Femoroacetabular impingement in former high-level youth soccer players.
ABSTRACT Femoroacetabular impingement (FAI) can be a source of hip pain in young adults. Repetitive kicking associated with youth soccer may lead to morphologic changes of the proximal femur that predispose a person to the development of FAI.
Young adults who participated in high-level soccer competition as youths are more likely to demonstrate radiographic changes consistent with FAI and to have increased alpha angles as compared with controls.
Cross-sectional study; Level of evidence, 3.
Pelvic radiographs (anteroposterior and frog-lateral) were obtained on 50 individuals who participated in high-level soccer during skeletal immaturity and 50 controls who did not participate in high-level soccer. There were 25 men and 25 women in each group. All subjects were between 18 and 30 years of age, had a body mass index of less than 30, and had not sought or received treatment for hip disorders. Radiographs were analyzed independently for the presence of FAI, and alpha angles were measured. Hips with alpha angles that measured greater than or equal to 55° were deemed to have cam deformity.
Fifteen of the 25 male subjects had evidence of cam deformity, compared with 14 male controls. Nine of the 25 female subjects had evidence of cam deformity, compared with 8 female controls. Neither of these differences was statistically significant. There was a significantly higher prevalence of cam deformity in men as compared with women (29 vs 17, P = .016).
Participation in high-level soccer during skeletal immaturity is not associated with a higher risk of development of cam deformity in the young adult years. There is a high prevalence of cam deformity in the young adult population. Males demonstrate a higher prevalence of cam deformity than do females.
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ABSTRACT: Sports participation is associated with an increased risk of future osteoarthritis (OA), much of which results from joint injury. No strong evidence exists that moderate sporting activity in the presence of normal joints predisposes to OA. Whether high-level participation in sport, particularly impact-type sports, is truly associated with OA is unclear owing to difficulties in differentiating the confounding effect of joint injury. Attention to strategies that prevent joint injury in athletes is paramount. Evidence does support the use of targeted neuromuscular exercise programmes, ankle taping and/or bracing and equipment or rule changes to prevent joint injuries in athletes. Optimal injury management, including rehabilitation and surgery if appropriate, is needed to facilitate healing and address biomechanical and neuromuscular impairments to reduce the risk of re-injury and minimize the onset and extent of joint symptoms. Management of OA in athletes requires attention to load-reducing strategies, activity modification, muscle strengthening and weight control.Nature Reviews Rheumatology 07/2012; 8(12). DOI:10.1038/nrrheum.2012.119 · 10.25 Impact Factor
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ABSTRACT: Background: Symptomatic femoroacetabular impingement (FAI) is associated with hip pain, functional limitations, and secondary osteoarthritis. There is limited information from large patient cohorts defining the specific population affected by FAI. Establishing a large cohort will facilitate the identification of ‘‘at-risk’’ patients and will provide a population for ongoing clinical research initiatives. The authors have therefore established a multicenter, prospective, longitudinal cohort of patients undergoing surgery for symptomatic FAI. Purpose: To report the clinical epidemiology, disease characteristics, and contemporary surgical treatment trends in North America for patients with symptomatic FAI. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Upon approval of the institutional review boards at 8 institutions, 12 surgeons enrolled consecutive patients undergoing surgical intervention for symptomatic FAI. Patient demographics, physical examination data, radiographic data, diagnoses, operative data, and standardized patient-reported outcome measures were collected. The first 1130 cases are summarized in this study. Results: A total of 1076 consecutive patients (1130 hips) were enrolled; 55% (n = 622) were female, and 45% (n = 508) were male, with an average age of 28.4 years and average body mass index (BMI) of 25.1. Demographics revealed that 88% of patients who were predominantly treated for FAI were white, 19% reported a family history of hip surgery, 47.6% of hips had a diagnosis of cam FAI, 44.5% had combined cam/pincer FAI, and 7.9% had pincer FAI. Preoperative clinical scores (pain, function, activity level, and overall health) indicated a major dysfunction related to the hip. Surgical interventions were arthroscopic surgery (50.4%), surgical dislocation (34.4%), reverse periacetabular osteotomy (9.4%), limited open osteochondroplasty with arthroscopic surgery (5.8%), and limited open by itself (1.5%). More than 90% of the hips were noted to have labral and articular cartilage abnormalities at surgery; femoral head-neck osteochondroplasty was performed in 91.6% of the surgical procedures, acetabular rim osteoplasty in 36.7%, labral repair in 47.8%, labral debridement in 16.3%, and acetabular chondroplasty in 40.1%. Conclusion: This multicenter, prospective, longitudinal cohort is one of the largest FAI cohorts to date. In this cohort, FAI occurred predominantly in young, white patients with a normal BMI, and there were more female than male patients. The disease pattern of cam FAI was most common. Contemporary treatment was predominantly arthroscopic followed by surgical hip dislocation. Keywords: FAI; hip arthroscopic surgery; surgical hip dislocation; epidemiologyThe American Journal of Sports Medicine 05/2013; 41(6). DOI:10.1177/0363546513488861 · 4.70 Impact Factor
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ABSTRACT: Symptomatic femoroacetabular impingement is a known prearthritic condition. Impingement morphology is poorly defined in the adolescent population. The purpose of this study was to document the prevalence of radiographic impingement morphology in adolescents with no symptomatic hip problems. Ninety anteroposterior images of the hip in forty-five consecutive adolescents with scoliosis met the inclusion criteria. Sex distribution was equal. The second cohort (ninety hips) was an age-matched group with no scoliosis. None had symptomatic hip problems. Images were analyzed for coxa profunda, protrusio acetabuli, Tönnis angle, anteroposterior alpha angle, center-edge angle, acetabular crossover, ischial spine sign, and neck-shaft angle. Of the 180 hips, 92.8% demonstrated at least one parameter suggesting impingement morphology, whereas 52.2% showed at least two signs. Evidence of coxa profunda was seen in 81.7% of the hips, while a negative Tönnis angle was seen in 31.1% and a center-edge angle indicative of acetabular overcoverage was seen in 15%. An acetabular crossover sign was detected in 27.2% of the hips, while an abnormal anteroposterior alpha angle was found in 5.6% of the hips in male patients and 6.7% of the hips in female patients. Statistical analysis revealed that abnormal alpha angles (p = 0.029), crossover signs (p = 0.029), and ischial spine signs (p = 0.026) were more common in the cohort without scoliosis, and coxa profunda was more common in females (p = 0.034). There was a high prevalence of radiographic impingement morphology beyond the spectrum of normal in this double-cohort study of adolescents. Femoroacetabular impingement remains a dynamic problem, and we caution against relying only on the use of hard-set static radiographic parameters when evaluating femoroacetabular impingement. This study raises the important question of what morphologic characteristics should be defined as abnormal, when at least one finding of impingement morphology is noted in such a large segment of the population. On the basis of the normative data obtained, reference values for radiographic parameters of femoroacetabular impingement morphology should be redefined. Normal values for a Tönnis angle were between -8° and 14°, the upper limit of the center-edge angle was 44°, and the normal values for femoral neck-shaft angle were between 121° and 144°. Surgical indications should be tailored to physical examination findings and not radiographic findings alone. Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.The Journal of Bone and Joint Surgery 07/2013; 95(13):e901-8. DOI:10.2106/JBJS.L.01030 · 4.31 Impact Factor