The Role of Hip Arthroscopy in the Athletic

J.W. Thomas Byrd, MD

Nashville Sports Medicine & Orthopaedic Center, 2011 Church Street, Suite 100, Nashville, TN37203, USA

he arthroscope has been instrumental in the growing understanding of hip joint injuries in athletes. Until recently, sports-related hip injuries have received little attention. There are three reasons for this. First, perhaps hip injuries are less common than other joints. Second, investigative skills for the hip have been less sophisticated, including clinical assessment and imaging studies. Third, there have been fewer interventional methods available to treat the hip including both surgical techniques and conservative modalities. Thus, there has been little incentive to pursue this area when there were few treatment options available. Operative arthroscopy has revolutionized the management of athletic hip injuries. Numerous intraarticular disorders have been identified that previously went unrecognized and untreated. In the past, athletes were simply resigned to living within the constraints of their symptoms, often ending their competitive careers. This is a work in progress. Clinical assessment skills are improving; understanding of hip joint pathology and associated pathomechanics is evolving; and the interventional methods available continue to expand.

In a study of athletes undergoing arthroscopy, 60% were treated for an average of 7 months before it was recognized that the joint was the source of their problems [1]. Most were initially diagnosed as various types of musculotendinous strains. Thus, it is prudent to include intraarticular pathology in the differential diagnosis when managing problems around the hip area. Extraarticular disorders may also coexist with intraarticular lesions.

Hip symptoms are most commonly referred to the anterior groin, and may radiate to the medial thigh. However, a very characteristic clinical feature that has been described is the "C-sign" [2]. A patient describing deep interior hip pain will often grip their hand above the greater trochanter with their thumb lying posteriorly and the fingers cupped within the anterior groin. Casually viewed, it may appear that they are describing lateral pain such as the iliotibial band or trochanteric bursa, but characteristically, they are reflecting pain within the hip joint.

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

doi:10.1016/j.csm.2005.12.007 sportsmed.theclinics.com

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