J Korean Orthop Assoc JKOA Journal of the Korean Orthopaedic Association 1226-2102 2005-8918 The Korean Orthopaedic Association 10.4055/jkoa.2011.46.4.303 Original Article Arthroscopic Treatment of Femoroacetabular Impingement in Young Taekwondo Players Kim Pil-Sung M.D. * Hwang Deuk-Soo M.D. Kang Chan M.D. Lee Jung-Bum M.D. † Lee Woo-Wong M.D. Han Sun-Cheol M.D. Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea. Department of Orthopedic Surgery, Bumin Hospital, Seoul, Korea. Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea. Correspondence to: Deuk-Soo Hwang, M.D. Department of Orthopedic Surgery, Chungnam National University School of Medicine, #33, Munhwa-ro, Jung-gu, Daejeon 301-721, Korea. TEL: +82-42-280-7350, FAX: +82-42-252-7098, dshwang@cnu.ac.kr 08 2011 31 08 2011 46 4 303 311 12 10 2010 22 03 2011 Copyright © 2011 by The Korean Orthopaedic Association 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

 Purpose

We wanted to evaluate the clinical results and the radiological and arthroscopic findings of femoroacetabular impingement (FAI) in young Taekwondo players and to investigate the rate of returning-to-play Taekwondo and the recurrence rate.

 Materials and Methods

Twenty Taekwondo players (16 males and, 4 females) who were arthroscopically treated for FAI from September 2003 to July 2008 were retrospectively analyzed. Their mean age was 21.6 years old (range: 17 to 32 years) and the mean follow up was 33.7 months (range: 24 to 71 months). Plain radiographs and 3 dimensional computed tomography were taken in all patients and magnetic resonance arthrography was performed in 11 with suspicious soft tissue lesions. Labral injury, cartilage injury and associated lesions were evaluated by arthroscopy. The preoperative and postoperative visual analogue scale (VAS), the modified Harris hip score (MHHS), the sports frequency score (SFS), and the non-arthritic hip score (NAHS) were compared. We investigated the rate of returning-to-play at postoperative 1 year and at postoperative 2 years and the recurrence rate within 2 years after surgery.

 Results

There were 10 cam types, 1 pincer type and 9 mixed types. The mean alpha angle improved from 65.8 degrees preoperatively to 43.2 degrees postoperatively (p<0.001). Acetabular labral tears were accompanied in all cases and the most common tear site and type were at 2 o'clock and degenerative tear, respectively. In descending order, the acetabular cartilage injuries were located in the anterosuperior, posteroinferior and anterior portion, respectively. The femoral cartilage injuries were mostly located in the anterosuperior portion. The range of motion at the final follow-up showed improvement in all except abduction (p=0.262). The VAS, MHHS and SFS showed statistically significant improvement (p<0.001). The NAHS was improved, but without statistical significance (p=0.31). The rates of returning-to-play at postoperative 1 year and postoperative 2 years were 85% (17/20) and 75% (15/20), respectively. The recurrence rate within postoperative 2 years was 15% (3/20).

 Conclusion

As screening test for FAI in young Taekwondo players is necessary at the beginning of Taekwondo. Arthroscopic treatment in symptomatic Taekwondo players is an effective procedure that can improve the postoperative exercise frequency and function. Returning-to-play Taekwondo is associated with the clinical improvements and the patients' will.

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(A) A frog leg lateral radiograph of a 18-year-old woman professional Taekwondo player, shows a secondary change (black arrow) of the right femoral head-neck junction by pincer impingement. (B) An oblique axial image of CT shows a bump (black arrow) on the right femoral head-neck junction. (C) 3D-CT image. (D) Arthroscopic finding: A debonding unstable acetabular cartilage with labral tear. (E) We performed labral refixation after acetabuloplasty. (F) Arthroscopic femoroplasty was performed.

(A) A plain hip AP radiograph of a 22-year-old man, who was a professional Taekwondo player, shows acetabular retroversion (white arrow) on left hip. (B) Plain hip frog leg lateral radiograph shows a finding of decreased femoral offset and femoral flattening (black arrow). (C) Arthroscopic finding: A labrum at 3 o'clock was torn. (D) Acetabuloplasty after partial labrectomy was performed. (E) Femoroplasty was performed.

Changes of Range of Motion

ER, external rotation; IR, internal rotation.

Changes between the Preoperative and Postoperative Scores

VAS, visual analogue scale; MHHS, modified Harris hip score; SFS, sports frequency score; NAHS, non-arhritic hip score.

Changes of the Sports Frequency Score between the Preoperative and at 1 Year Postoperatively

SFS, sports frequency score.

The Rate of Returning-to-play Taekwondo at 1 Year Postoperatively, at 2 Years Postoperatively and the Recurrence Rate within 2 Years Postoperatively