May 2011

Screening has benefit, but Philippon calls for more action to save hips in hockey

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His research group has identified three physical exam findings that can effectively screen for risk of femoral acetabular impingement in adolescent hockey players, but the world’s most famous hip surgeon thinks more drastic preventive measures may be warranted much earlier in a young player’s career.

Marc Philippon, MD, a partner at the Steadman Philippon Research Institute in Vail, CO, was in Monaco to present his group’s findings on the use of physical exam tests to screen for risk of FAI in 18 asymptomatic Major Midget hockey players (average age 17.1). The 12 players with positive scores on the FABER (flexion, abduction, external rotation) and impingement tests and with decreased internal rotation were 15 times more likely than the remaining players to have an alpha angle greater than 64° as measured on MRI.

But, noting the high percentage of players with AA values that many would consider a clinically significant symptom of FAI—not to mention that two players were excluded from the study because they had already undergone bilateral FAI surgery—Philippon suggested that prevention efforts should focus on the risk to young players of intense skating before their physes have closed.

“We have to determine if ice time at a young age is related to alpha angle,” he said. “It may be that, like we do with pitch counts in baseball, we need to limit ice time in young hockey players.”

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