title: Anterior Inferior Iliac Spine Morphology and Outcomes of Hip Arthroscopy in Soccer Athletes: A Comparison to Nonkicking Athletes.
abstract: OBJECTIVE
  To describe the anterior inferior iliac spine (AIIS) morphology and clinical outcomes following arthroscopic surgical decompression in a group of high-level soccer athletes presenting with symptomatic hip impingement when compared with a control group of nonkicking athletes.
  
  
  METHODS
  From 2009 to 2012, we retrospectively reviewed our prospective hip registry for soccer athletes who underwent arthroscopic treatment for femoroacetabular impingement (FAI) with 2-year follow-up, comparing with a control group of nonkicking athletes. Demographics were collected and radiographic studies (plain radiograph and computed tomographic scan) reviewed for several parameters, including AIIS morphology. Patient-reported outcome scores, including modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Sport-Specific Subscale (HOS-SSS), and International Hip Outcome Tool-33 (iHOT-33), were administered preoperatively, at 6 months, and at 1, 2, and 3 years postoperatively.
  
  
  RESULTS
  Twenty-six soccer players (34 hips) and 87 nonkicking athletes (115) hips were identified. Demographics, including age (19.2 ± 4.1 vs 20.1 ± 3.8 years) and gender distribution (53.8% vs 51.7% male), were similar between the soccer and nonkicking athletes (P = .288, .849). Eighty-four percent of soccer players demonstrated some abnormality of the AIIS extending to (type II, 52%) or below the anterior acetabular rim (type III, 32%), compared with 52% nonkicking athletes (P < .001). At a mean follow-up of 35 months (range, 24-57 months) there was significant improvement in all outcome scores in both groups from pre- to postoperation (P < .001). There was no evidence of differences in outcome scores between groups (mHSS: 89 ± 14.6 vs 88.2 ± 14.4, P = .804; HOS-ADL: 94.1 ± 9.1 vs 92.2 ± 11.1, P = .431; HOS-SSS: 86 ± 17.1 vs 81.3 ± 24.3, P = .362) with the exception of iHOT-33 (81.7 ± 19 vs 70.3 ± 23.6, P = .027).
  
  
  CONCLUSIONS
  High-level soccer players have a significantly higher rate of subspine impingement compared with nonkicking athletes. There should be a high index of suspicion when treating soccer players for FAI, where appropriate recognition and treatment of subspine impingement can yield excellent clinical results.
  
  
  METHODS
  Level III, retrospective case-control study.
authors.affiliation: Center for Hip Preservation, Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Danyal H
authors.initials: DH
authors.lastname: Nawabi
authors.affiliation: Center for Hip Preservation, Hospital for Special Surgery, New York, New York, U.S.A.. Electronic address: ryan.degen@gmail.com.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Degen
authors.affiliation: Center for Hip Preservation, Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Kara G
authors.initials: KG
authors.lastname: Fields
authors.affiliation: Center for Hip Preservation, Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Wentzel
authors.affiliation: Center for Hip Preservation, Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Olusanjo
authors.initials: O
authors.lastname: Adeoye
authors.affiliation: Center for Hip Preservation, Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Kelly
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D001182:Arthroscopy / Q000379:methods*; D001265:Athletic Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D057925:Femoracetabular Impingement / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011859:Radiography; D012042:Registries; D012189:Retrospective Studies; D012916:Soccer / Q000293:injuries*; D016896:Treatment Outcome; D055815:Young Adult