Femoroacetabular Impingement in Former High-Level Youth Soccer Players

Michigan State University/Kalamazoo Center for Medical Studies, Department of Orthopaedic Surgery, Kalamazoo, Michigan, USA.
The American Journal of Sports Medicine (Impact Factor: 4.36). 03/2012; 40(6):1342-6. DOI: 10.1177/0363546512439287
Source: PubMed


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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    • "FAI is assumed to be predominant in young male athletes with sport activities with high impact for the hip joints like soccer [13]. Agricola et al. demonstrated that FAI was more prevalent in 89 elite soccer players than in 92 nonathletic controls [14]. "
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    ABSTRACT: Femoroacetabular impingement (FAI) is predominant in young male athletes, but not much is known about gait differences in cases of increased hip alpha angles. In our study, the hip alpha angle of Notzli of soccer players was quantified on the basis of magnetic resonance imaging (MRI) with axial oblique sequences. The aim of the current study was to compare the rearfoot motion and plantar pressure in male semiprofessional soccer players with increased alpha angles to age-matched amateur soccer players. In a prospective analysis, male semiprofessional and amateur soccer players had an MRI of the right hip to measure the alpha angle of Notzli. In a biomechanical laboratory setting, 14 of these participants in each group ran in two shoe conditions. Simultaneously in-shoe pressure distribution, tibial acceleration, and rearfoot motion measurements of the right foot were performed. In the semiprofessional soccer group, the mean value of the alpha angle of group was 55.1 +/- 6.58[degree sign] (range 43.2-76.6[degree sign]) and 51.6 +/- 4.43[degree sign] (range 41.9-58.8[degree sign]) in the amateur group. In both shoe conditions, we found a significant difference between the two groups concerning the ground reaction forces, tibial acceleration, rearfoot motion and plantar pressure parameters (P < 0.01, P < 0.05, P = 0.04). Maximum rearfoot motion is about 22% lower in the semiprofessional group compared to the amateur group in both shoe conditions. This study confirmed that semiprofessional soccer players with increased alpha angles showed differences in gait kinematics compared to the amateur group. These findings support the need for a screening program for competitive soccer players. In cases of a conspicuous gait analysis and symptomatic hip pain, FAI must be ruled out by further diagnostic tests.
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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.
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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; epidemiology
    Full-text · Article · May 2013 · The American Journal of Sports Medicine
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