Athletes in Flexibility Sports Have Higher Rates of Hip Damage

High-level athletes in flexibility sports who were treated for femoroacetabular impingement syndrome with hip arthroscopy had higher rates of femoral head cartilage lesions and ligamentum teres tears requiring debridement compared to other athletes, a new study finds.

Flexibility sports include dancing, gymnastics, martial arts, figure skating, and cheerleading.

The study, “Pathologic Findings on Hip Arthroscopy in High-Level Athletes Competing in Flexibility Sports,” was published online on March 7, 2022, in The American Journal of Sports Medicine.

“Athletes who compete in flexibility sports place unique demands on their hip joints because of the supraphysiologic range of motion required,” the study authors wrote.

They compared the pathologic features, outcomes and return-to-sports rates of high-level flexibility sports athletes who underwent hip arthroscopy for femoroacetabular impingement syndrome and labral tear. Their outcomes were compared against a propensity score-matched cohort of high-level athletes who participate in non-flexibility sports.

The flexibility sports athletes underwent surgery between April 2008 and December 2018. They were matched to the controls by body mass index, age at time of surgery, sex, sports competition level, and labral treatment. The control athletes participated in sports such as distance running, soccer, volleyball, and softball.

The researchers analyzed data on baseline patient characteristics, intraoperative findings, and surgical procedures. They also compared minimum 2-year patient-reported outcome measures for the modified Harris Hip Score, Nonarthritis Hip Score, Hip Outcome Score-Sport Specific Subscale, and Visual Analog Scale for pain and satisfaction. Rates of secondary surgery and return to sports were also compared.

Overall, 47 patients (50 hips) who participated in flexibility sports were matched to 130 patients (150 hips) who participated in non-flexibility sports. Follow-up time was 37.5 ± 10.4 months (mean ± SD). A majority of the patients were female with a mean age of 19.5 ± 7.3 years.

The flexibility sports athletes had higher rates of femoral head cartilage lesions (Outerbridge ≥2; 12.0% vs 2.0%; p = .008) and ligamentum teres tears (48% vs 26%; p = .003).

However, both groups of athletes showed significant clinical improvements after surgery for all patient-reported outcome measures. Forty-five of the athletes who participated in flexibility sports attempted to return to sport, but only 34 were able to do it successfully. The other 11 continued to have ongoing hip issues. These return to sport numbers were not significantly different from those athletes who participated in other types of sports.

“High-level athletes who participated in flexibility sports and were treated for femoroacetabular impingement syndrome with hip arthroscopy exhibited higher rates of femoral head cartilage lesions and ligamentum teres tears requiring debridement when compared with a benchmark group of athletes who participated in other sports. Despite this, both groups demonstrated similar improvements in outcome scores and comparable rates of return to sports at minimum 2-year follow-up,” the researchers wrote.

The study authors include Benjamin R. Saks, M.D., Peter F. Monahan, B.S., David R. Maldonado, M.D., Andrew E. Jimenez, M.D., Hari K. Ankem, M.D., Payam W. Sabetian, M.D., Ajay C. Lall, M.D. and Benjamin G. Domb, M.D, all of the American Hip Institute Research Foundation in Chicago, Illinois.