterior hip impingement. Clinical orthopaedics and related research JID – 0075674. 0219(0009-921).
  6. Wall PD, Fernandez M FAU – Griffin, Damian,R., FAU GD, Foster NE. Nonoperative treatment for femoroacetabular impingement: A systematic review of the literature. PM & R : the journal of injury, function, and rehabilitation JID – 101491319. 0220.
  7. Kienle KP, Keck J, Werlen S, Kim YJ, Siebenrock KA, Mamisch TC. Femoral morphology and epiphyseal growth plate changes of the hip during maturation: MR assessments in a 1-year follow-up on a cross-sectional asymptomatic cohort in the age range of 9-17 years. Skeletal Radiol. 2012;41(11):1381-1390.
  8. Agricola R, FAU BJ, FAU GA, et al. The development of cam-type deformity in adolescent and young male soccer players. The American journal of sports medicine JID – 7609541. 0820.
  9. Gerhardt MB, Romero AA, Silvers HJ, Harris DJ, Watanabe D, Mandelbaum BR. The prevalence of radiographic hip abnormalities in elite soccer players. Am J Sports Med. 2012;40(3):584-588.
  10. Silvis ML, Mosher TJ, Smetana BS, et al. High prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. Am J Sports Med. 2011;39(4):715-721.
  11. Tveit M, FAU RB, FAU NJ, Karlsson MK. Former male elite athletes have a higher prevalence of osteoarthritis and arthroplasty in the hip and knee than expected. The American journal of sports medicine JID – 7609541. 0716.
  12. Lindberg H, Roos H, Gardsell P. Prevalence of coxarthrosis in former soccer players. 286 players compared with matched controls. Acta Orthop Scand. 1993;64(2):165-167.
  13. Mason JB. Acetabular labral tears in the athlete. Clinics in sports medicine JID – 8112473. 0226.
  14. Nepple JJ, Carlisle JC, Nunley RM, Clohisy JC. Clinical and radiographic predictors of intra-articular hip disease in arthroscopy. Am J Sports Med. 2011;39(2):296-303.
  15. Byrd JW, Jones KS. Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients. Am J Sports Med. 2004;32(7):1668-1674.
  16. Toomayan GA, Holman WR, Major NM, Kozlowicz SM, Vail TP. Sensitivity of MR arthrography in the evaluation of acetabular labral tears. AJR Am J Roentgenol. 2006;186(2):449-453.
  17. Esteve E, Rathleff MS, Bagur-Calafat C, Urrutia G, Thorborg K. Prevention of groin injuries in sports: A systematic review with meta-analysis of randomised controlled trials. Br J Sports Med. 2015;49(12):785-791.
  18. Steffen K, Myklebust G, Olsen OE, Holme I, Bahr R. Preventing injuries in female youth football–a cluster-randomized controlled trial. Scand J Med Sci Sports. 2008;18(5):605-614.
  19. van Beijsterveldt AM, van de Port IG, Krist MR, et al. Effectiveness of an injury prevention programme for adult male amateur soccer players: A cluster-randomised controlled trial. Br J Sports Med. 2012;46(16):1114-1118.
  20. Engebretsen AH, Myklebust G, Holme I, Engebretsen L, Bahr R. Prevention of injuries among male soccer players: A prospective, randomized intervention study targeting players with previous injuries or reduced function. Am J Sports Med. 2008;36(6):1052-1060.