Young Athletic Population Research Articles

Arrhythmias in Athletes: From Pathologic Substrates to Life-Saving Shock Therapy

Arrhythmias in Athletes: From Pathologic Substrates to Life-Saving Shock Therapy

Factor V Leiden Thrombophilia in a Female Collegiate Soccer Athlete: A Case Report

To raise awareness among health care providers caring for an active population to an uncommon genetic mutation that increases the risk for a potentially fatal venous thromboembolism. A 19-year-old previously healthy female collegiate soccer athlete complained of coughing and progressively decreased exercise tolerance, which were attributed to a recent illness and lack of sleep. Later that evening, she complained of dyspnea and pleuritic pain and was referred to the emergency department. Bilateral pulmonary emboli were identified with computed tomography, and a hypercoagulable panel revealed that the patient was heterozygous for the factor V Leiden mutation. Pneumonia, pneumothorax, pericarditis, pleuritis, gastroesophageal reflux disease, pulmonary embolism. Intravenous heparin therapy was initiated immediately in the emergency department. This was followed by inpatient anticoagulant therapy for 5 days and outpatient anticoagulant therapy for an additional 12 months. During this time, the patient was unable to participate in soccer drills or return to competition and was limited to conditioning activities due to the risk of increased bleeding time. Documented cases of pulmonary embolism in a young athletic population are rare and are usually associated with genetic risk factors. Factor V Leiden is a relatively uncommon genetic mutation that dramatically increases the risk for venous thromboembolism. Although the fatality rate in this population is low, fatality is preventable if the condition is recognized early and managed properly. Athletes should be encouraged to communicate with their athletic trainers regarding any changes in health status or medication usage. When an athlete presents with nonspecific symptoms such as dyspnea and chest pain, athletic trainers should consider the possibility of pulmonary embolism. A high degree of suspicion results in early diagnosis and treatment and may prevent a fatal event.

Normative Values for the KOOS and WOMAC in a Young Athletic Population

Background: The use of patient-reported outcome measures to assess clinical outcomes after injury and surgery has become common in treating young athletes with orthopaedic injuries; however, normative data for these measures are limited and often include a wide range of ages and activity levels. Purpose: To provide normative data for the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in a young and athletic population, and to compare scores between participants with a history of knee ligament injury and those with no history. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We administered the KOOS and WOMAC to 1177 college freshmen entering the United States Military Academy in June 2011. All participants were healthy and had been medically screened to meet the physical induction standards for military service. We calculated means, standard deviations, percentiles, ranges, and interquartile ranges for the KOOS and WOMAC by sex and injury history. We also compared median scale scores for those with a history of knee ligament injury with those with no history using the Kruskal-Wallis test. Results: Among the 1177 participants, 971 were male (age, 18.8 ± 0.9 years), and the remaining 206 were female (age, 18.7 ± 0.8 years). Normative median values and interquartile ranges (IQRs) for the KOOS scale scores among men with no history of knee ligament injury were the following: Symptoms (96.4; IQR, 10.7), Pain (100; IQR, 2.8), Functional Activities of Daily Living (ADL) (100; IQR, 0.0), Sports and Recreation Function (100; IQR, 5.0), and Knee-Related Quality of Life (QOL) (100; IQR, 12.5). For women with no history of knee ligament injury, the KOOS scale scores were the following: Symptoms (92.9; IQR, 14.3), Pain (100; IQR, 5.6), Functional ADL (100; IQR, 2.9), Sports and Recreation Function (100; IQR, 10.0), and Knee-Related QOL (93.8; IQR, 18.8). Among the men, 139 (14%) reported a history of knee ligament injury, while 33 (16%) women also reported a history of injury. All KOOS scale scores and the WOMAC Stiffness and Function scale scores were significantly lower (P < .05) for men who reported a history of knee ligament injury. Similarly, Symptoms, Pain, and Knee-Related QOL on the KOOS and Pain on the WOMAC were significantly lower among women with a history of knee ligament injury. Conclusion: Normative values for all KOOS scales suggest a high level of functioning among participants with no history of knee ligament injury. Despite meeting the medical standards for military service, participants with a history of knee ligament injury had significantly lower KOOS and WOMAC scores upon entry to military service.

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC/D): A Systematic Literature Review

Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a genetic form of cardiomyopathy (CM) usually transmitted with an autosomal dominant pattern. It primary affects the right ventricle (RV), but may involve the left ventricle (LV) and culminate in biventricular heart failure (HF), life threatening ventricular arrhythmias and sudden cardiac death (SCD). It accounts for 11%–22% of cases of SCD in the young athlete population. Pathologically is characterized by myocardial atrophy, fibrofatty replacement and chamber dilation.Diagnosis is often difficult due to the nonspecific nature of the disease and the broad spectrum of phenotypic variations. Therefore consensus diagnostic criteria have been developed and combined electrocardiography, echocardiography, cardiac magnetic resonance imaging (CMRI) and myocardial biopsy. Early detection, family screening and risk stratification are the cornerstones in the diagnostic evaluation. Implantable cardioverter-defibrillator (ICD) implantation, ablative procedures and heart transplantation are currently the main therapeutic options.

The Meniscus—A Key to Unfolding the Mystery of Osteoarthritis

Our appreciation of the molecular organization of the meniscus is leading to a greater understanding of its cellular function in disease. Meniscal tears can lead to knee osteoarthritis, but knee osteoarthritis can lead to a spontaneous meniscal tear through breakdown of the meniscal structure1. This study is timely and relevant regarding the predicted increase in the prevalence of new cases of osteoarthritis in the young athletic population of both sexes. The cross-reactivity of several molecular markers associated with osteoarthritis was demonstrated in the torn meniscus. Although the authors chose an age cutoff of forty years, the age at onset of meniscal injury influences the primary cellular response. Age-related changes coupled with tear location within the meniscus and contributions of the synovial fluid could influence gene expression. There is ample evidence that the meniscus has a related but distinct molecular signature that is different from that found in articular cartilage. The collagen ultrastructure places the meniscus at risk for longitudinal tears. Torn menisci and concomitant anterior cruciate ligament (ACL) rupture possess unique and specific phenotypic cells and gene expression with combined injuries. …

Review of Acetabular Labral Tears in Dancers

Over the past decade numerous articles have been published regarding the hip labrum. Injuries to the labrum are becoming better understood as biomechanical, kinematic, and diagnostic technologies improve. When the last article on acetabular labral tears appeared in the Journal of Dance Medicine and Science in 2006, this injury was widely handled surgically by debridement. Just 5 years later, we see a shift toward preservation and repair of the labrum and correction of morphology when possible. This change in philosophy has come about as new information on the function of the labrum and the stresses placed upon it at extremes of hip range of motion became available. It is now felt that an intact labrum is useful for preserving the hip's articular cartilage. The change in surgical technique has also necessitated a change in rehabilitation protocols focused on protecting the healing labrum and chondral surface. The vast majority of research available for analysis has not been addressed specifically to a dance population, yet most is relevant and helpful in determining better treatment for dancers. This article reviews the latest available data on labral function, stresses on the labrum resulting from dance, clinical and diagnostic detection of labral tears, and outcomes of labral tear treatment in the young athletic population, including dancers. Recommendations are offered to improve data collection and focus for future research.

Caracterización antropométrica y maduración de una población de futbolistas jóvenes portugueses

ObjectiveTo describe the anthropometric and maturity characteristics of a young athlete population who wish to play professional football SampleWe studied 108 players (14-16 years) belonging to the schools of Sporting Club of Portugal. MethodsThe variables used in this study were weight, height, predicted height and sitting height, maturity and the specific position. The players were grouped by age and by specific positions. ResultsWe found significant differences by age in all variables except for height prediction. The centers presented significant differences in all variables when compared with the forwards, in all but the weight when compared with the defenders, and in stature when compared with the goalkeepers. ConclusionsHeight and weight are not critical for performance, but should be considered for the choice of certain specific positions.

Impacto de la maduración y de los puestos específicos en la condición física en jóvenes futbolistas

ObjectiveTo describe the physical fitness of a young athlete population grouped in two categories: maturity and specific positions. SampleWe studied 95 players (13-16 years) belonging to soccer schools. MethodsThe variables used in this study were age, the specific position (center, defense, forward, goalkeeper), weight, height, maturity, the aerobic capacity, the maximum isometric strength of the upper arms, the maximum force, the explosive force and elastic-explosive of the lower body, speed in 30m (time), the rate of change of direction and agility and trunk flexibility. ResultsSignificant differences were found between normal and delayed maturity groups in: linear velocity, static force, maximum isometric force (right) and production of maximum rate of force. The same results and also significant differences in the variable flexibility were observed between delayed and advanced maturity groups. Significant differences were found between specific position (midfielders and forwards) in the static force variable. Conclusions(i) Advanced players (in maturity) scored better in physical fitness, (ii) the physical fitness evaluation at these ages does not appear to be appropriate to select soccer players, (iii) it seems important to include specific training for each position, (iv) it seems important to give more attention to goalkeeper training.

Clinical Outcomes Following Hip Arthroscopy for Femoroacetabular Impingement in Adolescents (SS-36)

Introduction There are many etiologies of adolescent hip impingement that, once symptomatic, can progress to labral tears or chondral lesions. As the teenager grows and engages sooner in competitive sports, more sport-induced hip pain is seen in this young athletic population, including femoroacetabular impingement (FAI). There are very few large studies with greater than one year outcomes of adolescent hip arthroscopy for hip impingement. The goal of this study is to report clinical outcomes and revision rates in the adolescent population after hip arthroscopy for FAI with subsequent labral tear and chondral lesions with a minimum 2 years follow-up. Methods After IRB approval was obtained, prospectively collected data on 70 consecutive adolescents who were 16 years of age or younger and underwent hip arthroscopy for FAI were retrospectively reviewed. All patients had either isolated cam impingement, isolated pincer impingement, or mixed pathology. Surgical treatment for FAI in this adolescent population was with hip arthroscopic acetabular or femoral head-neck osteoplasty, labral debridement versus suture anchor repair, or a chondroplasty for articular cartilage defects. A limited osteoplasty was performed on cam lesion with an open physis. Data analyzed included patient demographics, radiographic parameters, intra-operative findings, and clinical outcomes at a minimum of 2 years. Clinical outcomes measurements included the modified Harris Hip Score (mHHS), and patient satisfaction with outcome (10=very satisfied, 1=very unsatisfied). Results Mean age at time of surgery was 15 years (range, 13 to 16 years) with 22 males and 48 females. CAM impingement was found in 10% of cases, pincer type in 15%, and mixed-type in 75%. Femoral head-neck osteoplasty was performed in 56 patients and rim trimming was performed in 55 patients. Labral tears were identified in all patients, and 83% of these were repaired. The remaining labral tears were debrided. 7 had grade 3-4 chondral defect on the femoral head and 3 on the acetabulum. All were treated with chondroplasty. The mean time of follow up was 3 years (range, 2 to 5 years). Mean preoperative mHHS was 60 (range, 31 to 85), and it improved to an average of 93 (range, 68 to 100). The median patient satisfaction was 10 (range, 5 to 10). After the index procedure, 8 patients needed revision arthroscopy for adhesions at the capsule/labral junction. All revision were females. Median satisfaction following revision was 9 (range 7 to 10). Conclusion Arthroscopic treatment of FAI, labral tears, and chondral lesions in the adolescent population is a safe procedure with excellent clinical outcomes. Females had a higher revision rate but with improved satisfaction after revision surgery.

Tibial Tunnel Aperture Irregularity After Drilling With 5 Reamer Designs

Background: There is limited information in the literature on comparisons of antegrade versus retrograde reaming techniques and the effect on the creation of anterior cruciate ligament (ACL) tibial tunnel entry and exit apertures. Hypothesis: Proximal and distal apertures of ACL tibial tunnels, as created with different reamers, will be affected by type of reamer design. Study Design: Controlled laboratory study. Methods: Forty skeletally mature porcine tibias with bone mineral density values comparable with a young athletic population were included in this study. Five 9-mm reamer models were used (3 antegrade: A1, smooth-bore reamer; A2, acorn-head reamer; A3, flat-head reamer; 2 retrograde: R1, retrograde acorn reamer; R2, single-blade retrograde reamer), and a new reamer was used for each tibia (8 reamer-tibia pairs per reamer model). All specimens underwent micro–computed tomography scanning, and images were reconstructed and analyzed using 3-dimensional image analysis software. Aperture rim fractures were graded on a 0-IV scale that described the proportion of the fractured aperture circumference. Specimens with incomplete apertures were also recorded. Because of the unique characteristics of various tunnels, intratunnel characteristics were observed and recorded. Results: In sum, 1 proximal and 7 distal aperture rim fractures were found; 3, 0, and 4 distal aperture rim fractures were found with groups A1, A2, and A3, respectively. Incomplete apertures were more commonly found at the distal aperture (n = 15) than the proximal aperture (n = 8); there were no tibias with this finding at both apertures. All incomplete distal apertures occurred with the retrograde technique, and all incomplete proximal apertures occurred with the antegrade technique, most commonly with reamer design A3. An added finding of tunnel curvature at the distal aspect of the tunnel was observed in all 8 tibias with R1 reamers and 5 tibias with R2 reamers. This phenomenon was not observed in any of the tibias reamed with the antegrade technique. Conclusion: Anterior cruciate ligament tibial tunnel aperture characteristics were highly dependent on reamer design. Optimal proximal aperture characteristics were produced by the retrograde reamers, whereas optimal distal aperture characteristics were obtained with the antegrade reamers. In addition, a phenomenon of tunnel curvature in retrograde-type reamers was found, which may have effects on ACL graft or screw fixation. Clinical Relevance: Differences in tunnel aperture shapes and fractures depend on reamer design. This information is important for the creation of ACL reconstruction tunnels with different reamer designs.

Cerebral Microhemorrhages in a Collegiate Football Player

Most concussions in sports medicine are managed without advanced neurological imaging. However, computed tomography and magnetic resonance imaging are sometimes used in the management of complex sports concussions to identify acute/delayed intracranial bleeding or other associated pathology. Advances in imaging techniques have led to greater resolution and the identification of pathology of uncertain clinical significance. This report describes the presence of persistent cerebral microhemorrhages identified on magnetic resonance imaging in a collegiate football player who suffered a concussion. The associated risks and clinical significance of cerebral microhemorrhages have not been determined in the young athletic population. This case highlights provocative issues in the management of sports concussions as related to findings on modern neurological imaging and their potential implication on to return-to-play considerations.

Pre-participation cardiac screening: Considerations for young athletes

This article is the first of two focusing on the utility and evidence base for pre-participation cardiac screening in competitive athletic populations. The second article will focus on the diagnostic value of different screening modalities used in the large-scale screening of athletic populations. The current article, however, focuses on the incidence of sudden cardiac death (SCD) in young athletic populations and goes on to consider the effectiveness of cardiac screening programmes for reducing the risk of SCD. Cardiac screening in athletic populations is problematic as it may be difficult to distinguish between physiological adaptations resulting from a specific exercise training stimulus and pathological conditions. Different types of chronic exercise training can induce eccentric or concentric myocardial hypertrophy, which may mimic pathological conditions. The final section discusses some of the practical issues that a clinician may face when needing to advise a young athlete to either stop or modify his/her habitual patterns of physical activity including future exercise considerations.

Magnetic Resonance Imaging–Documented Chondral Injuries About the Knee in College Football Players: 3-Year National Football League Combine Data

To evaluate the incidence and risk factors for knee cartilage injury in elite college football players invited to attend the US National Football League (NFL) Scouting Combine over a 3-year period. All players entering the NFL Scouting Combine (National Invitational Camp) from 2005 through 2007 were evaluated. "At-risk" knees underwent magnetic resonance imaging (MRI), and the results were evaluated for chondral injuries. During the 3-year period reviewed, a total of 980 players were available for analysis, and a total of 516 players' knee MRI scans were obtained (53% of all players at the Combine). The total number of full-thickness chondral injuries evident on MRI was 197 (20.1%) among all players, or 38.2% of the players who had an MRI scan. Of the players, 30 (3.06% of all players at the Combine, or 5.8% of the players who had an MRI scan) had isolated medial compartment full-thickness chondral injuries, 41 (4.2%, or 7.9%) had isolated lateral compartment full-thickness chondral injuries, 48 (4.9%, or 9.3%) had patellofemoral compartment full-thickness chondral damage, and 78 (7.96%, or 15.1%) had full-thickness chondral injuries in more than 1 compartment. The epidemiologic and risk assessment data presented in this study offer a cross-section of a young and elite athletic population who were "prescreened" at the NFL Combine over a 3-year period and judged to have at-risk knees. The total number of full-thickness chondral injuries evident on MRI was 197 (20.1%) among all players, or 38.2% of the players who had an MRI scan: 30 players (3.06%, or 5.8%) had an isolated medial compartment full-thickness chondral injury, 41 players (4.2%, or 7.9%) had an isolated lateral compartment full-thickness chondral injury, 48 players (4.9%, or 9.3%) had isolated patellofemoral compartment full-thickness chondral damage, and 78 players (7.96%, or 15.1%) had full-thickness chondral injuries in more than 1 compartment. Level IV, diagnostic study.

Arthroscopic Repair of Anterior-Inferior Glenohumeral Instability Using a Portal at the 5:30-o’Clock Position

Background: Traumatic anterior-inferior shoulder joint dislocations are common injuries among the young athletic population. The aim of this study was to assess which factors, including concomitant injury (rotator cuff tears, superior labral anterior posterior [SLAP] lesions), patient age, and fixation methods, led to redislocation after arthroscopic stabilization. Hypothesis: There are several risk factors for the outcome after arthroscopic anterior-inferior glenohumeral stabilization. Study Design: Cohort Study; Level of evidence, 3. Methods: Between 1996 and 2000, 221 patients were treated with arthroscopic stabilization for anterior-inferior shoulder dislocation. Of these 221 consecutive patients, 190 (140 male, 50 female) with an average age of 28.0 years (range, 14.4-59.2 years) were available for follow-up (average follow-up, 37.4 ± 15.8 months). Fixation methods were FASTak (n = 138), Suretac (n = 28), or Panalok (n = 24) anchors. Concomitant SLAP lesions were seen in 38 of 190 cases (20%). Results: Redislocation rates varied between anchor systems (FASTak, 6.5%; Suretac, 25%; Panalok, 16.8%). Superior labral anterior posterior lesions, when treated, did not influence clinical outcomes or redislocation rate. A concomitant rotator cuff tear did not influence redislocation rate. Postoperative outcomes (Rowe score, Constant score, American Shoulder and Elbow Surgeons [ASES] shoulder index, 12-item questionnaire) in patients with a partial tear were also not altered. On the other hand, the redislocation rate correlated with patient age and number of prior dislocations. Return to sports at preinjury level was possible in 80% of cases. Conclusion: Arthroscopic repair of anterior-inferior instability using the 5:30-o’clock portal is dependent on anchor type and can show good to excellent results. Because of several coinjuries in anterior-inferior instability, an arthroscopic approach may be required to identify and treat such lesions.

Expert Opinion and Controversies in Musculoskeletal and Sports Medicine: Preventing Sudden Cardiac Death in Young Athletes

Rao AL, Standaert CJ, Drezner JA, Herring SA. Expert opinion and controversies in musculoskeletal and sports medicine: preventing sudden cardiac death in young athletes. Sudden cardiac death in young athletes has become a highly visible public health concern. Over the past 2 decades, unexplained or premature deaths of numerous athletes at the youth, collegiate, and professional levels have garnered extensive media coverage and stimulated a discussion centered on prevention of such tragic events. A number of issues related to the prevention and management of sudden cardiac arrest on the playing field are currently debated in the medical literature, including the true incidence of sudden death in the young athletic population, the adequacy of the preparticipation physical evaluation, and the emergency response and effectiveness of secondary prevention strategies such as use of automated external defibrillators in the athletic setting. Clinicians who care for competitive athletes and/or cover youth sporting events must be aware of the benefits and limitations of different preparticipation screening programs to identify at-risk athletes, and they must be prepared to respond to life-threatening emergencies during athletic participation.

Chondral Injuries about the Knee at the NFL Combine (SS-56)

Each year at the NFL combine, approximately 330 of the nation's best collegiate football players are invited to display their skills. An integral component of the process is the medical evaluation, as injuries are a key component in the ranking, draft status, and ultimately player value. MRI is used liberally to evaluate any worrisome history or physical findings. This offers an outstanding opportunity to examine chondral injury patterns in this unique young athletic population.

Does Cardiac Morphology Predict Plasma Brain Natriuretic Peptide Levels in Adolescent Athletes?

The purpose of this study was to establish the relationship of plasma levels of brain natriuretic peptide (BNP) to physiologic parameters and cardiac morphologic characteristics in a population of young athletes. Our hypothesis is that physiologic and cardiac morphologic characteristics do not predict BNP levels in adolescent athletes. Observational study. Outpatient hospital. Thirty healthy male adolescent high school football players (16.0 +/- 1.1 years). Physical exam, electrocardiography, plasma BNP measurement by rapid fluorescent immunoassay, and limited echocardiography. Null hypothesis-physiologic parameters and cardiac morphology do not predict plasma BNP levels in healthy adolescent football players. Significance level set at P < 0.05. Plasma BNP for this population was 11.9 +/- 10.2 pg/mL. There was no correlation between BNP and mean arterial pressure (r = -0.09, P = 0.64), body mass index (r = 0.11, P = 0.57), interventricular septal thickness (r = -0.15, P = 0.44), left ventricular (LV) wall thickness (r = 0.00, P = 0.99), relative wall thickness (r = -0.04, P = 0.84), LV mass (r = 0.05, P = 0.79), or LV mass index (r = 0.11, P = 0.55). Plasma BNP levels in healthy adolescent athletes have no correlation to body mass index or LV mass, even when corrected for body surface area.

The Recognition and Treatment of First-Time Shoulder Dislocation in Active Individuals

Anterior shoulder dislocation occurs in the general population; however, the incidence is doubled in the young athletic population. Over 90% of shoulder dislocations are in the anterior direction. For the first-time dislocation, a systematic approach to evaluating the patient and prompt reduction are critical. This injury is frequently witnessed on the field or later in the emergency department. On the field, closed reductions, without prereduction radiographs, is controversial. If the athlete is encountered in the emergency department, radiographs should be obtained prior to a closed reduction. After a closed reduction is achieved, several factors, such as timing in the season, type of sport, position, and patient goals, must be considered when deciding whether further surgical intervention is required. Conservative management will usually consist of a brief period of immobilization in a sling, followed by rehabilitation. Surgical treatment consists of an arthroscopic Bankart repair. Therapy, level 5.

Die arthroskopische ventrale Schulterstabilisierung

Traumatic antero-inferior dislocation of the shoulder is a common injury among the young athletic population. The incidence of reluxation after conservative treatment in young patients is up to 80%. Arthroscopic antero-inferior shoulder stabilization has become the gold standard in recent years due to technical and material improvement. The recurrence rate after arthroscopic and open surgery is similar (approximately 6.5%), but morbidity after arthroscopic surgery is less. The authors of this paper advise the use of suture anchors for refixation of the capsulolabral complex. An antero-inferior approach is used for ideal positioning of the anchors on the glenoid rim and lesions of the superior biceps tendon or other co-morbidities can be addressed at the same time. In conclusion arthroscopic shoulder stabilization is an appropriate treatment for antero-inferior shoulder dislocation.

Arthroscopic Management of Labral Tears in the Hip

Over the last decade, the diagnosis and arthroscopic management of labral tears of the hip in the young athletic population has evolved substantially due to improvements in clinical examination, diagnostic tools, surgical techniques, and flexible instrumentation in hip arthroscopy. Arthroscopic management of labral injuries in the hip has become an accepted therapeutic modality in appropriately selected patients. The treatment of labral tears and their associated disorders is crucial for hip preservation in young and active patients because several studies have demonstrated an association between labral tears and the early onset of osteoarthritis1-3. This paper will review the main causes of labral tears in the hip, including labral tears secondary to trauma, femoroacetabular impingement, instability, psoas impingement, dysplasia, and degenerative arthritis. We will discuss relevant anatomy and history, typical findings on physical examination, types of imaging studies performed, and treatment options, with a focus on the arthroscopic management of labral injuries, including labral repair. The outcomes associated with open surgical dislocation as compared with arthroscopic treatment of femoroacetabular impingement will also be reviewed. The acetabular labrum is a fibrocartilaginous structure that is located circumferentially around the acetabular perimeter and becomes attached to the transverse acetabular ligament posteriorly and anteriorly. Neuroreceptors have been identified within the labrum, and these structures may provide proprioception to the hip joint4. The articular surface of the labrum has decreased vascularity and a limited synovial covering in comparison with the portion of the labrum at the peripheral capsulolabral junction5 (Figs. 1-A and 1-B). Thus, similar to the healing potential of the menisci in the knee, which is greatest at the periphery, the healing potential of the labrum is greatest at the peripheral capsulolabral junction5-8. The labrum has an important sealing function in the hip. It plays …