Amy Torgerson - Femoroacetabular Impingement

"Torgerson was spectacular, making 52 stops…”

The newspaper reports said it all. In the final match of the 2011 ice hockey season, Amy Torgerson, a 22-year-old from Wentzville, MO, logged a “spectacular” game as a goalie for the Division III Yellowjackets from the University of Wisconsin-Superior. The effort was impressive to coaches because Torgerson was back on a team after undergoing hip surgery to repair a torn labrum in her left hip.

“The labrum is basically the cartilage seal that helps hold the ball of the hip joint in the socket,” says Ryan Nunley, MD, associate professor of orthopaedic surgery at Washington University School of Medicine. “In Amy’s case, she was hampered with a genetic problem. The ball and socket were abnormally shaped, causing a condition called femoroacetabular impingement (FAI). The repetitive and aggressive nature of hockey caused her labrum to tear. If the condition is left untreated, it can cause early arthritis of the hip and lead to the need for a hip replacement at a young age.”

Torgerson, a highly active athlete, grew up playing ice hockey in Minnesota, where her mother says, “pretty much every town had its own hockey rink and there were lots of opportunities for girls to play.” Her father was a hockey goalie and a coach, and Torgerson wanted to be like her dad.

“I started skating when I was 5 or 6 years old,” she says. “My dad said if I became one of the best skaters forward and backward on the ice, I could be goalie. I did that by the time I was 10 years old.”

Torgerson was so passionate about ice hockey that she transferred to a boarding prep school to play competitively. At age 15, she tried out for the Olympic team. “As she moved up through the ranks,” says her mother, Laurie, “there were times she had forty or more stops per game. She is an incredible athlete and I am so proud of her.”

But near the end of her high school years, Torgerson began feeling pain. “I thought they were growing pains so I tried to shrug it off. In college, it got worse. In my sophomore year, we had a new trainer and I was doing intense lifting programs to build strength but I felt myself getting weaker in my left leg.”

The trainer thought the problem originated in Torgerson’s hip, but an MRI scan revealed nothing. Her trainer pushed for a second opinion and Torgerson came to Washington University School of Medicine. Mark Halstead, MD, assistant professor of orthopedic surgery, reviewed and then ordered new MRI scans. He immediately noticed that Torgerson had a torn labrum as a result of femoroacetabular impingement (FAI). Halstead referred Torgerson to Ryan Nunley, MD, who specializes in reconstructive hip and knee surgery and in treatments for FAI and labral tears. “The labral tissue is not always visible on a plain MRI and tears are easily missed,” explains Dr. Nunley, who published a paper on the subject in the American Journal of Sport Medicine in 2011. “A dye-injected procedure makes it easier to see a tear, which is what we did with Amy.”

Once diagnosed, Dr. Nunley surgically repaired the labrum arthroscopically in an outpatient procedure and reshaped the bone to create a more normal anatomy and remove any impingement. “It’s technical surgery in that we shave a little bone, a millimeter at a time, and then we check for range of motion,” says Dr. Nunley. “The goal is to remove as little of the bone as possible so that we don’t destabilize the ball and hip socket but eliminate the impingement.”

Nunley surgically treats FAI in an estimated 150 patients annually. “These patients often are told they have a groin pull because it presents symptoms in much the same way as a muscle strain,” he says. “In this case, a goalie in ice hockey gets down into a “w” position to block a puck time after time.

It was the repetitive nature of hockey as well as the FAI that caused Amy Torgerson hip pain and labral injury. She had a sizeable tear in her labrum, but it had not yet encroached on the permanent articular cartilage so it was fixable. Once the permanent cartilage is damaged, the results of hip arthroscopy are less predictable and a hip replacement is sometimes the only answer.”

Nunley adds, “Five years ago, these high school, college, and professional athletes couldn’t return to sports. With continued improvement in both the understanding and treatment of the disease, however, we are seeing remarkable progress in enabling these individuals to continue their athletic careers.”

Nunley’s goal now is to figure out the early signs of FAI, possibly developing a screening test similar to one for scoliosis. “We should be able to screen and find those with limited internal rotation of their hip joint due to the patient’s structural anatomy,” he says. “If they can’t lay flat on their back and flex leg up 90 degrees and rotate their leg outwardly, they are at risk and should be counseled to be aware of that risk or modify their activities so that they won‘t end up with a torn labrum, or worse, having to undergo a hip replacement at a young age.”

Torgerson underwent lengthy physical rehabilitation to give her hip time to heal and to strengthen her weak muscles. When she decided to transfer to University of Michigan-Superior from Rochester Institute of Technology (RIT), she was nervous, wondering whether it was a longshot that she could play again.

She did so well during practices that she was named goalie for the home opener. “I wondered how the hip would feel, if she’d be at the top of her game, if she’d feel any pain,” recalls Laurie Torgerson. “She did great, and the team won the first of many games.”

In her senior year, 16 months after hip surgery, Torgerson and her team battled in a nationally ranked Division III women’s hockey playoff in St. Peter, MN. Torgerson fought off a flurry of goal attempts, blocking 52 stops. Although her team lost 1-0 in overtime, Torgerson was triumphant.

“My coach was teasing that the other guys couldn’t even score on a goalie that had hip surgery,” she laughed. “But they got one by me.”

“I’m so glad that I could close out my hockey career on the ice and not on the bench,” she says.” That’s all thanks to my doctors who believed in what I wanted to do and did their best to see that I could continue to play.”

 

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