Abstract
Tennis participation continues to grow and has quickly become one of the most popular sports in the world with over 75 million players globally [1]. The unique functional demands of the sport require multidirectional movements, repetitive loading, and rapid torsional forces across the lower extremity for on-court performance. Importantly, the ability to generate energy from the lower extremity and trunk muscle groups can translate to greater force applied to the eventual racquet strike via the kinetic chain. However, these same gameplay characteristics can also lead to an increased risk for lower extremity injury in tennis players [2]. Anecdotally, we have seen an increase in the diagnosis and treatment of hip-related pain in these athletes. While traditionally hip injuries have been thought of being muscular in origin (hip flexor and adductor), intra-articular sources of hip pain have become more commonplace. Furthermore, professional tennis players are undergoing hip arthroscopy more frequently for related injuries. While early experiences with hip arthroscopy showed more modest results, recent reports demonstrate the growing success with this modality of treatment. Nonetheless, hip injuries in this population can be particularly difficult to manage, often due to the high-demand activity and the innate desire for earlier return to play.
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References
Pluim BM, Miller S, Dines D, et al. Sport science and medicine in tennis. Br J Sports Med. 2007;41(11):703–4.
Abrams GD, Renstrom P, Safran MR. Epidemiology of musculoskeletal injury in the tennis player. Br J Sports Med. 2012;46(7):492–8.
Byrd JWT. Femoroacetabular impingement in athletes: current concepts. Am J Sports Med. 2014;42(3):737–51.
Byrd JW, Jones KS. Arthroscopic management of femoroacetabular impingement: minimum 2-year follow-up. Arthroscopy. 2011;27(10):1379–88.
Vaughn ZD, Safran MR. Arthroscopic femoral osteoplasty/chielectomy for cam-type femoroacetabular impingement in the athlete. Sports Med Arthrosc. 2010;18(2):90–9.
Nho SJ, Magennis EM, Singh CK, Kelly BT. Outcomes after the arthroscopic treatment of femoroacetabular impingement in a mixed group of high-level athletes. Am J Sports Med. 2011;39(Suppl(1_suppl)):14S–9S.
Philippon M, Schenker M, Briggs K, Kuppersmith D. Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression. Knee Surg Sports Traumatol Arthrosc. 2007;15(7):908–14.
Anderson CN, Riley GM, Gold GE, Safran MR. Hip-femoral acetabular impingement. Clin Sports Med. 2013;32(3):409–25.
Bondi E. Using the open stance forehand may subject tennis players to increased hip joint force. In: Presented at Society for Tennis Medicine & Science, Amelia Island, FL; December 5, 2016.
Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;(417):112–20.
Crawford MJ, Dy CJ, Alexander JW, et al. The 2007 Frank Stinchfield Award. The biomechanics of the hip labrum and the stability of the hip. Clin Orthop Relat Res. 2007;465:16–22.
Freehill MT, Safran MR. The labrum of the hip: diagnosis and rationale for surgical correction. Clin Sports Med. 2011;30(2):293–315.
Hutchinson MR, Laprade RF, Burnett QM, Moss R, Terpstra J. Injury surveillance at the USTA boys’ tennis championships: a 6-yr study. Med Sci Sports Exerc. 1995;27(6):826–30.
Lynall RC, Kerr ZY, Djoko A, Pluim BM, Hainline B, Dompier TP. Epidemiology of National Collegiate Athletic Association men’s and women’s tennis injuries, 2009/2010–2014/2015. Br J Sports Med. 2015;50(7):1–6.
Dines JS, Bedi A, Williams PN, et al. Tennis injuries: epidemiology, pathophysiology, and treatment. J Am Acad Orthop Surg. 2015;23(3):181–9.
Samora JB, Ng VY, Ellis TJ. Femoroacetabular impingement: a common cause of hip pain in young adults. Clin J Sport Med. 2011;21(1):51–6.
Diamond LE, Dobson FL, Bennell KL, Wrigley TV, Hodges PW, Hinman RS. Physical impairments and activity limitations in people with femoroacetabular impingement: a systematic review. Br J Sports Med. 2015;49(4):230–42.
Packer JD, Safran MR. The etiology of primary femoroacetabular impingement: genetics or acquired deformity? J Hip Preserv Surg. 2015;2(3):249–57.
Pollard TCB, Villar RN, Norton MR, et al. Genetic influences in the aetiology of femoroacetabular impingement: a sibling study. J Bone Joint Surg Br. 2010;92(2):209–16.
Van Houcke J, Yau WP, Yan CH, et al. Prevalence of radiographic parameters predisposing to femoroacetabular impingement in young asymptomatic Chinese and white subjects. J Bone Joint Surg Am. 2015;97(4):310–7.
Safran M, Hariri S, Smith L. Paper 31: Is there a genetic link to FAI: a DNA pilot study of GDF5 and frizzle single nucleotide polymorphisms. YJARS. 2010;27:e18.
Frank JM, Harris JD, Erickson BJ, et al. Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: a systematic review. Arthroscopy. 2015;31(6):1199–204.
Siebenrock KA, Ferner F, Noble PC, Santore RF, Werlen S, Mamisch TC. The cam-type deformity of the proximal femur arises in childhood in response to vigorous sporting activity. Clin Orthop Relat Res. 2011;469(11):3229–40.
Agricola R, Bessems JHJM, Ginai Z, et al. The development of cam-type deformity in adolescent and young male soccer players. Am J Sports Med. 2012;40(5):1099–106.
Kapron AL, Anderson AE, Aoki SK, et al. Radiographic prevalence of femoroacetabular impingement in collegiate football players: AAOS Exhibit Selection. J Bone Joint Surg Am. 2011;93-A(19):e111(1–10).
Sanchis-Moysi J, Idoate F, Izquierdo M, Calbet JAL, Dorado C. Iliopsoas and gluteal muscles are asymmetric in tennis players but not in soccer players. PLoS One. 2011;6(7). https://doi.org/10.1371/journal.pone.0022858.
Young SW, Dakic J, Stroia K, Nguyen ML, Harris AHS, Safran MR. Hip range of motion and association with injury in female professional tennis players. Am J Sports Med. 2014;42(11):2654–8.
Moreno-Pérez V, Ayala F, Fernandez-Fernandez J, Vera-Garcia FJ. Descriptive profile of hip range of motion in elite tennis players. Phys Ther Sport. 2016;19:43–8.
Akutagawa S, Kojima T. Trunk rotation torques through the hip joints during the one- and two-handed backhand tennis strokes. J Sports Sci. 2005;23(8):781–93.
Klingenstein GG, Martin R, Kivlan B, Kelly BT. Hip injuries in the overhead athlete. Clin Orthop Relat Res. 2012;470:1579–85.
Martin RL, Sekiya JK. The interrater reliability of 4 clinical tests used to assess individuals with musculoskeletal hip pain. J Orthop Sports Phys Ther. 2008;38(2):71–7.
Kulund DN, McCue FC 3rd, Rockwell DA, Gieck JH. Tennis injuries: prevention and treatment. A review. Am J Sports Med. 1979;7(4):249–53.
Reiman MP, Goode AP, Cook CE, Holmich P, Thorborg K. Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis. Br J Sports Med. 2015;49(12):811.
Kapron AL, Aoki SK, Peters CL. In-vivo Hip arthrokinematics during supine clinical exams: application to the study of femoroacetabular impingement. J Biomech. 2016;116(8):1477–90.
Vandenberg C, Crawford EA, Enselman ES, Robbins CB, Wojtys EM, Bedi A. Restricted hip rotation is correlated with an increased risk for anterior cruciate ligament injury. Arthroscopy. 2016;33:317–25.
Martin RL, Kelly BT, Leunig M, et al. Reliability of clinical diagnosis in intraarticular hip diseases. Knee Surg Sport Traumatol Arthrosc. 2010;18(5):685–90.
Nötzli HP, Wyss TF, Stoecklin CH, et al. Ovid: the contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br. 2002;84(4):556–60.
Riley GM, McWalter EJ, Stevens KJ, Safran MR, Lattanzi R, Gold GE. MRI of the hip for the evaluation of femoroacetabular impingement; past, present, and future. J Magn Reson Imaging. 2015;41(3):558–72.
Sutter R, Zubler V, Hoffmann A, et al. Hip MRI: how useful is intraarticular contrast material for evaluating surgically proven lesions of the labrum and articular cartilage? Am J Roentgenol. 2014;202(1):160–9.
Kivlan BR, Martin RL, Sekiya JK. Response to diagnostic injection in patients with femoroacetabular impingement, labral tears, chondral lesions, and extra-articular pathology. Arthroscopy. 2011;27(5):619–27.
Blankenbaker DG, Tuite MJ. Acetabular labrum. Magn Reson Imaging Clin N Am. 2013;21(1):21–33.
Jiajue R, Jiang Y, Wang O, et al. Suppressed bone turnover was associated with increased osteoporotic fracture risks in non-obese postmenopausal Chinese women with type 2 diabetes mellitus. Osteoporos Int. 2014;25(8):1999–2005.
Shu B, Safran MR. Hip instability: anatomic and clinical considerations of traumatic and atraumatic instability. Clin Sports Med. 2011;30(2):349–67.
Kalisvaart MM, Safran MR. Microinstability of the hip—it does exist: etiology, diagnosis and treatment. J Hip Preserv Surg. 2015;2(2):123–35.
Kalisvaart MM, Safran MR. Hip instability treated with arthroscopic capsular plication. Knee Surg Sport Traumatol Arthrosc. 2016. https://doi.org/10.1007/s00167-016-4377-6.
Byrd JWT, Jones KS. Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients. Am J Sports Med. 2004;32(7):1668–74.
Ayeni OR, Farrokhyar F, Crouch S, Chan K, Sprague S, Bhandari M. Pre-operative intra-articular hip injection as a predictor of short-term outcome following arthroscopic management of femoroacetabular impingement. Knee Surg Sport Traumatol Arthrosc. 2014;22(4):801–5.
Palmer a JR, Ayyar-Gupta V, Dutton SJ, et al. Protocol for the femoroacetabular impingement trial (FAIT): a multi-centre randomised controlled trial comparing surgical and non-surgical management of femoroacetabular impingement. Bone Joint Res. 2014;3(11):321–7.
Beck M, Kalhor M, Leunig M, Ganz R, Surgeon O. Hip morphology influences the pattern of damage to the acetabular cartilage femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87:1012–8.
Tönnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am. 1999;81(12):1747–70.
Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: Part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004;418:67–73.
Philippon MJ, Wolff AB, Briggs KK, Zehms CT, Kuppersmith DA. Acetabular rim reduction for the treatment of femoroacetabular impingement correlates with preoperative and postoperative center-edge angle. Arthroscopy. 2010;26(6):757–61.
Seldes RM, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald RH. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res. 2001;382:232–40.
Larson CM, Giveans MR. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement. Arthroscopy. 2009;25(4):369–76.
Kelly BT, Weiland DE, Schenker ML, Philippon MJ. Arthroscopic labral repair in the hip: surgical technique and review of the literature. Arthroscopy. 2005;21(12):1496–504.
Krych AJ, Thompson M, Knutson Z, Scoon J, Coleman SH. Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: a prospective randomized study. Arthroscopy. 2013;29(1):46–53.
Philippon MJ, Weiss DR, Kuppersmith DA, Briggs KK, Hay CJ. Arthroscopic labral repair and treatment of femoroacetabular impingement in professional hockey players. Am J Sports Med. 2010;38(1):99–104.
White BJ, Patterson J, Herzog MM. Revision arthroscopic acetabular labral treatment: repair or reconstruct? Arthroscopy. 2016;32(12):2513–20.
Boykin RE, Patterson D, Briggs KK, Dee A, Philippon MJ. Results of arthroscopic labral reconstruction of the hip in elite athletes. Am J Sports Med. 2013;41(10):2296–301.
Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U. Surgical dislocation of the adult hip. J Bone Joint Surg. 2001;83(8):1119–24.
Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular impingement: Part I. Techniques of joint preserving surgery. Clin Orthop Relat Res. 2004;418(February):61–6.
Cohen SB, Huang R, Ciccotti MG, Dodson Christopher C, Parvizi J. Treatment of femoroacetabular impingement in athletes using a mini-direct anterior approach. Am J Sports Med. 2012;40(7):1620–8.
Casartelli NC, Leunig M, Maffiuletti NA, Bizzini M. Return to sport after hip surgery for femoroacetabular impingement: a systematic review. Br J Sports Med. 2015;49(12):819–24.
Bozic KJ, Chan V, Valone FH, Feeley BT, Vail TP. Trends in hip arthroscopy utilization in the United States. J Arthroplast. 2013;28(8 Suppl):140–3.
Colvin AC, Harrast J, Harner C. Trends in hip arthroscopy. J Bone Joint Surg. 2012;94(4):e23.
Montgomery SR, Ngo SS, Hobson T, et al. Trends and demographics in hip arthroscopy in the United States. Arthroscopy. 2013;29(4):661–5.
Nwachukwu BU, Rebolledo BJ, McCormick F, Rosas S, Harris JD, Kelly BT. Arthroscopic versus open treatment of femoroacetabular impingement: a systematic review of medium- to long-term outcomes. Am J Sports Med. 2016;44(4):1062–8.
Zingg PO, Ulbrich EJ, Buehler TC, Kalberer F, Poutawera VR, Dora C. Surgical hip dislocation versus hip arthroscopy for femoroacetabular impingement: clinical and morphological short-term results. Arch Orthop Trauma Surg. 2013;133(1):69–79.
Gerhardt MB, Romero AA, Silvers HJ, Harris DJ, Watanabe D, Mandelbaum BR. The prevalence of radiographic hip abnormalities in elite soccer players. Am J Sports Med. 2012;40(3):584–8.
Nawabi DH, Bedi A, Tibor LM, Magennis E, Kelly BT. The demographic characteristics of high-level and recreational athletes undergoing hip arthroscopy for femoroacetabular impingement: a sports-specific analysis. Arthroscopy. 2014;30(3):398–405.
Malviya A, Paliobeis CP, Villar RN. Do professional athletes perform better than recreational athletes after arthroscopy for femoroacetabular impingement? Clin Orthop Relat Res. 2013;471:2477–83.
Shibata KR, Safran MR. Arthroscopic hip surgery in the elite athlete: comparison of female and male elite athletes. Am J Sports Med. 2017;45(8):1730–9.
Byrd JWT, Jones KS, Gwathmey FW. Arthroscopic management of femoroacetabular impingement in adolescents. Arthroscopy. 2016;32(9):1800–6.
Sampson JD, Safran MR. Biomechanical implications of corrective surgery for FAI: an evidence-based review. Sports Med Arthrosc. 2015;23(4):169–73.
Rylander J, Shu B, Favre J, Safran M, Andriacchi T. Functional testing provides unique insights into the pathomechanics of femoroacetabular impingement and an objective basis for evaluating treatment outcome. J Orthop Res. 2013;31(9):1461–8.
Lamontagne M, Brisson N, Kennedy MJ, Beaulé PE. Preoperative and postoperative lower-extremity joint and pelvic kinematics during maximal squatting of patients with cam femoroacetabular impingement. J Bone Joint Surg. 2011;93(2):40–5.
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Safran, M.R., Costantini, A. (2018). Treatment of Femoroacetabular Impingement and Labral Injuries in Tennis Players. In: Di Giacomo, G., Ellenbecker, T., Kibler, W. (eds) Tennis Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-71498-1_24
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DOI: https://doi.org/10.1007/978-3-319-71498-1_24
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