Summary

The purpose of this study was to determine the prevalence of chondral defects among elite athletes and determine if there is an association between types of biomechanical stress in a sport and articular cartilage injury patterns in the hip.

Abstract

Purpose

Chondral defects have been shown to be associated with femoroacetabular impingement (FAI). It is unclear if the type of sport or specific motions are related to the prevalence or severity of chondral defects seen in athletes. The purpose of this study was to determine the prevalence of chondral defects among elite athletes and determine if there is an association between types of biomechanical stress in a sport and articular cartilage injury patterns in the hip.

Methods

Elite athletes, 18 years old or greater, who underwent arthroscopy for symptomatic FAI between January 2005 and November 2018 were considered for inclusion. Exclusion criteria consisted of prior ipsilateral hip surgery, presence of osteoarthritis (joint space < 2 mm), history of confounding injury or prior hip conditions. Patients were classified by their sport using a classification system based on ‘at-risk’ hip motions (rotational, repetitive, extreme, contact, and high-speed). Prevalence, size, severity (Outerbridge grade), and location of chondral defects were compared.

Results

A total of 431 hips (107 female, 324 male, mean age 26.8 +/- 5.1) of elite athletes were included, representing 24 sports at various levels of play. Chondral defects (grade I-IV) were found in 408 (95%) of cases. Severe chondral defects (grade III/IV) were seen in 218 (51%) of cases and most commonly found in football, soccer, and baseball players. Microfracture was performed in 72 (17%) of total cases. There was significantly higher prevalence of acetabular (p=.04), femoral head (p=.04), and combined (p=.04) grade III/IV lesions in the rotational versus non-rotational group and acetabular (p=<.001) and combined (p=.02) grade III/IV lesions in the contact group versus non-contact group.

Conclusion

In elite athletes, the prevalence of chondral defects was high when undergoing hip arthroscopy. The severity, size, and location varied based on type of motion and stress on the hip that was determined by the sport. The more severe (grade III/IV) defects were more common in the rotational and contact athletes according to the motion classification system. The nature of high speed and extreme range of motion sports may be somewhat protective or select-out for athletes with hip chondral defects. This classification system can be used to identify athletes at risk of chondral damage for close monitoring and injury prevention. This information can also be used to pre-operatively counsel these athletes on the likely findings and to set expectations.
Keywords
hip; cartilage defect; sports; at-risk hip