Original Article
Characterization of Symptomatic Hip Impingement in Butterfly Ice Hockey Goalies

https://doi.org/10.1016/j.arthro.2014.10.010Get rights and content

Purpose

This study aimed to characterize the radiographic deformity observed in a consecutive series of butterfly goalies with symptomatic mechanical hip pain and to use computer-based software analysis to identify the location of impingement and terminal range of motion. We also compared these analyses to a matched group of positional hockey players with symptomatic femoroacetabular impingement (FAI).

Methods

A consecutive series of 68 hips in 44 butterfly-style hockey goalies and a matched group of 34 hips in 26 positional hockey players who underwent arthroscopic correction for symptomatic FAI were retrospectively analyzed. Each patient underwent preoperative anteroposterior (AP) and modified Dunn lateral radiographs and computed tomography (CT) of the affected hips. Common FAI measurements were assessed on plain radiographs. Patient-specific, CT-based 3-dimensional (3D) models of the hip joint were developed, and the femoral version, alpha angles at each radial clock face position, and femoral head coverage were calculated. Maximum hip flexion, abduction, internal rotation in 90° flexion (IRF), flexion/adduction/internal rotation (FADIR), and butterfly position were determined, and the areas of bony collision were defined.

Results

Butterfly goalies had an elevated mean alpha angle on both AP (61.3°) and lateral radiographs (63.4°) and a diminished beta angle (26.0°). The mean lateral center-edge angle (LCEA) measured 27.3° and acetabular inclination was 6.1°. A crossover sign was present in 59% of the hips. The maximum alpha angle on the radial reformatted computed tomographic scan was significantly higher among the butterfly goalies (80.9° v 68.6°; P < .0001) and was located in a more lateral position (1:00 o'clock v. 1:45 o'clock; P < .0001) compared with positional players.

Conclusions

Symptomatic butterfly hockey goalies have a high prevalence of FAI, characterized by a unique femoral cam-type deformity and noted by an elevated alpha angle and loss of offset, which is greater in magnitude and more lateral when compared with that in positional hockey players. Associated acetabular dysplasia is also common among hockey goalies.

Level of Evidence

Level IV, prognostic case series.

Section snippets

Methods

This study was performed under an institutional review board–approved protocol obtained at all participating sites. We performed a retrospective review of a consecutive series of 68 hips in 44 high school, collegiate, and professional butterfly-style hockey goalies. Inclusion criteria included any ice hockey goalie who presented to 2 of the authors' (B.T.K., C.M.L.) clinic with symptomatic hip pain from 2010 to 2013. Additionally, the patients had to be diagnosed with symptomatic FAI by the

Demographics

Sixty-eight hips (44 hockey goalies) were identified during the study period. Thirty-five (51.5%) of the surgical procedures involved the left hip. The average age of the butterfly hockey goalies was 21.1 ± 5.7 years (range, 14 to 43 years). The mean body mass index was 24.7 ± 3.0 kg/m2 (range, 18.5 to 32.1 kg/m2). The demographic data for the comparison positional hockey players were not significantly different when compared with hockey goalies (Table 1).

Plain Film Measurements

Ninety percent (61 of 68) of the hockey

Discussion

Ice hockey players are at increased risk for lower abdominal and groin injuries, which are a common and major cause of disability.2 A National Hockey League study found a cumulative incidence of 20 groin/abdominal injuries per 100 players per year during the 1996 to 1997 season, which was significantly increased from the 1991 to 1992 season.2 Although Stull et al.9 recently pointed to the sprint start position as a potential cause for impingement in positional hockey players, no study has

Conclusions

Symptomatic butterfly hockey goalies have a high prevalence of FAI characterized by a unique femoral cam-type deformity and noted by an elevated alpha angle and loss of offset, which is greater in magnitude and more lateral when compared with that in positional hockey players. Associated acetabular dysplasia is also common among hockey goalies.

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    The authors report the following potential conflict of interest or source of funding: C.M.L. receives support from Smith & Nephew and A3 Surgical.

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