Is There an Association Between Noncontact Anterior Cruciate Ligament Injuries and Decreased Hip Internal Rotation or Radiographic Femoroacetabular Impingement? A Systematic Review

Nickolas Boutris, Rory A. Byrne, Domenica A. Delgado, Timothy E. Hewett, Patrick McCulloch, David M. Lintner, Joshua D. Harris

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Purpose: To perform a systematic review to determine if there is (1) an association between decreased hip internal rotation and anterior cruciate ligament (ACL) tear rates; (2) an association between radiographic femoroacetabular impingement (FAI) and ACL tear rates; and (3) biomechanical evidence demonstrating increased strain in the ACL of patients with decreased hip internal rotation. Methods: A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies investigating relationships between hip motion, hip radiographs, and ACL tear were sought. Studies with Levels of evidence I-IV were eligible for inclusion. Study methodology/evidence were evaluated using Methodological Index for Non-Randomized Studies (MINORS), Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results: Eleven studies were analyzed (2 cadaveric in vitro models, 8 clinical studies measuring hip internal rotation (2 concurrently assessing radiographic FAI), and 1 clinical study assessing radiographic FAI alone). Mean MINORS, STROBE, and GRADE for the studies was 82.4%, 20.9 out of 22, and "low," respectively. A total of 959 subjects (84.8% male; mean age 23.6 ± 3.8 years) were analyzed. Overall, 378 subjects sustained 427 ACL tears (399 primary ACL ruptures, 28 reruptures). Six of 8 clinical studies identified a significant association between limited rotation (internal rotation [IR; loss greater than 10°-20°], external rotation [ER], or combined IR + ER [loss greater than 20°]) and ACL tears. Two studies found an association between ACL ruptures and radiographic cam/pincer impingement. Two cadaveric models found a significant association between ACL strain and limited hip internal rotation. Conclusions: This systematic review identified a significant association between ACL tear and both limited hip rotation and radiographic FAI. Level of Evidence: Level IV, systematic review of Levels II-IV studies.

Original languageEnglish (US)
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
DOIs
StateAccepted/In press - 2017

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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