CORR Insights®: Elite Rowers Demonstrate Consistent Patterns of Hip Cartilage Damage Compared With Matched Controls: A T2* Mapping Study

Where Are We Now?

Each sport generally is associated with a specific pattern of injuries—from forearm flexor injuries in Major League Baseball players [5] to femoroacetabular impingement (FAI) in professional soccer players [6]. While other sports like golf and tennis have been extensively analyzed as well [10, 11], less is known about the injuries associated with elite rowers.

A 2009 survey of 398 elite junior rowers attending the Junior World Rowing Championships in Beijing found that 290 injuries (73.8%) were related to overuse, with the predominant areas of pain located in the lower back followed by the knee and the forearm/wrist [8].

But rowing also includes repetitive axial loading with the hip in flexion, and although hip movement falls within the normal ROM during rowing [9], hip kinematics while rowing harbors the potential to cause labral tears and articular cartilage damage. A 2013 study investigated rowers with intraarticular pathology of the hip confirmed with MRT. The authors found no single, dominant location for the labral tears [3]. In this cohort, the high incidence of radiographic FAI (15 of 21 hips; 71%) was notable and may have caused the labral tears [9]. These data are vulnerable to selection bias, though, since only symptomatic patients were included in the study.

Bittersohl and colleagues [2], who examined the cartilage damage in asymptomatic elite rowers, found an advanced stage of cartilage and labral degeneration in this group of athletes.

Where Do We Need To Go?

The correlation between advanced cartilage damage and rowing in asymptomatic patients is alarming, but the reasons for such damage remain unclear. The authors speculated that perhaps the abutment at the acetabular rim during flexion and the repetitive axial loading associated with competitive rowing contributed to the observed injury patterns.

The current study does not provide data on the presence of FAI in this patient population. However, we do know that hip morphology has an impact on the pattern of cartilage damage of the hip [1] and deviation from the natural anatomic situation favors the development of hip osteoarthritis [4]. Since FAI is one form of morphologic deviation of the hip, we need to learn more about the possible interaction of anatomic alterations in rowers and sport kinematics including loading conditions. Currently, it is unclear whether the combination of anatomical features and the characteristics of a given sport increases the risk of early hip degeneration or the progression of hip osteoarthritis. Future studies focusing on rowing could help us identify rowers at an increased risk of developing hip pathologies and with this information, physicians could create training programs that prevent hip osteoarthritis.

How Do We Get There?

Prospective cross-sectional studies examining the natural history of hip degeneration in rowers can help us better understand the pathophysiology of early hip degeneration in these athletes.

Rowing’s governing body (USRowing, for example) and medical professionals should work closely to establish annual medical examinations for elite rowers to identify any predisposition of long-term injuries based on sport-specific loading. Based on these results, different therapeutic strategies can be established depending on the level of degenerative progression. This includes a wide range of different treatment options starting from specific training programs to sophisticated methods for cartilage repair. Furthermore, novel biochemical imaging techniques could potentially detect cartilage degeneration at its origin and reveal the pathophysiological pathway in more detail. Additionally, novel biomarkers obtained from serum or urine could monitor the biochemical pathway of cartilage degeneration. All of this data could contribute to a better treatment options for cartilage damage or even the prevention of hip degeneration. The technical progress in terms of imaging technologies might provide a deeper insight regarding the first steps of cartilage alterations, potentially improving our understanding of early cartilage damage.