ARRS 2022 Abstracts


E1573. Magnetic Resonance Imaging Findings of Intra-Articular Hip Pathology in Collegiate American Football Players
  1. Alexander Lubinski; University of Missouri Hospital
  2. James Stensby; University of Missouri Hospital
  3. Hunter Pharis; Ohio University Heritage College of Osteopathic Medicine
  4. Robert Wissman; University of Missouri Hospital
Multiple studies of intra-articular hip disorders have been published, many of which address femoral acetabular impingement (FAI). Although FAI can affect various intra-articular locations, much of the literature has focused on anterior superior joint pathology. We have encountered hip injuries in uncommon locations in American football players. The purpose of this study was to identify the location of intra-articular hip pathology in this patient population and to propose a mechanism for these injuries.

Materials and Methods:
A retrospective search of radiology reports was performed of MRI examinations of the hip in collegiate football players over an 8-year period at our institution. Two fellowship-trained musculoskeletal radiologists retrospectively reviewed the MRI examinations. Intra-articular pathology including labral tears, cartilage lesions, fractures, bone marrow edema, joint effusion, and abnormalities of the round ligament were reached by consensus.

A total of 14 male football players (mean age: 21 years, range: 18–23 years) were included in the study. Ten labral tears were identified with a nearly equal distribution between the anterior superior and posterior labrum. Nine cartilage abnormalities were identified, which were equally distributed in the anterior superior, superior, and posterior regions of the acetabulum. Four individuals had fractures, all of which involved the posterior wall. Little to no bone marrow edema was identified in these acute fractures. Nine individuals had joint effusions, and three partial tears of the round ligament were identified. One patient required a total hip replacement. Some MRI findings were undetected at initial interpretation. Based on the constellation of different hip injuries seen, the proposed mechanism of injury involves axial loading of a flexed knee in varying degrees of hip flexion resulting in the pathology seen in both the anterior and posterior aspects of the acetabulum.

Intra-articular hip injuries are rare and potentially devastating injuries in American football players. Osseous, cartilaginous, and labral pathology are widely distributed throughout the joint, with a predominant involvement of the posterior labrum and acetabular wall. These lesions may be difficult to detect owing to their uncommon locations and lack of significant bone marrow edema on acute presentation. Increased awareness of these uncommon injury locations will aid radiologists in interpretation in this patient population.