Background: It has been reported that relative to other sports participants, ice hockey players suffer from cam-type femoroacetabular impingement (FAI) in higher numbers. α angles have been reported to increase with the likelihood of symptomatic FAI. It is unclear how prevalent increased α angles, commonly associated with cam FAI, are in asymptomatic young ice hockey players. Hypothesis: There would be a higher prevalence of α angles associated with cam FAI in youth ice hockey players than in a non–hockey-playing (skier) youth control group. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 61 asymptomatic youth ice hockey players (aged 10-18 years) and 27 youth skiers (controls) (aged 10-18 years) underwent a clinical hip examination consisting of the flexion/abduction/external rotation (FABER) distance test, impingement testing, and measurement of hip internal rotation. The hip α angle was measured by magnetic resonance imaging, and labral tears and articular cartilage lesions were documented. Hockey players were grouped according to their USA Hockey classification as peewees (ages 10-12 years), bantams (ages 13-15 years), and midgets (ages 16-19 years). Results: Overall, ice hockey players had significantly higher α angles than did the control group, and hockey players had a significant correlation between increased age and increased α angles, while the control group did not. In the ice hockey group, 75% had an α angle of ≥55°, while in the skier group, 42% had an α angle of ≥55° ( P < .006). Hockey players were 4.5 times more likely to have an α angle commonly associated with cam impingement than skiers. Midget players had the highest risk of increased α angles. Conclusion: Even at young ages, ice hockey players have a greater prevalence of α angles associated with cam FAI than do skier-matched controls. Properties inherent to ice hockey likely enhance the development of a bony overgrowth on the femoral neck, leading to cam FAI.
Objectives: The objective of this study was to compare the risk of Outerbridge grade 3 or 4 defects in hips with different labrum thickness in patients undergoing primary hip arthroscopy for FAI. Methods: Between 2005 and 2014, patients who underwent hip arthroscopy by a single surgeon and met the inclusion criteria were included in this study. The labrum was measured with an arthroscopic ruler at 3 points that corresponded with 9 o’clock, 12 o’clock and 3 o’clock during hip arthroscopy from the chondrolabral junction to the edge of the labrum. Four specific measurements were stablished as a parameter for the labral thickness (4, 5, 6 and 7 cm). The lower labral thickness measurement of the three performed was used as a guide for the groups classification. Patients were compared based on the labrum thickness regarding the prevalence of Outerbridge grade III and IV on the femoral head (FH) and acetabulum. Patients were excluded if they had previous arthroscopic or open hip surgery, had inmeasurement of the labrum or had insurgical data. Results: Eight hundred forty-three patients were included on this study, the average age was 31.7 years old, regarding gender, 468 females and 367 males. There was no difference in the sample characterization variables. Hips with small labrums were more likely to have a grade 3 or 4 chondral defect on the femoral head. First, comparing patients with 7 and 6 mm of labral thickness, patients measuring 6mm had an 1.7 relative risk for severe chondral damage on the FH [1.04 to 2.7] p=0.033. Second, when patients with 7 and 5 mm are compared, patients with 5mm of labral thickness have a 4.3 relative risk[2.2 to 4.3]p<0.001. Lastly, when the comparison between 7 and 4 mm is established, patients measuring 4mm have a relative risk 4.5 for severe chondral damage on the femoral head. No difference in the prevalence of chondral damage was found between patients measuring 7 and 8 mm. There was no difference in the prevalence of grade 3 and 4 defects on the acetabulum between the all the labrum measurements evaluated. Regarding the labral procedure performed, patients with 4mm of labral width in at least one point, 28% underwent labral reconstruction. On the other hand, in patients with 7, 6 and 5 mm of labral width, 98.6, 94.9 and 85.8% underwent labral repair, respectively. Conclusion: Patients with femoroacetabular impingement with a labrum wide measuring less than 6mm have a higher likelihood to have Grade III and IV chondral damage on the femoral head, but not on the acetabular cartilage. Patients with less than 5mm had a likelihood for labral reconstruction need. [Table: see text]
Background: Outcomes assessment after the treatment of shoulder disorders has involved the use of various condition-specific outcome instruments. The purpose of this study was to determine the psychometric properties of the American Shoulder and Elbow Surgeons subjective shoulder scale in patients with shoulder instability, rotator cuff disease, and glenohumeral arthritis. Methods: Test-retest reliability, internal consistency, content validity, criterion validity, construct validity, and responsiveness to change were determined for the American Shoulder and Elbow Surgeons shoulder scale within subsets of an overall study population of 455 patients with shoulder instability, 474 patients with rotator cuff disease, and 137 patients with glenohumeral arthritis. Results: There was acceptable test-retest reliability for the overall American Shoulder and Elbow Surgeons shoulder scale (intraclass correlation coefficient = 0.94) and ten of eleven domains. There was acceptable internal consistency for patients with instability (Cronbach alpha = 0.61), rotator cuff disease (0.64), and arthritis (0.62). There were acceptable floor and ceiling effects for patients with instability (0% and 1.3%, respectively), rotator cuff disease (0% for both), and arthritis (0% for both). There was acceptable and appropriate criterion validity, with significant correlations (p < 0.05) between the overall American Shoulder and Elbow Surgeons scale and the physical functioning, role-physical, and bodily pain domains of the Short Form-12 scale, and nonsignificant correlations (p > 0.05) with the role-emotional, mental health, vitality, and social function domains. There was acceptable construct validity, with all twenty-three hypotheses demonstrating significance (p < 0.05), and acceptable responsiveness to change for patients with instability (standardized response mean, 0.93), rotator cuff disease (1.16), and arthritis (1.11). Conclusions: The use of outcome instruments with psychometric properties that have been vigorously established is essential. The American Shoulder and Elbow Surgeons subjective shoulder scale demonstrated overall acceptable psychometric performance for outcomes assessment in patients with shoulder instability, rotator cuff disease, and glenohumeral arthritis.
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