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Meniscal Injuries

History of the Meniscus One of the earliest descriptions of the menisci was recorded by Bland-Sutton in 1897. At that time, the menisci were thought to be vestigial tissue and were depicted as “the functionless remnants of intra-articular leg muscles.” Further advances in our understanding of the menisci have demonstrated that they provide mechanical support and secondary stabilization, localized pressure distribution and load sharing, lubrication, and…

Arthroscopic Synovectomy of the Knee

The synovial lining is a specialized mesenchymal tissue that is integral to the normal functioning of a joint. Synovial disorders can involve varying amounts of the synovium. Rheumatoid arthritis shows total joint involvement, whereas on the other end of the spectrum, plica syndrome is caused by an isolated synovial lesion. Volkman performed the first synovectomy in 1855 for tuberculous synovitis. Although the indications and technique have…

Basics of Knee Arthroscopy

Few areas in orthopaedic surgery have grown as rapidly as knee arthroscopy. Arthroscopy often can be performed more quickly and with increased accuracy, lower complication rates, decreased hospitalization time, and shorter recovery periods, compared with many more open operative techniques. The effective use of arthroscopy is based on the understanding of the benefits and indications for arthroscopy, as well as its limitations. The knee was the…

Imaging of the Knee

Background Imaging plays an important role in diagnosing knee joint pathology. There are a variety of imaging techniques that allow visualization of abnormalities that can affect the bones as well as directly visualizing articular cartilage. In addition, after treatment intervention, imaging can assess interval change. The most common pathologic processes affecting the knee joint are traumatic and degenerative in nature and can be major causes of…

Knee Diagnosis and Decision-Making

For the experienced practitioner, the history and physical examination remains the most efficient, sensitive, specific, accurate, and cost-effective method of establishing a diagnosis in patients with knee-related complaints. Several investigators have demonstrated that the history and physical examination have equivalent sensitivity and specificity to magnetic resonance imaging (MRI) for a variety of intra-articular pathologies, with an overall accuracy of 93%. When taking a systematic approach to…

Hip Arthritis in the Athlete

Hip arthritis is a common disease. One in four people may develop symptomatic hip osteoarthritis in their lifetime. The treatment of arthritis in the active individual is challenging. The often intuitive recommendation of avoiding pain generating activities and sports seems unthinkable to the athlete. Our understanding of the hip joint has increased substantially in the past 2 decades, with the modern description of femoroacetabular impingement by…

Hip and Thigh Contusions and Strains

Contusions Contusions are the most common injuries to the hip, thigh, and pelvis. Collisions with other athletes and falls to the ground are the most common causes of contusions. Contusions can be superficial and limited to the subcutaneous tissue, or they can be deep, involving the bone, muscle, and ligaments. When they are associated with muscle involvement, contusions can result in slow bleeding with significant hematoma…

Hamstring Injuries

Introduction Hamstring injuries are common in athletic populations and can affect athletes at all levels of competition. Several studies have shown that the rates of muscle strain in high school football (12% to 24%) and collegiate football (18.9% to 22.2%) are fairly high. In one study, injury surveillance conducted by the National Football League identified 1716 hamstring strains among all players, with a range of 132…

Posterior Hip Pain

Posterior hip pain can be a debilitating condition, and a structured physical examination is essential for a differential diagnosis in patients with a posterior hip complaint. The examination incorporates the five levels of the hip: osseous, capsulolabral, musculotendinous, neurovascular, and the kinematic chain. To adequately develop a comprehensive treatment plan, diagnostic strategies require the interpretation of abnormal anatomy and biomechanics of each level. Utilizing a comprehensive…

Athletic Pubalgia/Core Muscle Injury and Adductor Pathology

Athletic pubalgia , or core muscle injury, is an umbrella term describing several anatomic injury patterns present in athletes with groin pain. The term sports hernia has fallen out of favor, as it is clearly a misnomer where no true hernia is involved. The correct diagnosis and treatment of this entity can be challenging. However, increased recognition and surgical treatment of athletic pubalgia has increased dramatically…

Peritrochanteric Disorders

Peritrochanteric disorders often present with hip pain that is challenging for the clinician to diagnose and treat. Recently extra-articular disorders that generate pain throughout the hemipelvis have been defined more clearly as biomechanics and anatomic relationships have become better understood. Although nonoperative therapies are sufficient for the treatment of many peritrochanteric disorders, surgical intervention can be utilized in specific cases. Increasingly, the intra-articular advancements in arthroscopy…

Iliopsoas Pathology

The iliopsoas musculotendinous unit is a powerful hip flexor that is important for normal hip strength and function; however, disorders of the iliopsoas can be a significant source of pain and disability in the athletic population. These conditions include iliopsoas bursitis, tendonitis, impingement, and snapping; they have been shown to be the primary cause of chronic groin pain in 12% to 36% of athletes and are…

Hip Dysplasia and Instability

Overview of Pathologies Hip dysplasia, or developmental dysplasia of the hip (DDH), is a common cause of pain in young adults, including athletes. Hip dysplasia encompasses a wide spectrum of disease pathology, from severe dysplasia with hip subluxation/dislocation, to milder deformities often not recognized until adulthood. Several factors appear to play a role in the pathophysiology of hip dysplasia, including acetabular deformity (acetabular dysplasia), femoral deformity…

Femoroacetabular Impingement in Athletes

The concept of hip impingement was first described in the medical literature in the 19th century, and the idea that variations in hip morphology can contribute to secondary hip arthritis has been known for more than 100 years. The first surgical description of treating femoral head and neck deformities appeared in 1913, with good results following resection. The modern concept of femoroacetabular impingement (FAI) was formulated…

Hip Arthroscopy

The technique of hip arthroscopy has undergone a period of rapid evolution and growth. In its infancy, hip arthroscopy was mostly for diagnostic and limited therapeutic utility. It was “a technique looking for indications.” Now, improved understanding of intra- and extra-articular hip disease has led to increased investigation of both non- and prearthritic hip disorders. The unique technical challenges to arthroscopic access imposed by the hip…

Hip Imaging

A multitude of structural hip disorders can occur in athletes with hip pain. Although the history and physical examination play a critical role in determining the diagnosis, it is also important to have a systematic approach to help diagnose these disorders radiographically. This chapter describes the key imaging studies used when examining a skeletally mature patient with a pathologic hip, as well as a systematic approach…

Hip Diagnosis and Decision-Making

Overview of Pathologies Understanding the differential diagnosis for hip pathology is necessary before collecting a history and performing a physical examination. This background allows the clinician to tease out important elements in the history to narrow the differential and provide a focus for the physical examination. An overview of hip pathology is presented in the following sections ( Box 77.1 ). Box 77.1 Overview of Hip…

Hip Anatomy and Biomechanics

The hip joint ( coxa in Latin) is the articulation connecting the pelvis and the femur. It is an encapsulated synovial joint with a ball-and-socket architecture in which the femoral head is the ball and the acetabulum is the socket. Although its structure may seem simple, it is actually very complex, with more than 20 muscles spanning the joint and a three-dimensional (3D) bony morphology that…

Neuropathies of the Wrist and Hand

Although athletes at all levels of participation may experience the same entrapment neuropathies as the general population, some sport-specific peripheral nerve factors must be considered with regard to the wrist and hand. Neuropathies may occur as a result of chronic repetitive motion or acute isolated trauma experienced during athletic activities. Just as with other pathologies that may have an effect on, or be affected by, sports…