Runner’s hip: the possible association between running and the development of degenerative acetabular labral tears (SS-35)

      The increasing use of hip arthroscopy has helped delineate intra-articular pathology to a new level. One group of patients that are prone to hip difficulties is runners. The subtle development of degenerative changes may be a result of the repetitive impact loading associated with running, leading to degeneration accelerated by subtle acetabular deformities and possibly instability. In this series, we present eight cases of acetabular labral tears in high level runners and delineate a common constellation of intra-articular pathology. Materials: From a series of 162 hip arthroscopies, eight high level runners with an average age of 36 (range 19–45) were seen for complaints of increasing hip pain with running with no history of macrotrauma. Medical records, imaging studies, and arthroscopic findings were reviewed. Patients were also administered the WOMAC survey at follow-up. Clinical and radiographic follow-up ranged from 3 to 29 months. Results: All cases were unilateral with respect to the complaints of pain and catching. All of the patients had either run several marathons (4), were triathletes (1), Olympic middle distance runners (1), or had run more than ten miles per week for greater than 5 years (2). All of the patients complained of pain beginning at the start of their runs and progressing in severity with increasing mileage. Two were unable to run altogether as a result of pain. Physical examination was consistent only for pain with forced internal rotation of the affected hip. Plain radiographic analysis revealed no degenerative changes and an average center-edge (CE) angle of 36.7° (range 28°–44°). Six patients underwent preoperative MRI with intra-articular gadolinium. All of these studies revealed anterosuperior labral tears. The two studies without contrast showed no labral tear. All patients underwent hip arthroscopy with labral debridement, with all being in the 10 to 2 o’clock (right hip) region. In six patients, there was also a chondral injury of the acetabular cartilage underlying the labral tear. These lesions were all grade III. In addition, three cases revealed ligamentum teres disruptions. All patients completed the WOMAC scoring scale postoperatively at an average of 9 months (range 3 to 29). The average value was 94. All patients were able to return to their previous running levels. Discussion: The hip joint is exposed to an inordinate amount of force during athletic activities. Few studies have examined the exact role of the labrum in extreme positions, but it is clear that episodic or repetitive maneuvers at the extremes of motion are responsible for some labral pathologies. It is possible that the development of these tears is due to subtle instability which is made worse with the repetitive impact of running, eventually leading to labral tearing and possible ligamentum teres disruption. While this study does not confirm an association between running and the development of labral tears or chondral lesions in the hip, it certainly questions whether there is an injury pattern that is common to this population.