Femoroacetabular Impingement in Elite Ice Hockey Goaltenders

Background: Femoroacetabular impingement (FAI) is particularly prevalent in ice hockey. The butterfly goalie technique is thought to involve extreme ranges of hip motion that may predispose goaltenders to FAI. Purpose: To quantify hip mechanics during 3 common goaltender movements and interpret their relevance to the development of FAI. Study Design: Descriptive laboratory study. Methods: Fourteen collegiate and professional goaltenders performed skating, butterfly save, and recovery movements on the ice. Hip mechanics were compared across the 3 movements. Results: The butterfly did not exhibit the greatest range of hip motion in any of the 3 planes. Internal rotation was the only hip motion that appeared close to terminal in this study. When subjects decelerated during skating—shaving the blade of their skate across the surface of the ice—the magnitude of peak hip internal rotation was 54% greater than in the butterfly and 265% greater than in the recovery. No movement involved levels of concomitant flexion, adduction, and internal rotation that resembled the traditional impingement (FADIR) test. Conclusion: The magnitude of internal rotation was the most extreme planar hip motion (relative to end-range) recorded in this study (namely during decelerating) and appeared to differentiate this cohort from other athletic populations. Consequently, repetitive end-range hip internal rotation may be the primary precursor to symptomatic FAI in hockey goaltenders and provides the most plausible account for the high incidence of FAI in these athletes. Resection techniques should, therefore, focus on enhancing internal rotation in goaltenders, compared with flexion and adduction. While the butterfly posture can require significant levels of hip motion, recovering from a save and, in particular, decelerating during skating are also demanding on goaltenders’ hip joints. Therefore, it appears critical to consider and accommodate a variety of sport-specific hip postures to comprehensively diagnose, treat, and rehabilitate FAI.