Advertisement

Restricted Hip Rotation Is Correlated With an Increased Risk for Anterior Cruciate Ligament Injury

Published:November 10, 2016DOI:https://doi.org/10.1016/j.arthro.2016.08.014

      Purpose

      The primary purpose was to compare ipsilateral hip internal rotation (IR) in male and female athletes with or without an anterior cruciate ligament (ACL) tear. A secondary purpose was to compare radiographic markers of femoroacetabular impingement (FAI) in patients with or without an ACL tear.

      Methods

      In this prospective case-control study, based on a power analysis, a convenience sample of 25 ACL-injured and 25 control patients matched by age and gender were examined over 14 months. The ACL injury group included preoperative patients 12-40 years old with an ACL rupture within the previous 3 months with no prior lower extremity injuries, ligamentous laxity, or arthralgias. Controls included patients presenting with an upper extremity complaint with no history of knee injury. In the outpatient clinic, hip axial rotation range of motion was measured with a goniometer on physical examination and hip radiographs were evaluated for morphologic variations consistent with FAI. Univariate analysis of variance was used to examine differences between groups.

      Results

      Each group had 13 males and 12 females, average ages of 22.8 ± 7.2 years (ACL group) versus 24.5 ± 7.9 years (controls; P = .439). The average sum of hip rotation (internal plus external) in patients with an ACL tear was 60.3 ± 12.4° compared with 72.6 ± 17.2° in controls (P = .006). ACL-injured patients had decreased hip IR compared with controls, with respective mean measurements of 23.4 ± 7.6° versus 30.4 ± 10.4° (P = .009). For every 10° increase in hip IR, the odds of having an ACL tear decreased by a factor of 0.419 (P = .015).

      Conclusions

      Risk of ACL injury is associated with restricted hip IR, and as hip IR increases, the odds of having an ACL tear decreases. In addition, ACL injury is associated with FAI in a generalized population of male and female athletes, although causality cannot be determined and most ACL-injured patients do not exhibit hip complaints.

      Level of Evidence

      Level II, prognostic, prospective cohort study.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Joseph A.M.
        • Collins C.L.
        • Henke N.M.
        • Yard E.E.
        • Fields S.K.
        • Comstock R.D.
        A multisport epidemiologic comparison of anterior cruciate ligament injuries in high school athletics.
        J Athl Train. 2013; 48: 810-817
        • McCarthy M.M.
        • Voos J.E.
        • Nguyen J.T.
        • Callahan L.
        • Hannafin J.A.
        Injury profile in elite female basketball athletes at the Women's National Basketball Association combine.
        Am J Sports Med. 2013; 41: 645-651
        • Riordan E.A.
        • Frobell R.B.
        • Roemer F.W.
        • Hunter D.J.
        The health and structural consequences of acute knee injuries involving rupture of the anterior cruciate ligament.
        Rheum Dis Clin North Am. 2013; 39: 107-122
        • Orchard J.
        • Seward H.
        • McGivern J.
        • Hood S.
        Intrinsic and extrinsic risk factors for anterior cruciate ligament injury in Australian footballers.
        Am J Sports Med. 2001; 29: 196-200
        • Shultz S.J.
        • Schmitz R.J.
        • Benjaminse A.
        • Chaudhari A.M.
        • Collins M.
        • Padua D.A.
        ACL Research Retreat VI: An update on ACL injury risk and prevention.
        J Athl Train. 2012; 47: 591-603
        • Kristianslund E.
        • Krosshaug T.
        Comparison of drop jumps and sport-specific sidestep cutting: Implications for anterior cruciate ligament injury risk screening.
        Am J Sports Med. 2013; 41: 684-688
        • Shin C.S.
        • Chaudhari A.M.
        • Andriacchi T.P.
        Valgus plus internal rotation moments increase anterior cruciate ligament strain more than either alone.
        Med Sci Sports Exerc. 2011; 43: 1484-1491
        • Torry M.R.
        • Shelburne K.B.
        • Myers C.
        • et al.
        High knee valgus in female subjects does not yield higher knee translations during drop landings: A biplane fluoroscopic study.
        J Orthop Res. 2013; 31: 257-267
        • Wordeman S.C.
        • Quatman C.E.
        • Kaeding C.C.
        • Hewett T.E.
        In vivo evidence for tibial plateau slope as a risk factor for anterior cruciate ligament injury: A systematic review and meta-analysis.
        Am J Sports Med. 2012; 40: 1673-1681
        • Audenaert E.A.
        • Peeters I.
        • Vigneron L.
        • Baelde N.
        • Pattyn C.
        Hip morphological characteristics and range of internal rotation in femoroacetabular impingement.
        Am J Sports Med. 2012; 40: 1329-1336
        • Ellera Gomes J.L.
        • Palma H.M.
        • Ruthner R.
        Influence of hip restriction on noncontact ACL rerupture.
        Knee Surg Sports Traumatol Arthrosc. 2014; 22: 188-191
        • Gomes J.L.
        • de Castro J.V.
        • Becker R.
        Decreased hip range of motion and noncontact injuries of the anterior cruciate ligament.
        Arthroscopy. 2008; 24: 1034-1037
        • Lopes Jr., O.V.
        • Gomes J.L.
        • de Freitas Spinelli L.
        Range of motion and radiographic analysis of the hip in patients with contact and non-contact anterior cruciate ligament injury.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 2868-2873
        • Tainaka K.
        • Takizawa T.
        • Kobayashi H.
        • Umimura M.
        Limited hip rotation and non-contact anterior cruciate ligament injury: A case-control study.
        Knee. 2014; 21: 86-90
        • Bedi A.
        • Warren R.F.
        • Wojtys E.M.
        • et al.
        Restriction in hip internal rotation is associated with an increased risk of ACL injury.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 2024-2031
        • Philippon M.
        • Dewing C.
        • Briggs K.
        • Steadman J.R.
        Decreased femoral head-neck offset: A possible risk factor for ACL injury.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 2585-2589
        • Hack K.
        • Di Primio G.
        • Rakhra K.
        • Beaule P.E.
        Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers.
        J Bone Joint Surg Am. 2010; 92: 2436-2444
        • Jung K.A.
        • Restrepo C.
        • Hellman M.
        • AbdelSalam H.
        • Morrison W.
        • Parvizi J.
        The prevalence of cam-type femoroacetabular deformity in asymptomatic adults.
        J Bone Joint Surg Br. 2011; 93: 1303-1307
        • Frank J.M.
        • Harris J.D.
        • Erickson B.J.
        • et al.
        Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: A systematic review.
        Arthroscopy. 2015; 31: 1199-1204
        • Laborie L.B.
        • Lehmann T.G.
        • Engesaeter I.O.
        • Eastwood D.M.
        • Engesaeter L.B.
        • Rosendahl K.
        Prevalence of radiographic findings thought to be associated with femoroacetabular impingement in a population-based cohort of 2081 healthy young adults.
        Radiology. 2011; 260: 494-502
        • Monazzam S.
        • Bomar J.D.
        • Dwek J.R.
        • Hosalkar H.S.
        • Pennock A.T.
        Development and prevalence of femoroacetabular impingement-associated morphology in a paediatric and adolescent population: A CT study of 225 patients.
        Bone Joint J. 2013; 95-B: 598-604
        • Reichenbach S.
        • Juni P.
        • Werlen S.
        • et al.
        Prevalence of cam-type deformity on hip magnetic resonance imaging in young males: A cross-sectional study.
        Arthritis Care Res (Hoboken). 2010; 62: 1319-1327
        • Olsen O.E.
        • Myklebust G.
        • Engebretsen L.
        • Bahr R.
        Injury mechanisms for anterior cruciate ligament injuries in team handball: A systematic video analysis.
        Am J Sports Med. 2004; 32: 1002-1012
        • Quatman C.E.
        • Kiapour A.M.
        • Demetropoulos C.K.
        • et al.
        Preferential loading of the ACL compared with the MCL during landing: A novel in sim approach yields the multiplanar mechanism of dynamic valgus during ACL injuries.
        Am J Sports Med. 2014; 42: 177-186
        • Oh Y.K.
        • Kreinbrink J.L.
        • Wojtys E.M.
        • Ashton-Miller J.A.
        Effect of axial tibial torque direction on ACL relative strain and strain rate in an in vitro simulated pivot landing.
        J Orthop Res. 2012; 30: 528-534
        • Oh Y.K.
        • Lipps D.B.
        • Ashton-Miller J.A.
        • Wojtys E.M.
        What strains the anterior cruciate ligament during a pivot landing?.
        Am J Sports Med. 2012; 40: 574-583
        • Beaulieu M.L.
        • Oh Y.K.
        • Bedi A.
        • Ashton-Miller J.A.
        • Wojtys E.M.
        Does limited internal femoral rotation increase peak anterior cruciate ligament strain during a simulated pivot landing?.
        Am J Sports Med. 2014; 42: 2955-2963
        • Beaulieu M.L.
        • Wojtys E.M.
        • Ashton-Miller J.A.
        Risk of anterior cruciate ligament fatigue failure is increased by limited internal femoral rotation during in vitro repeated pivot landings.
        Am J Sports Med. 2015; 43: 2233-2241
        • Sankar W.N.
        • Laird C.T.
        • Baldwin K.D.
        Hip range of motion in children: What is the norm?.
        J Pediatr Orthop. 2012; 32: 399-405
        • Nepple J.J.
        • Prather H.
        • Trousdale R.T.
        • et al.
        Diagnostic imaging of femoroacetabular impingement.
        J Am Acad Orthop Surg. 2013; 21: S20-S26
        • Bedi A.
        • Dolan M.
        • Leunig M.
        • Kelly B.T.
        Static and dynamic mechanical causes of hip pain.
        Arthroscopy. 2011; 27: 235-251
        • de Castro J.V.
        • Machado K.C.
        • Scaramussa K.
        • Gomes J.L.
        Incidence of decreased hip range of motion in youth soccer players and response to a stretching program: A randomized clinical trial.
        J Sport Rehabil. 2013; 22: 100-107
        • Mandelbaum B.R.
        • Silvers H.J.
        • Watanabe D.S.
        • et al.
        Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up.
        Am J Sports Med. 2005; 33: 1003-1010
        • Palmer K.
        • Hebron C.
        • Williams J.M.
        A randomised trial into the effect of an isolated hip abductor strengthening programme and a functional motor control programme on knee kinematics and hip muscle strength.
        BMC Musculoskelet Disord. 2015; 16: 105
        • Bedi A.
        • Dolan M.
        • Hetsroni I.
        • et al.
        Surgical treatment of femoroacetabular impingement improves hip kinematics: A computer-assisted model.
        Am J Sports Med. 2011; 39: 43S-49S
        • Kelly B.T.
        • Bedi A.
        • Robertson C.M.
        • Dela Torre K.
        • Giveans M.R.
        • Larson C.M.
        Alterations in internal rotation and alpha angles are associated with arthroscopic cam decompression in the hip.
        Am J Sports Med. 2012; 40: 1107-1112
        • Kubiak-Langer M.
        • Tannast M.
        • Murphy S.B.
        • Siebenrock K.A.
        • Langlotz F.
        Range of motion in anterior femoroacetabular impingement.
        Clin Orthop Relat Res. 2007; 458: 117-124
        • Doege T.C.
        • Houston T.P.
        Guide to the evaluation of permanent impairment.
        Ed 4. American Medical Association, Chicago1995
        • Kettunen J.A.
        • Kujala U.M.
        • Raty H.
        • et al.
        Factors associated with hip joint rotation in former elite athletes.
        Br J Sports Med. 2000; 34: 44-48
        • Kouyoumdjian P.
        • Coulomb R.
        • Sanchez T.
        • Asencio G.
        Clinical evaluation of hip joint rotation range of motion in adults.
        Orthop Traumatol Surg Res. 2012; 98: 17-23
        • Macedo L.G.
        • Magee D.J.
        Differences in range of motion between dominant and nondominant sides of upper and lower extremities.
        J Manipulative Physiol Ther. 2008; 31: 577-582
        • Sauers E.L.
        • Huxel Bliven K.C.
        • Johnson M.P.
        • Falsone S.
        • Walters S.
        Hip and glenohumeral rotational range of motion in healthy professional baseball pitchers and position players.
        Am J Sports Med. 2014; 42: 430-436
        • Kaneko M.
        • Sakuraba K.
        Association between femoral anteversion and lower extremity posture upon single-leg landing: Implications for anterior cruciate ligament injury.
        J Phys Ther Sci. 2013; 25: 1213-1217