Michael K Shindle MD Anil S Ranawat MD Bryan T Kelly MD

lthough hip stability relies primarily on its osseous anatomy, its unique soft tissue anatomy also plays a critical role. As in the shoulder, hip instability does occur. The consequences of both acute bony and soft tissue injuries must be considered. The etiology of hip instability can be either traumatic or atraumatic in nature. Although hip instability is relatively uncommon, it is a potential source of great disability, because it is a commonly unrecognized injury.

Hip instability can be considered either traumatic or atraumatic in origin. Traumatic instability has defined acute events. The spectrum of traumatic hip instability ranges from subluxation to dislocation with or without concomitant injuries. Atraumatic instability, on the other hand, is a more subtle and less well-defined entity. It can be a consequence of chronic overuse secondary to rotational instability or microinstability such as in elite golfers or gymnasts. The spectrum may also include patients with hip pain secondary to more generalized ligamentous laxity or, in the extreme form, in patients with connective tissue disorders such as Marfan syndrome or Ehlers-Danlos syndrome [1]. In addition to this spectrum of atraumatic instability, we would consider patients with underlying mild to moderate dysplasia as a separate category. These patients have instability secondary to abnormal bony architecture and therefore have increased stresses applied to their soft tissue structures. Each of these entities has unique diagnostic and management dilemmas.

Recently, hip arthroscopy has gained considerable interest as both a diagnostic and therapeutic tool for both acute and chronic hip pain. It has the potential to effectively treat many of the associated injury patterns of hip instability; however, many of its indications are still undefined. In this article, we will outline the basic anatomy, physiology, and management principles of the spectrum of hip instability in the athletic patient.

* Corresponding author. E-mail address: [email protected] (B.T. Kelly).

0278-5919/06/$ - see front matter © 2006 Elsevier Inc. All rights reserved.

doi:10.1016/j.csm.2005.12.003 sportsmed.theclinics.com

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