Current Concepts Hip and Groin Injuries in Athletes

Although athletic injuries about the hip and groin occur less commonly than injuries in the extremities, they can result in extensive rehabilitation time. Thus, an accurate diagnosis and well-organized treatment plan are critical. Because loads of up to eight times body weight have been demonstrated in the hip joint during jogging, presumably even greater loads can occur during vigorous athletic competition. The available imaging modalities are effective diagnostic tools when selected on the basis of a thorough history and physical examination. Considerable controversy exists as to the cause and optimal treatment of groin pain in athletes, or the so-called “sports hernia.” There has also been significant recent attention focused on intraarticular lesions that may be amenable to hip arthroscopy. This article briefly reviews several common hip and groin conditions affecting athletic patients and highlights some newer topics. Athletic injuries about the hip and groin occur at a low frequency relative to injuries at the more distal lower extremities. Epidemiologic studies have shown that injuries to the hip region compose approximately 5% to 9% of the injuries in high school athletes. Rehabilitation times can be prolonged, making early and accurate diagnosis essential. The anatomic and biomechanical considerations for injuries in these areas are among the most complex in the musculoskeletal system, making the management of these injuries very challenging. The immature skeleton can add to this complexity and broaden the differential diagnosis. Loads of up to eight times body weight have been demonstrated in the hip joint during jogging, with potentially greater loads present during vigorous athletic competition. The structures about the hip are uniquely adapted to transfer such forces. The body’s center of gravity is located within the pelvis, anterior to the second sacral vertebra; thus, the loads that are generated or transferred through this area are important in virtually every athletic endeavor. Imaging modalities continue to be developed and refined to help clinicians diagnose more accurately, and these often provide prognostic information. These imaging studies are most effective when selected on the basis of a thorough history and physical examination. Both nonoperative and operative treatment options for injuries to the hip and groin have improved. For example, the importance of trunk stability rehabilitation is being increasingly recognized. Among the many surgical advances for these injuries are the use of hip arthroscopy for intraarticular abnormalities and laparoscopy for lower abdominal injuries. It should be emphasized that many hip and groin injuries frequently require the involvement of several different medical and surgical specialists. A preplanned, multidisciplinary approach is often necessary for optimal management of these complex athletic injuries. This article briefly reviews the pertinent anatomy and biomechanics about the hip and describes the evaluation and management of the more common conditions affecting athletes. These conditions are categorized according to the typical onset, acute or insidious. Table 1 shows a brief outline of the injuries that will be discussed. ANATOMY AND BIOMECHANICS The sacrum and two innominate bones form the pelvis. The ilium, ischium, and pubis are typically fused by the late teenage years, but the ischial tuberosity and anterior superior iliac spine may not be fused until the middle of the 3rd decade of life. The secondary ossification centers of the proximal femur appear at an early age, particularly that of the femoral head (4 to 6 months), and are generally †Address correspondence and reprint requests to Kyle Anderson, MD, William Clay Ford Center for Athletic Medicine, 6525 Second Avenue, Detroit, MI, 48202. No author or related institution has received financial benefit from research in this study. 0363-5465/101/2929-0521$02.00/0 THE AMERICAN JOURNAL OF SPORTS MEDICINE, Vol. 29, No. 4 © 2001 American Orthopaedic Society for Sports Medicine