Skip to main content

Influence of hip restriction on noncontact ACL rerupture



This study investigated variables associated with hip restriction (reduced range of motion) in a group of soccer players presenting with noncontact rerupture of the anterior cruciate ligament (ACL) and compared results with a group of sport-matched healthy professional athletes.


In this case series, 28 male soccer players with noncontact ACL rerupture were examined for clinical hip range of motion findings potentially associated with ACL rerupture, namely anterior knee displacement, internal–external hip rotation, and cruciate ligament insufficiency. Results were compared with data obtained from 27 healthy professional players. Patients presenting gross surgical errors (e.g. poorly positioned tunnel) or reporting major accidents affecting the lower limbs, such as leg or ankle fractures, were excluded from analysis. Internal–external rotation was measured in the supine position, with knee and hip at 90° of flexion. ACL insufficiency was assessed using the Pivot Shift test and the Lachman’s test with the aid of a Rolimeter RM® arthrometer and confirmed by magnetic resonance imaging.


The most prevalent finding was a significantly lower mean internal–external hip rotation in the rerupture group (45.0°) when compared with healthy professional soccer players (56.2°).


Assessing hip restriction in patients presenting noncontact ACL rerupture showed to be extremely important during ACL reconstruction planning.

Level of evidence


This is a preview of subscription content, access via your institution.


  1. Allander E, Bjornsson OJ, Olafsson O, Sigfusson N, Thorsteinsson J (1974) Normal range of joint movements in shoulder, hip, wrist and thumb with special reference to side: a comparison between two populations. Int J Epidemiol 3(3):253–261

    CAS  PubMed  Article  Google Scholar 

  2. Biau DJ, Tournoux C, Katsahian S, Schranz PJ, Nizard RS (2006) Bone-patellar tendon-bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis. BMJ 332(7548):995–1001

    PubMed  Article  Google Scholar 

  3. Boone DC, Azen SP (1979) Normal range of motion of joints in male subjects. J Bone Jt Surg Am 61(5):756–759

    CAS  Google Scholar 

  4. Ellenbecker TS, Ellenbecker GA, Roetert EP, Silva RT, Keuter G, Sperling F (2007) Descriptive profile of hip rotation range of motion in elite tennis players and professional baseball pitchers. Am J Sports Med 35(8):1371–1376

    PubMed  Article  Google Scholar 

  5. Ellera Gomes JL, de Castro JV, Becker R (2008) Decreased hip range of motion and noncontact injuries of the anterior cruciate ligament. Arthroscopy 24(9):1034–1037

    Article  Google Scholar 

  6. Ellera Gomes JL, Palma HM, Becker R (2010) Radiographic findings in restrained hip joints associated with ACL rupture. Knee Surg Sports Traumatol Arthrosc 18(11):1562–1567

    PubMed  Article  Google Scholar 

  7. Freeman MA, Pinskerova V (2005) The movement of the normal tibio-femoral joint. J Biomech 38(2):197–208

    CAS  PubMed  Article  Google Scholar 

  8. Fuss FK, Bacher A (1991) New aspects of the morphology and function of the human hip joint ligaments. Am J Anat 192(1):1–13

    CAS  PubMed  Article  Google Scholar 

  9. Gerhardt MB, Romero AA, Silvers HJ, Harris DJ, Watanabe D, Mandelbaum BR (2012) The prevalence of radiographic hip abnormalities in elite soccer players. Am J Sports Med 40(3):584–588

    PubMed  Article  Google Scholar 

  10. Iwaki H, Pinskerova V, Freeman MA (2000) Tibiofemoral movement 1: the shapes and relative movements of the femur and tibia in the unloaded cadaver knee. J Bone Jt Surg Br 82(8):1189–1195

    CAS  Article  Google Scholar 

  11. Jacobsen S (2006) Adult hip dysplasia and osteoarthritis. Studies in radiology and clinical epidemiology. Acta Orthop Suppl 77(324):1–37

    PubMed  Google Scholar 

  12. Philippon M, Dewing C, Briggs K, Steadman JR (2012) Decreased femoral head-neck offset: a possible risk factor for ACL injury. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-012-1881-1

    PubMed Central  Google Scholar 

  13. Prather H, Harris-Hayes M, Hunt DM, Steger-May K, Mathew V, Clohisy JC (2010) Reliability and agreement of hip range of motion and provocative physical examination tests in asymptomatic volunteers. PM R 2(10):888–895

    PubMed Central  PubMed  Article  Google Scholar 

  14. Pugh L, Mascarenhas R, Arneja S, Chin PY, Leith JM (2009) Current concepts in instrumented knee-laxity testing. Am J Sports Med 37(1):199–210

    PubMed  Article  Google Scholar 

  15. Quatman CE, Quatman-Yates CC, Hewett TE (2010) A ‘plane’ explanation of anterior cruciate ligament injury mechanisms: a systematic review. Sports Med 40(9):729–746

    PubMed  Article  Google Scholar 

  16. Roach KE, Miles TP (1991) Normal hip and knee active range of motion: the relationship to age. Phys Ther 71(9):656–665

    CAS  PubMed  Google Scholar 

  17. Shimokochi Y, Ambegaonkar JP, Meyer EG, Lee SY, Shultz SJ (2012) Changing sagittal plane body position during single-leg landings influences the risk of non-contact anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-012-2011-9

    PubMed  Google Scholar 

  18. Shimokochi Y, Shultz SJ (2008) Mechanisms of noncontact anterior cruciate ligament injury. J Athl Train 43(4):396–408

    PubMed Central  PubMed  Article  Google Scholar 

  19. Souryal TO, Moore HA, Evans JP (1988) Bilaterality in anterior cruciate ligament injuries: associated intercondylar notch stenosis. Am J Sports Med 16(5):449–454

    CAS  PubMed  Article  Google Scholar 

  20. Wordeman SC, Quatman CE, Kaeding CC, Hewett TE (2012) In vivo evidence for tibial plateau slope as a risk factor for anterior cruciate ligament injury: a systematic review and meta-analysis. Am J Sports Med 40(7):1673–1681

    PubMed  Article  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations


Corresponding author

Correspondence to João L. Ellera Gomes.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ellera Gomes, J.L., Palma, H.M. & Ruthner, R. Influence of hip restriction on noncontact ACL rerupture. Knee Surg Sports Traumatol Arthrosc 22, 188–191 (2014).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Anterior cruciate ligament (ACL)
  • Noncontact ACL rerupture
  • Restrained hip joint
  • Soccer players