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Young Adult Hip Injuries in Athletes: Where Are We in 2018? Part 2
25 January 2019 (online)
Open and arthroscopic management of prearthritic hip conditions continues to grow in popularity. In this Journal of Hip Surgery Special Edition (Part 2), we address operative and nonoperative care of the young adult hip. We begin with management of several controversial areas including borderline hip dysplasia, acetabular retroversion, and proximal hamstring injuries. As we transition to a value-based (outcome divided by cost) healthcare system, selection and utilization of patient-reported outcome instruments will be important—a review of available patient-reported outcomes is presented here. Physical rehabilitation is a cornerstone of treatment for athletes and young adults with femoroacetabular impingement syndrome—a topic comprehensively covered in the present issue.
In the first article, Willey et al review the diagnosis and management of two controversial acetabular deformities: borderline (mild) hip dysplasia and acetabular retroversion. In the review, they discuss common clinical presentations, conservative treatment standards, and the impact of soft tissue laxity in clinical decision making. A comprehensive review of the current literature for both conditions is eloquently presented including several reports of good short-term outcomes following arthroscopic treatment for both conditions. The authors highlight important gaps in the present literature including short follow-up periods for arthroscopic outcomes and a relative paucity of periacetabular osteotomy data—potential areas for future study.
Next, Sonnenfeld et al review the current patient-reported outcome instruments used in young adult hip populations. They conclude that the Modified Harris Hip Score, while being widely used, does have some limitations in this population. They identified outcome instruments that appear to be highly reliable, valid, and consistent in athletes and young adults with prearthritic hip conditions including the International Hip Outcome Tool-33, the Hip Disability and Osteoarthritis Outcome Score, and the Hip Outcome Score. Careful consideration to these outcome instruments should be given for practitioners looking to evaluate the treatment effect on their patient populations.
In the third article, Buckwalter et al present a review of operative and nonoperative care of proximal hamstring injuries. First, they review the current evidence for the treatment of complete proximal hamstring avulsions and highlight the importance of acute surgical repair. They describe treatment strategies for partial tears and tendinopathy including conservative measures as well as delayed surgical outcomes. Finally, biologic treatments and therapies, while data are limited, were reviewed.
In the final article, Hagen et al review physical therapy and rehabilitation for young adult hip conditions. Rehabilitation has a tremendous role in the comprehensive treatment of young patients with prearthritic hip disorders. The authors review the wide variety of nonoperative and postoperative care for patients with femoroacetabular impingement syndrome and conclude higher levels of evidence may be required to optimize rehabilitation practices in this patient population.