Young Adult Hip Injuries in Athletes: Where Are We in 2018?

The evaluation and treatment of athletic young adult hip injuries is one of the fastest growing aspects of hip and sports medicine practice today. Arthroscopic management of these conditions has grown exponentially over the past two decades. In this special issue of the Journal of Hip Surgery, we present articles covering the hottest topics in young adult hip conditions, including capsular management, extra-articular impingement, early osteoarthritis in young active patients, and a point-counterpoint from leading hip arthroscopy and core muscle injury (CMI) surgeons recognized nationally and internationally.

In the first article, Neal et al discuss the anatomy and management of the hip capsule during arthroscopic treatment of intra-articular hip disorders. The iliofemoral ligament, often transected during capsulotomy to gain access to the hip arthroscopically, is described anatomically and biomechanically; clinical outcomes comparing closure of this ligament to nonclosure are reviewed and indicate patients may have better outcomes and fewer revisions when the capsulotomy is repaired. The senior author's preferred technique for capsular management is also described.

Next, Day et al review the current evidence for treatment of early onset hip osteoarthritis in the young, active patient. In a hip-focused practice, the patient who has too much arthritis for a reliable result with arthroscopy, yet has too little arthritis or is too young to consider arthroplasty, can present a tremendous clinical challenge. This article presents the current data on nonoperative treatments including injections, physical therapy, and nonsteroidal anti-inflammatory drugs, as well as more invasive options including arthroscopy, and periacetabular osteotomy (in the setting of femoroacetabular impingement [FAI] or dysplasia), and reviews the outcomes of emerging biologic therapies.

In the third article, Larson and Zaltz present a review of extra-articular hip impingement conditions. These two thought leaders were among the first to popularize this phenomenon in hip preservation community. While many causes of hip impingement come from within the synovial joint, this article reviews common causes of extra-articular impingement and treatment; these include anterior inferior iliac spine impingement or “subspine impingement,” ischiofemoral impingement, and trochanteric–pelvic impingement. This thoughtful review covers patient evaluation, treatment, and outcomes for these complex hip impingement conditions seen in athletic young adult populations.

The fourth article is part one of a point-counter point approach to the high level athlete with groin pain. Poor et al present the workup, diagnosis, and management approach to the athlete with groin pain from CMI (or athletic pubalgia). Dr. Meyers, as a leading core muscle injury surgeon for high level athletes, presents his approach to the patient with special consideration given to the overlap between CMI and intra-articular hip conditions. Furthermore, the authors provide a review of the efficacy of platelet-rich-plasma for these conditions and caution providers regarding its widespread use.

In part two of the point-counterpoint approach to the young athlete with hip and groin pain, Philippon et al describes an approach to the athlete with hip pain and FAI. This article describes activities in sports that are often associated with the condition and correlates these movements with structural abnormalities that predispose certain athletes to hip injury. Conservative and arthroscopic management of FAI is reviewed alongside the socioeconomic impact hip preservation surgery plays in the lives and careers of athletes competing at the highest professional levels.