Arthroscopy is no longer limited to the shoulder and knee. Patients, athletes, commentators, and doctors frequently talk about “scopes” or “arthroscopy.” It refers to the use of a camera to see inside a joint without having to make a large incision. These days rotator cuffs, meniscal tears, and even ACLs can be repaired entirely arthroscopically. What is more novel, however, is the use of arthroscopy in the hip joint.
Athletes subject their bodies to extreme forces; the hip joint may experience forces up to five times body weight during activities such as running, jumping, and twisting. Through either repetitive overuse injuries or direct trauma, the hip may develop injuries to the muscles, tendons, and ligaments surrounding the joint, or the cartilage, capsule, and fibrocartilage structures inside the joint. The majority of injuries to the hip joint are typically muscular strains or inflammation of the tendons and ligaments around the joint. These types of injuries generally improve with appropriate treatments such as rest, ice, massage, muscle stimulation, ultrasound, and a variety of manual therapy techniques. If hip pain does not resolve after an appropriate period of these types of treatments, the athlete and trainer/doctor should consider injuries to the inside of the joint involving cartilage structures such as articular cartilage and the labrum.
According to Dr. Bryan Kelly, a hip and sports medicine specialist at The Hospital for Special Surgery and a team physician for the NY Giants Football Team:
“Hip arthroscopy is a minimally invasive outpatient procedure that allows the doctor to look inside the hip joint with a small camera and fix small tears in structures including the joint capsule, the labrum, and the joint surface. Many of the procedures that are now performed during hip arthroscopy allow surgeons to address problems that were previously undiagnosed and untreated.”
Hip arthroscopy has been very effective for the treatment of numerous athletic injuries including labral tears, the removal of bones spurs that cause a condition called “impingement”, injuries to the cartilage surfaces, hip instability, injuries to the ligamentum teres, snapping hip syndromes (internal and external snapping hip) and the removal of loose bodies. In addition, hip arthroscopy can be used as a diagnostic tool to look inside the hip joint of patients with long-standing, unresolved hip joint pain that cannot be clearly visualized on other imaging tests. A brief overview of some of these problems follows.
Injuries to the labrum are the most common source of hip pain identified at the time of arthroscopy. The labrum is a relatively small tissue similar in structure to the meniscus in the knee and the labrum in the shoulder. It surrounds the outer perimeter of the hip socket, known as the acetabulum, and forms a seal around the joint which helps to preserve joint mechanics. When the labrum tears, the torn fragment can get pinched between the ball of the hip joint (the femoral head) and the socket (the acetabulum). The diagnosis of a labral tear remains largely clinical and is similar to those patients who present with a meniscus tear in the knee. The athlete almost always describes pain in the groin particularly with twisting maneuvers. Oftentimes there will be a sense of catching or locking within the joint as the torn tissue gets caught in the joint. Sometimes their presentation is more subtle, with symptoms of dull, activity-induced, positional pain that fails to improve with rest. Frequently the athlete will mis-interpret the pain as a chronic groin strain or injury. If these “groin pulls” don’t respond effectively to more traditional treatments such as rest, ice treatments, manual therapies, muscle stimulation and ultrasound, then a labral tear within the joint may be present and further evaluation should be performed. Hip arthroscopy may be appropriate to either remove or repair the torn tissue in athletes who have persistent hip pain for greater than six to eight weeks, and clinical signs and radiographic findings consistent with a labral tear.
Hip impingement (femoroacetabular impingement or FAI) results from bony impingement of the femoral head within the acetabulum. In this condition, the femoral head is not perfectly round, but rather egg-shaped. Since the hip was designed to have a perfect fit between the ball and the socket, if there is any mismatch, the bones bump into one another with motion across the joint resulting in the pinching of the surrounding soft tissue. Bony contact between the egg-shaped femoral head and the acetabulum results in injury to the labrum and the cartilage within the socket. Athletes with underlying impingement are at increased risk for developing labral tears due to the extreme motions and rotational forces that are subjected across the hip joint. Hip arthroscopy allows for access into the joint during which time the labral tear can be fixed or removed and the shape of the bones can be re-contoured to create a better match between the ball and the socket.
