Thanks everyone, my name is Aaron Casp, I'm on faculty at the University of Alabama-Birmingham. I'd like to thank the committee as well as my co-authors for having me present this. Our project was titled Hip Cartilage Defects in Elite Athletes, Their Association with Specific Sports and At-Risk Motions. Disclosures can be found on the AOS website and unpertinent to the study. Just a little bit of background, high impact activities such as athletics obviously found to be associated with chondral injuries. Repetitive loading or trauma on these chondral injuries can eventually lead to degenerative changes of the joint and chondral lesions in the hip joint specifically in athletes may cause pain and worsen performance. Because I practice in Alabama where college football is king, I'm sure most people here in the audience have remembered when Tua dislocated his hip when he landed on his right knee right there. Obviously there's a fracture dislocation component to this, but I'm certain that there was a large chondral injury associated with it. Chondral lesions in the hip don't usually occur in isolation, often associated with FAI, labral tearing, loose bodies or hip instability. There's been a number of prior studies that have shown good return to sport rates in elite athletes even with full thickness chondral defects. However, there's a relative gap in the literature that associates specific sports and their motions associated with them with the cartilaginous injuries of the hip in these elite or professional athletes. So the goal of this study was twofold, one, determine the prevalence of chondral defects among elite athletes undergoing hip arthroscopy, and then two, associate the type of biomechanical stress in that particular athlete's sport with the corresponding articular cartilage injury patterns that we found at the time of surgery. In order to accomplish this, we took elite athletes, which we defined as college or professional athletes only, undergoing primary hip arthroscopy for FAI by a single surgeon between 2005 and 2018. We were able to utilize our institutional database for this, excluded for any prior ipsilatal hip surgery or presence of radiographic osteoarthritis, tonus grade 2 or greater. And then we collected and evaluated the chondral damage data, which included the Outerbridge score at the time of arthroscopy, location of the lesion, size of the lesion and cartilage damage pattern. We also took these patients and athletes and then classified their sport into a novel classification system based on at-risk hip motions, including rotational, contact, extreme range of motion, repetitive and high speed. There's a lot of crossover between a lot of different sports. So a sport is allowed to have more than one classification system, or classification point. So results, we had 431 HIPS event inclusion criteria. We had 24 sports that were represented. You can see the list of sports, the motion classification as well as the number of athletes per. Chondral defects of any sort, grade 1-4 were found in 95% of HIPS. Severe lesions defined as grade 3 or 4 were seen in 51%. And the grade 3 and 4 lesions most commonly were found in American football, soccer and baseball players. If we look at the comparisons across the actual motion groups, the rotational sport group had a higher prevalence of acetabular, femoral head and combined acetabular and femoral head grade 3 and 4 lesions versus the non-rotational sports. And the contact sport had a higher prevalence of acetabular and combined femoral and acetabular grade 3 and 4 lesions. Somewhat interestingly, looking at the femoral head, the non-high speed actually had a higher rate of chondral injury. So in conclusion, there's a high prevalence of chondral injuries in elite athletes undergoing hip arthroscopy for FAI. The more severe defects were common in rotational and contact athletes based on our classification system. And we thought this classification system was somewhat useful in that it can be used to identify the athletes at risk for chondral damage. That might be a colt on MRI, could sort of inform the decision and discussion of surgical timing and season management if this person had to undergo a cartilage procedure at the time of surgery. It might slow down your rehab protocol and might change the decision of timing of surgery. Obviously this is retrospective in nature, so further study is needed to determine how these chondral injuries actually translate into career longevity. And that's a future paper coming out in the next few years as we follow up with these athletes again. And you know, the overall goal is to intervene on these athletes early and hopefully be able to avoid ever doing one of these. Thank you.

Hip Cartilage Defects

Elite Athletes

Specific Sports

At-Risk Motions

Chondral Defects