Cyclists Have Greater Chondromalacia Index Than Age-Matched Controls at the Time of Hip Arthroscopy

Austin V. Stone; Elizabeth A. Howse; Sandeep Mannava; Allston J. Stubbs

doi:10.1016/j.arthro.2016.04.014

Cyclists Have Greater Chondromalacia Index Than Age-Matched Controls at the Time of Hip Arthroscopy

Austin V. Stone
, Elizabeth A. Howse
, Sandeep Mannava
, Allston J. Stubbs

College of Medicine

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

Purpose To evaluate the clinical symptoms and intraoperative pathology associated with hip pain in the cyclist compared with a matched hip arthroscopy surgical group. Methods In an institutional review board–approved study, we retrospectively reviewed a prospective database of 1,200 consecutive hip arthroscopy patients from 2008 to 2015. Adult patients were identified who reported cycling as a major component of their activity. Patients were age, gender, and body mass index matched to a control, noncycling group. Pain symptoms, preoperative examinations, radiographic and operative findings were compared. Primary outcome variables included the femoral and acetabular Outerbridge chondromalacia grade. Additional outcome measurements included the involved area and the chondromalacia index (CMI; the product of the Outerbridge chondromalacia grade and surface area [mm² × severity]). Results A total of 167 noncyclists were matched to the cycling group (n = 16). Cyclists had significantly greater femoral head chondromalacia grade (2.0 [95% confidence interval (CI), 1.5-2.5] v 1.4 [95% CI, 1.3-1.6], P =.043), femoral head chondromalacia area (242 mm² [95% CI, 191-293 mm²] v 128 mm² [95% CI, 113-141 mm²], P <.001), and femoral head CMI (486 [95% CI, 358-615] v 247 [95% CI, 208-286], P =.001) assessed intraoperatively. Hip pain in cyclists positively correlated with an increased acetabular center-edge angle (R = 0.261, P <.001) and an increased Tonnis grade (R = 0.305, P <.001). Cyclists were also more likely to have a coxalgic gait on physical examination (R = 0.250, P =.006). Conclusions Cyclists had a greater degree of femoral chondromalacia than a matched group of noncyclists. Cycling activity positively correlated with the presence of femoral chondromalacia with clinically significant gait alterations. These data support the hypothesis that cyclists with hip pain have more chondral pathology than a similar group of other patients with hip pain. Ultimately, cyclists with hip pain should be identified as higher risk for more advanced chondral damage. Level of Evidence Level III, case-control study, therapeutic.

Original language	English
Pages (from-to)	2102-2109
Number of pages	8
Journal	Arthroscopy - Journal of Arthroscopic and Related Surgery
Volume	32
Issue number	10
DOIs	https://doi.org/10.1016/j.arthro.2016.04.014
State	Published - Oct 1 2016

Bibliographical note

Publisher Copyright:
© 2016 Arthroscopy Association of North America

Funding

The authors report the following potential conflict of interest or source of funding: A.J.S. receives support from International Society of Hip Arthroscopy (board membership, no payment received), Smith & Nephew Endoscopy (consultant for company; no money/financial benefit received for this project), Wake Forest Baptist Health (employee), Bauerfeind (research grant support not related to this project), patents pending not related to project, Johnson & Johnson (shareholder), Arthroscopy Association of North America (committee member), Journal of Arthroscopy (editorial board member), and American Orthopaedic Society for Sports Medicine (committee member). S.M. receives support from a Wake Forest Innovations Spark Award Research Grant (institutional research funding for development of a tensioning device for use during rotator cuff tendon repair and similar tendon repair surgery) and a patent issued to Mannava S, Tanaka MF, Tuohy CJ, Wake Forest University Health Sciences, Patent No. 08926626 awarded January 6, 2015, by the United States Patent and Trademark Office. A.V.S. receives support from Smith & Nephew (grant for suture anchor and graft research). This study was internally funded by the Department of Orthopaedics, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A.

Funders	Funder number
Department of Orthopaedics
University of North Carolina and North Carolina State University
Smith & Nephew
Wake Forest Innovations Spark
Wake Forest School of Medicine, Winston-Salem
Wake Forest University Health Sciences	08926626

ASJC Scopus subject areas

Orthopedics and Sports Medicine

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10.1016/j.arthro.2016.04.014

Cite this

@article{0de980c79fb649b78ea8bf6cb4a2eb61,

title = "Cyclists Have Greater Chondromalacia Index Than Age-Matched Controls at the Time of Hip Arthroscopy",

abstract = "Purpose To evaluate the clinical symptoms and intraoperative pathology associated with hip pain in the cyclist compared with a matched hip arthroscopy surgical group. Methods In an institutional review board{\textendash}approved study, we retrospectively reviewed a prospective database of 1,200 consecutive hip arthroscopy patients from 2008 to 2015. Adult patients were identified who reported cycling as a major component of their activity. Patients were age, gender, and body mass index matched to a control, noncycling group. Pain symptoms, preoperative examinations, radiographic and operative findings were compared. Primary outcome variables included the femoral and acetabular Outerbridge chondromalacia grade. Additional outcome measurements included the involved area and the chondromalacia index (CMI; the product of the Outerbridge chondromalacia grade and surface area [mm2 {\texttimes} severity]). Results A total of 167 noncyclists were matched to the cycling group (n = 16). Cyclists had significantly greater femoral head chondromalacia grade (2.0 [95\% confidence interval (CI), 1.5-2.5] v 1.4 [95\% CI, 1.3-1.6], P =.043), femoral head chondromalacia area (242 mm2 [95\% CI, 191-293 mm2] v 128 mm2 [95\% CI, 113-141 mm2], P <.001), and femoral head CMI (486 [95\% CI, 358-615] v 247 [95\% CI, 208-286], P =.001) assessed intraoperatively. Hip pain in cyclists positively correlated with an increased acetabular center-edge angle (R = 0.261, P <.001) and an increased Tonnis grade (R = 0.305, P <.001). Cyclists were also more likely to have a coxalgic gait on physical examination (R = 0.250, P =.006). Conclusions Cyclists had a greater degree of femoral chondromalacia than a matched group of noncyclists. Cycling activity positively correlated with the presence of femoral chondromalacia with clinically significant gait alterations. These data support the hypothesis that cyclists with hip pain have more chondral pathology than a similar group of other patients with hip pain. Ultimately, cyclists with hip pain should be identified as higher risk for more advanced chondral damage. Level of Evidence Level III, case-control study, therapeutic.",

author = "Stone, \{Austin V.\} and Howse, \{Elizabeth A.\} and Sandeep Mannava and Stubbs, \{Allston J.\}",

note = "Publisher Copyright: {\textcopyright} 2016 Arthroscopy Association of North America",

year = "2016",

month = oct,

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doi = "10.1016/j.arthro.2016.04.014",

language = "English",

volume = "32",

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T1 - Cyclists Have Greater Chondromalacia Index Than Age-Matched Controls at the Time of Hip Arthroscopy

AU - Stone, Austin V.

AU - Howse, Elizabeth A.

AU - Mannava, Sandeep

AU - Stubbs, Allston J.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Purpose To evaluate the clinical symptoms and intraoperative pathology associated with hip pain in the cyclist compared with a matched hip arthroscopy surgical group. Methods In an institutional review board–approved study, we retrospectively reviewed a prospective database of 1,200 consecutive hip arthroscopy patients from 2008 to 2015. Adult patients were identified who reported cycling as a major component of their activity. Patients were age, gender, and body mass index matched to a control, noncycling group. Pain symptoms, preoperative examinations, radiographic and operative findings were compared. Primary outcome variables included the femoral and acetabular Outerbridge chondromalacia grade. Additional outcome measurements included the involved area and the chondromalacia index (CMI; the product of the Outerbridge chondromalacia grade and surface area [mm2 × severity]). Results A total of 167 noncyclists were matched to the cycling group (n = 16). Cyclists had significantly greater femoral head chondromalacia grade (2.0 [95% confidence interval (CI), 1.5-2.5] v 1.4 [95% CI, 1.3-1.6], P =.043), femoral head chondromalacia area (242 mm2 [95% CI, 191-293 mm2] v 128 mm2 [95% CI, 113-141 mm2], P <.001), and femoral head CMI (486 [95% CI, 358-615] v 247 [95% CI, 208-286], P =.001) assessed intraoperatively. Hip pain in cyclists positively correlated with an increased acetabular center-edge angle (R = 0.261, P <.001) and an increased Tonnis grade (R = 0.305, P <.001). Cyclists were also more likely to have a coxalgic gait on physical examination (R = 0.250, P =.006). Conclusions Cyclists had a greater degree of femoral chondromalacia than a matched group of noncyclists. Cycling activity positively correlated with the presence of femoral chondromalacia with clinically significant gait alterations. These data support the hypothesis that cyclists with hip pain have more chondral pathology than a similar group of other patients with hip pain. Ultimately, cyclists with hip pain should be identified as higher risk for more advanced chondral damage. Level of Evidence Level III, case-control study, therapeutic.

AB - Purpose To evaluate the clinical symptoms and intraoperative pathology associated with hip pain in the cyclist compared with a matched hip arthroscopy surgical group. Methods In an institutional review board–approved study, we retrospectively reviewed a prospective database of 1,200 consecutive hip arthroscopy patients from 2008 to 2015. Adult patients were identified who reported cycling as a major component of their activity. Patients were age, gender, and body mass index matched to a control, noncycling group. Pain symptoms, preoperative examinations, radiographic and operative findings were compared. Primary outcome variables included the femoral and acetabular Outerbridge chondromalacia grade. Additional outcome measurements included the involved area and the chondromalacia index (CMI; the product of the Outerbridge chondromalacia grade and surface area [mm2 × severity]). Results A total of 167 noncyclists were matched to the cycling group (n = 16). Cyclists had significantly greater femoral head chondromalacia grade (2.0 [95% confidence interval (CI), 1.5-2.5] v 1.4 [95% CI, 1.3-1.6], P =.043), femoral head chondromalacia area (242 mm2 [95% CI, 191-293 mm2] v 128 mm2 [95% CI, 113-141 mm2], P <.001), and femoral head CMI (486 [95% CI, 358-615] v 247 [95% CI, 208-286], P =.001) assessed intraoperatively. Hip pain in cyclists positively correlated with an increased acetabular center-edge angle (R = 0.261, P <.001) and an increased Tonnis grade (R = 0.305, P <.001). Cyclists were also more likely to have a coxalgic gait on physical examination (R = 0.250, P =.006). Conclusions Cyclists had a greater degree of femoral chondromalacia than a matched group of noncyclists. Cycling activity positively correlated with the presence of femoral chondromalacia with clinically significant gait alterations. These data support the hypothesis that cyclists with hip pain have more chondral pathology than a similar group of other patients with hip pain. Ultimately, cyclists with hip pain should be identified as higher risk for more advanced chondral damage. Level of Evidence Level III, case-control study, therapeutic.

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Cyclists Have Greater Chondromalacia Index Than Age-Matched Controls at the Time of Hip Arthroscopy

Abstract

Bibliographical note

Funding

ASJC Scopus subject areas

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