Radiographic findings of femoroacetabular impingement in capoeira players

Prevalence of hip femoroacetabular impingement deformities in high-level (La Liga) male professional football players

BACKGROUND

Femoroacetabular impingement (FAI) is considered one of the main causes of hip osteoarthritis in young adults, especially in athletes. In recent years, morphological changes in FAI in the hip have been linked to early and intense sports participation, but studying top-level athlete samples is not easy. This paper presents the prevalence of FAI radiological markers in 120 active white male professional football players in the Spanish First Division League (La Liga) and compares the morphological changes with those of a control group of healthy individuals without significant sport activity.

METHODS

The precontract medical evaluation hip X-rays of 120 white male professional football players from four different First Division Spanish football teams were prospectively filed and retrospectively reviewed by a dedicated skeletal radiologist. The footballers' hip X-rays were compared with those of a control group of 80 healthy individuals (age-sex matched) without significant sport activity (obtained from routine work medical checks).

RESULTS

The femoral head-neck deformity associated with the Cam type of femoroacetabular impingement was observed in 61.6% of professional football players and only in 11.6% of the control group (p <0.01). The presence of "herniation pit" (11.6%) and os acetabuli (13.3%) also reached statistical significance in the professional football players group. In the other analyzed parameters, no statistically significant differences between the groups were observed.

CONCLUSIONS

White professional top-level football players have an increased incidence of abnormal lateral epiphyseal extension ("pistol grip deformity"), os acetabuli and herniation pits.

Musculoskeletal Injuries in Capoeira Athletes: An Epidemiological Study

Capoeira involves fighting movements, turns, acrobatic jumps, and repeated movements, which can lead to injury. This study determined the incidence of injuries in capoeira athletes and analyzed the associated factors. The sample included 157 capoeira athletes, 94 (59.9%) of which were males aged 8-67 years. A questionnaire was administered; in the results, 95 (60.5%) athletes suffered injury during their entire capoeira practice, totaling 218 injuries, and 48 (30.6%) athletes had incurred an injury in the previous year, totaling 81 injuries. There were 0.85 injuries per 1000 h of capoeira training. The most common injuries were sprains (19.23%) and muscle bruises (14.10%), which were located in the ankles (20.51%) and knees (16.67%). Falls (24.36%) and repetitive movements (15.38%) were the most prevalent injury mechanisms. Male athletes presented a higher risk of sustaining capoeira-related injuries than women (odds ratio = 2.19; 95% CI: 1.05-4.61; p = 0.037). Individuals who trained equal to or more than three times per week were more at risk by 0.44 (p ≤ 0.001) than those who trained up to two times per week. This study showed a high prevalence of injuries in this sample. Sex (male) and a training frequency that was equal to or greater than three times per week were the associated risk factors. The data obtained can be used to create specific training programs for preventing injuries.

Osteoarthritis Risks and Sports: An Evidence-based Systematic Review

PURPOSE

Regular sports activities are associated with multiple physical and psychological health benefits. However, sports also may lead to injuries and the development of osteoarthritis (OA). This systematic review investigated the association between sports activity, sports type, and the risk of developing OA.

METHODS

A systematic review was performed by assessing studies that have investigated the risk of OA development in sports. Data extracted included general information, study design, number of participants, related body mass index, sports type, and assessment of OA. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale.

RESULTS

A total of 63 studies were included in this systematic review. The overall Newcastle-Ottawa Scale score was 6.46±1.44 demonstrating a good methodological quality of the articles included in the present study. A total of 628,036 participants were included, with a mean follow-up of 8.0±8.4 years. The mean age of the included athletes was 45.6±15.8, with a mean body mass index of 24.9±2.3 kg/m 2 .

CONCLUSION

Football and soccer players seem to be at higher risk for the development of OA, although the injury status of the joint should be considered when assessing the risk of OA. High equipment weight and increased injury risk also put military personnel at a higher risk of OA, although elite dancing leads to more hip labral tears. Femoroacetabular impingement was also often diagnosed in ice-hockey players and ballet dancers.

Does the Type of Sport Influence Morphology of the Hip? A Systematic Review

BACKGROUND

Femoroacetabular impingement (FAI) has been extensively investigated and is strongly associated with athletic participation.

PURPOSE

To assess (1) the prevalence of cam-type FAI across various sports; (2) whether kinematic variation among sports influences hip morphology; and (3) whether performance level, duration, and frequency of participation or other factors influence hip morphology in a sporting population.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

A systematic search of Embase, PubMed, and the Cochrane Library was undertaken following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Prospective and retrospective case series, case reports, and review articles published after 1999 were screened, and those that met the inclusion criteria decided a priori were included for analysis.

RESULTS

The literature search identified 58 relevant articles involving 5683 participants. A total of 49 articles described a higher prevalence of FAI across various "hip-heavy" sports, including soccer, basketball, baseball, ice hockey, skiing, golf, and ballet. In studies including nonathlete controls, a greater prevalence of FAI was reported in 66.7% of studies (n = 8/12). The highest alpha angle was identified at the 1-o'clock position (n = 9/9) in football, skiing, golf, ice hockey, and basketball. The maximum alpha angle was located in a more lateral position in goalkeepers versus positional players in ice hockey (1 vs 1:45 o'clock). A positive correlation was also identified between the alpha angle and both age and activity level (n = 5/8 and n = 2/3, respectively) and between prevalence of FAI and both age and activity level (n = 2/2 and n = 4/5).

CONCLUSION

Hip-heavy sports show an increased prevalence of FAI, with specific sporting activities influencing hip morphology. There is some evidence to suggest that a longer duration and higher level of training also result in an increased prevalence of FAI.

REGISTRATION

CRD4202018001 (PROSPERO).

Hip Pain Increases With Age and Experience Level in Adult Karate Athletes: A Statewide Survey Study

Purpose

To investigate the prevalence of hip pain from labral tears and femoroacetabular impingement (FAI) in karate athletes using a statewide online survey.

Methods

An anonymous electronic survey was distributed via Qualtrics to all registered members of a statewide karate organization who were a purple belt or higher. Basic demographic information was collected as well as belt level, competitive level, and information regarding hip pain and treatment for hip pain. Microsoft Excel was used to store and analyze data.

Results

Of 180 respondents, 123 (68.3%) never had hip pain when practicing karate, and 54 (30.0%) had hip pain at some point in their karate career. Three subjects did not provide an answer and were excluded. Furthermore, of the symptomatic individuals, 52 reported the location of their hip pain, whereas 2 subjects did not. Of the symptomatic individuals (54), 32 had formal diagnoses by a medical professional, 4 (12.5%) were diagnosed with FAI of the hip, 6 (18.8%) diagnosed with a hip labral tear, 3 (9.4%) diagnosed with hip bursitis, 3 (9.4%) diagnosed with hip arthritis, and 16 (50%) had other diagnoses. The remaining 22 participants have not received a formal diagnosis by a medical professional.

Conclusions

The prevalence of hip pain in karate athletes in this survey was lower compared to athletes of other martial arts and kicking sports. No differences in the percentage of injuries were found between sex and years practiced; however a higher incidence of hip pain was found between elite status and age group. When evaluating hip pain in the karate population, orthopaedic surgeons should maintain an index of suspicion for FAI and hip labral tears.

Level of Evidence

Level IV, retrospective cross-sectional study.

Disability and pain in capoeira practitioners

OBJECTIVE

This study aims to analyze the level of disability and pain in capoeira practitioners.

METHODS

This is a cross-sectional study. Data collection took place at the training sites of participants. The Self-Estimated Functional Inability because of Pain questionnaire for athletes (SEFIP-sport) was used to assess the pain and disability. Descriptive analysis was performed with the presentation of variables through mean and standard deviation (SD) or absolute number and percentage.

RESULTS

The sample consisted of 65 capoeira practitioners. Of these, 42 (64.61%) reported pain or discomfort. The total score of the SEFIP-sport presented an average of 2.28 points (SD=2.65). The body regions with the highest reports of pain and disability were the knees, lower back, and wrist/hands. However, we observed a mild degree of disability measured by SEFIP-sport.

CONCLUSIONS

The knees, lower back, and wrists/hands were the regions of the body with the highest reports of pain and disability. However, the disability presented by capoeira practitioners was slight.

Relationship between cam morphology, hip symptoms, and hip osteoarthritis: the Musculoskeletal pain in Ullersaker STudy (MUST) cohort

BACKGROUND

The primary aim of this study was to determine the prevalence of cam morphology in a cohort of people aged 40-55 years. Secondary aims were to: (1) determine differences in participant characteristics, physical impairments, radiographic and ultrasound appearances of people with and without cam morphology; and (2) explore associations between cam morphology and radiographic measures of hip osteoarthritis (OA).

METHODS

107 people (68% women; 49 ± 4 years) from the Musculoskeletal pain in Ullensaker (MUST) Study underwent the clinical and imaging examinations. Examinations included questionnaires, hip range, functional task performance, pelvic radiographs and ultrasound. Alpha angle and radiographic hip OA (Kellgren Lawrence (KL) and minimal joint space (MJS)) were determined.

RESULTS

The prevalence of cam morphology was 42% and was bilateral in 47%. People with cam morphology were 6 times more likely to have a KL score ⩾2 (adjusted odds ratio [95% confidence intervals, p-value]) 6.386 [1.582-37.646, p = 0.012]) and 4 times more likely to have MJS <2.0 mm (adjusted odds ratio 4.032 [1.031-12.639, p = 0.045]). The prevalence of radiographic OA features ranged from 4-13% in people with cam morphology, and 0-3% in those without. Those with cam morphology also demonstrated reduced hip flexion and rotation range (p = 0.018-0.036) compared with those without. There was no association between ultrasonic features and patient reported outcomes, and cam morphology.

CONCLUSIONS

In a cohort aged 40-55 years, the prevalence of cam morphology was high (42%), with a significant relationship between cam morphology and radiographic measures of hip OA. Further longitudinal studies should explore the relationship between cam morphology and hip OA in younger people.

The Size and Prevalence of Bony Hip Morphology Do Not Differ Between Football Players With and Without Hip and/or Groin Pain: Findings From the FORCe Cohort

OBJECTIVE

To compare the size and prevalence of bony hip morphology in football players with and without hip and/or groin pain.

DESIGN

Case-control.

METHODS

We recruited 184 soccer and Australian football players with self-reported hip and/or groin pain of greater than 6 months in duration and a positive flexion, adduction, and internal rotation (FADIR) test (290 hips, 21% women), and 55 football players with no pain and a negative FADIR test (110 hips, 26% women) as a control group. Bony hip morphology was identified by the alpha angle and lateral center-edge angle (LCEA) on anteroposterior pelvis and Dunn 45° radiographs. The alpha angle and LCEA were analyzed as continuous measures (size) and dichotomized using threshold values to determine the presence of bony hip morphology (cam, large cam, pincer, and acetabular dysplasia). Regression analyses estimated differences in the size and prevalence of bony hip morphology between football players with and without pain.

RESULTS

In all football players and in men, the size and prevalence of bony hip morphology did not differ between those with and without hip and/or groin pain. Cam morphology was evident in 63% of hips in players without pain and 71% of symptomatic hips in players with hip and/or groin pain. In female football players with hip and/or groin pain compared to those without pain, larger alpha angle values were observed on the Dunn 45° view (5.9°; 95% confidence interval: 1.2°, 10.6°; P = .014).

CONCLUSION

The size and prevalence of bony hip morphology appear to be similar in football players with and without hip and/or groin pain. J Orthop Sports Phys Ther 2021;51(3):115-125. Epub 25 Dec 2020. doi:10.2519/jospt.2021.9622.

Prevalence of Femoroacetabular Impingement Syndrome among Young and Middle-aged White Adults

Objective.

The purpose of the study was to determine the prevalence of femoroacetabular impingement syndrome (FAIS) in white adults 20 to 49 years of age.

Methods.

Participants were white men and women aged 20–49 years, recruited through random digit dialing from the population of Metro Vancouver, British Columbia, Canada. Participants filled out a self-administered questionnaire and underwent a physical examination and radiographs of both hips. FAIS was defined as a combination of hip symptoms, physical signs of impingement, and radiological findings of cam or pincer morphology as recommended by the Warwick Agreement. All analyses were weighted to reflect the population from which the sample was drawn.

Results.

Data were obtained for 500 participants. In the study population, 48.9% were males and the age distribution was 32.2%, 31.4%, and 36.4% in the groups 20–29, 30–39, and 40–49 years, respectively. The physical signs of impingement correlated significantly with symptoms, but there was no significant association between either symptoms or physical examination with radiographic findings. FAIS on either side was found in 3.0% (95% CI 1.5–4.5) of the population.

Conclusion.

In this study, FAIS was present in 3% of whites aged 20–49 years. Further research is needed to develop consistent criteria for assessing hip symptoms, physical signs, and hip joint morphology, and to better understand the relationships between them.

Relationship Between Hip Morphology and Hip-Related Patient-Reported Outcomes in Young and Middle-Aged Individuals: A Population-Based Study

Objective

Radiographic measurements of the alpha angle and the lateral center edge (LCE) angle in the hip joint are important for the diagnosis of femoroacetabular syndrome, a potential risk factor for hip osteoarthritis. Our objective was to determine whether these measurements are associated with hip‐related patient‐reported outcomes in young and middle‐aged individuals.

Methods

A stratified random sample of white men and women ages 20–49 years, with and without hip pain, was selected using random digit dialing from the population of metro Vancouver, Canada. The alpha and LCE angles were measured bilaterally on radiographs using Dunn and anteroposterior views, respectively. Patient‐reported outcomes were measured by the Copenhagen Hip And Groin Outcome Score (HAGOS), which has scales for symptoms, pain, daily activities, sports, physical activity, and quality of life (QoL). We performed descriptive analyses and a regression analysis with restricted cubic splines, adjusted for age and sex and weighted for the sampling design.

Results

Data were obtained for 500 subjects. The alpha angle distribution was strongly skewed, with a mean of 54°. The LCE angle distribution was symmetric, with a mean of 34°. In the restricted cubic splines analysis, the relationship between the alpha angle and HAGOS scores was nonlinear, with higher alpha angles generally associated with worse HAGOS scores for alpha >60°. The associations were statistically significant for symptoms, sports, and QoL. No association was found between the LCE angle and HAGOS scales.

Conclusion

In a general population sample ages 20–49 years, we have found an association between the alpha angle and hip‐related patient‐reported outcomes.

Evaluation of the isokinetic muscle function, postural control and plantar pressure distribution in capoeira players: a cross-sectional study

Background

Capoeira is a cultural practice with Brazilian roots that combines several elements including dance, fighting and body rhythm. Because of the diverse elements involved in its practice, capoeira is excellent at developing the physical and social abilities of its players. The aim of this study was to compare the biomechanical profile of muscle strength, plantar pressure distribution, and postural balance between players and non-players of capoeira.

Methods

We evaluated 51 subjects who were allocated into two groups: capoeira group and control group. Subjects were evaluated using a baropodometer (Diasu^®) and an isokinetic dynamometer (Biodex^®).

Results

When comparing plantar pressure distribution between groups and limbs, there were significant differences in mean load of forefoot (p=0.008) and total load (p=0.001). There were no significant differences between groups and limbs in balance and muscle strength; however, a significant difference was found in quadriceps torque peak (p=0.001) and agonist/antagonist ratio (p=0.001) when comparing these variables between the groups.

Conclusion

Capoeira players displayed a tendency to have an asymmetric profile in plantar pressure distribution. No difference was found in balance between groups. Despite the fact that capoeira players showed increased strength of the quadriceps muscle, their agonist/antagonist ratio was more asymmetrical than the control group.

Level of evidence

IV.

CLINICAL MEASURES OF HIP RANGE OF MOTION DO NOT CORRELATE WITH THE DEGREE OF CAM MORPHOLOGY IN SEMI-ELITE AUSTRALIAN FOOTBALLERS: A CROSS-SECTIONAL STUDY

Background

Clinical testing to determine the presence of a cam morphology is becoming more common however the correlation between hip range of motion and the degree of cam morphology remains controversial in the literature. The prevalence of a cam morphology in athletes has been reported as higher than in the general population but the prevalence of cam morphology has not been reported in Australian Football (AF).

Purpose

The purpose of this study was to determine the correlation between hip range of motion and hip alpha angle and report the proportion of players with a cam morphology in a sample of AF players.

Design

Cross-sectional Study.

Methods

Twenty-one semi-elite AF players (42 hips) from the Peel Thunder Football Club were included in this study. A hip Flexion Internal Rotation (IR) test and a modified maximal squat test using the difference in depth of squat in hip internal and external rotation were used. These measures were then compared to alpha angles on 90 degree Dunn view x-rays.

Results

Four of the 42 hips (9.5%) had a cam morphology (alpha angle > 60 degrees). There was no significant correlation between alpha angle and ROM in a Flexion IR test or the difference in modified maximal squat test depth within this sample of players.

Conclusions

The proportion of cam morphology seems to be lower in this sample than the previously reported prevalence in other sports. The lack of correlations between hip range and hip alpha angle in players means that screening hips using clinical measures to detect cam morphology associated with poor hip range of motion may be inaccurate.

Level of Evidence

Level 3a.

Postoperative imaging in arthroscopic hip surgery

Arthroscopic surgery of the hip, compared to that of the knee or the shoulder, has only recently been developed in any significant way. Current indications for arthroscopic surgery of the hip include: diagnosis and treatment of lesions symptomatic of the acetabular labrum, femoroacetabular impingement (FAI), chondral lesions, joint infections, lesions of the teres ligament, impingement of the psoas tendon, pathology of the peritrochanteric space, external snapping hip (coxa saltans), and traumatic and atraumatic instability. Principal indications for imaging of the hip with arthroscopic techniques are represented by persistent groin pain which may be caused by inadequate recognition or treatment of bone alteration of FAI, fractures in the site of resectioned bones, intra-articular adhesion, development of cartilaginous lesions, iatrogenic chondral lesions, recurrent lesions of the fibrocartilaginous acetabular labrum and heterotopic ossification. Postoperative checkup examinations can be undertaken with conventional radiography. The appearance or persistence of groin pain may be investigated using MRI, arthro-MRI and even CT scans.

[Resection at symptomatic cam impingement. Use of a minimally invasive antero-lateral approach]

BACKGROUND

Surgical treatment of femoroacetabular impingement (FAI) is nowadays achieved by either open surgical hip dislocation or hip arthroscopy. However, drawbacks of both procedures include the invasiveness of the open procedure and a high learning curve to successfully perform arthroscopic treatment. In our institution, we established a minimally invasive, arthroscopically assisted, antero-lateral approach for the correction of cam type FAI.

OBJECTIVES

The goal of the study was to describe the surgical technique and highlight the short-term clinical outcome in a consecutive series of patients operated between 2011 and 2014 in our institution.

MATERIALS AND METHODS

In total, 77 patients were included in this study. The patients were allocated to two groups (Toennis = 0: Group I; Toennis 1 and 2: Group II). Clinical and radiographic follow up was obtained at 6 and 12 weeks postoperatively. Clinical outcome was assessed using the Hip-Outcome-Score.

RESULTS

The mean age of patients in Group I was 25 (16-48) years and in Group II 38 (17-50) years respectively. Internal rotation (IR) in 90° flexion increased by 11 degrees from pre- to postoperatively in Group I (p < 0.001) and by 14° in Group II (p < 0.001). The Hip Outcome Score revealed the ability to perform sports with reduced pain at three months follow up. Subjectively, all patients benefitted in terms of pain and hip function in both groups (p < 0.001). There were no complications with long-term morbidity during the perioperative course.

CONCLUSION

Arthroscopically assisted cam resection using a minimally invasive anterolateral approach is a safe technique for the treatment of FAI. At short term follow up, nearly all operated patients seem to benefit in terms of pain and hip function. The influence of progression of osteoarthritis still has to be shown.

Inter- and intra-observer agreement of femoroacetabular impingement (FAI) parameters comparing plain radiographs and advanced, 3D computed tomographic (CT)-generated hip models in a surgical patient cohort

PURPOSE

The purpose of our study was to investigate whether advanced, 3D computed tomographic (CT)-generated hip models improves inter-and intra-observer agreement when compared to plain radiographs in identifying femoroacetabular impingement (FAI) morphology.

METHODS

Eight consecutive patients who underwent surgery for FAI pathology were selected for this study. Preoperative CT scan image data were used to create high resolution, 3D hip reconstruction models. Four observers (two attending hip surgeons and radiologists) performed a blinded review of preselected radiographs and 3D CT hip models. Alpha and lateral center-edge angle measurements, location of cam lesion and the presence of a "crossover sign" were assessed. Inter- and intra-observer agreement was determined by calculating the intra-class correlation coefficients (ICC) or kappa coefficients to evaluate agreement for categorical variables.

RESULTS

The parameter that demonstrated the highest and poorest inter-observer agreement was the presence of a "crossover sign" using 3D CT-generated high resolution hip models (ICC = 0.76, p = 0.00) and anteroposterior pelvis radiography, respectively (ICC = 0.20, p = 0.02). Alpha angle values were significantly higher using plain radiographs when compared to 3D hip reconstruction models (61.1° ± 10.4° versus 55.4° ± 14.4°, p = 0.003). Furthermore, when compared to radiographs, 3D hip reconstruction models demonstrated significantly higher intra-observer agreement (ICC = 0.856 versus 0.405, p = 0.005) when determining the presence of a "crossover sign".

CONCLUSIONS

Our findings were suggestive that for most commonly used FAI morphology parameters, CT-generated hip models demonstrated little benefit over plain radiographs in improving inter-observer agreement among providers.

LEVEL OF EVIDENCE

III.

Hip morphology in elite golfers: asymmetry between lead and trail hips

Aim

During a golf swing, the lead hip (left hip in a right-handed player) rotates rapidly from external to internal rotation, while the opposite occurs in the trail hip. This study assessed the morphology and pathology of golfers’ hips comparing lead and trail hips.

Methods

A cohort of elite golfers were invited to undergo MRI of their hips. Hip morphology was evaluated by measuring acetabular depth (pincer shape=negative measure), femoral neck antetorsion (retrotorsion=negative measure) and α angles (cam morphology defined as α angle >55° anteriorly) around the axis of the femoral neck. Consultant musculoskeletal radiologists determined the presence of intra-articular pathology.

Results

55 players (mean age 28 years, 52 left hip lead) underwent MRI. No player had pincer morphology, 2 (3.6%) had femoral retrotorsion and 9 (16%) had cam morphology. 7 trail hips and 2 lead hips had cam morphology (p=0.026). Lead hip femoral neck antetorsion was 16.7° compared with 13.0° in the trail hip (p<0.001). The α angles around the femoral neck were significantly lower in the lead compared with trail hips (p<0.001), with the greatest difference noted in the anterosuperior portion of the head neck junction; 53° vs 58° (p<0.001) and 43° vs 47° (p<0.001). 37% of trail and 16% of lead hips (p=0.038) had labral tears.

Conclusions

Golfers’ lead and trail hips have different morphology. This is the first time side-to-side asymmetry of cam prevalence has been reported. The trail hip exhibited a higher prevalence of labral tears.

Return to Play Following Hip Arthroscopy

Femoroacetabular impingement may be particularly disabling to the high-demand athlete, especially those with significant cutting and pivoting requirements. If nonoperative treatment fails to adequately alleviate symptoms or sufficiently restore function in the athlete, hip arthroscopy can lead to improved pain, improved range of motion, and high rates of return to play with proper postoperative rehabilitation. The rate of return to previous level of competition is also high with accurate diagnosis and well-executed correction of deformity. A clear understanding of the etiology, diagnosis, management, and outcomes is essential for clinicians to optimally help patients to return to play.

Prevalence of cam hip shape morphology: a systematic review

OBJECTIVE

Cam hip shape morphology is a recognised cause of femoroacetabular impingement (FAI) and is associated with hip osteoarthritis. Our aim was to systematically review the available epidemiological evidence assessing the prevalence of cam hip shape morphology in the general population and any studied subgroups including subjects with and without hip pain.

DESIGN

All studies that reported the prevalence of cam morphology, measured by alpha angles, in subjects aged 18 and over, irrespective of study population or presence of hip symptoms were considered for inclusion. We searched AMED, MEDLINE, EMBASE, CINAHL and CENTRAL in October 2015. Two authors independently identified eligible studies and assessed risk of bias. We planned to pool data of studies considered clinically homogenous.

RESULTS

Thirty studies met inclusion criteria. None of the included studies were truly population-based: three included non-representative subgroups of the general population, 19 included differing clinical populations, while eight included professional athletes. All studies were judged to be at high risk of bias. Due to substantial clinical heterogeneity meta analysis was not possible. Across all studies, the prevalence estimates of cam morphology ranged from 5 to 75% of participants affected. We were unable to demonstrate a higher prevalence in selected subgroups such as athletes or those with hip pain.

CONCLUSIONS

There is currently insufficient high quality data to determine the true prevalence of cam morphology in the general population or selected subgroups. Well-designed population-based epidemiological studies that use homogenous case definitions are required to determine the prevalence of cam morphology and its relationship to hip pain.

Professional golfers’ hips: prevalence and predictors of hip pain with clinical and MR examinations

Aims

This study aimed to determine the prevalence of hip pain in professional golfers, comparing the lead (left hip in right-handed golfer) and trail hips, and to establish what player characteristics predicted hip symptoms.

Methods

Male elite professional golf players were invited to complete questionnaires and undergo clinical and MR examinations while attending the Scottish Hydro Challenge 2015. Questionnaires determined player demographics, self-reported hip pain and an International Hip Outcome Tool 12 (iHOT12) score (hip-related quality of life). Clinical examinations determined hip range of motion and the presence of a positive impingement test. MR scans determined the presence of labral pathology and player hip morphology with measures of α angle (cam), acetabular depth (pincer) and femoral neck antetorsion.

Results

A total of 109 (70% of tournament field) of players completed questionnaires, 73 (47%) underwent clinical examination and 55 (35%) underwent MR examination. 19.3% of players reported of hip pain. 11.9% of lead and 9.1% of trail hips were painful (p=0.378), iHOT12 scores were lower in the lead (94.1) compared to the trail hip (95.3) (p=0.007). Stepwise multiple linear regression modelling was able to predict 20.7% of the variance in iHOT12 scores with mean α angles between 12 and 3 o'clock, and increasing age-significant variables (R2=0.207, p<0.001; β=−0.502, p<0.001 and β=−0.399, p=0.031, respectively).

Conclusions

19.3% of male professional golfers reported hip pain. The presence of an increasing α angle and increasing age were significant predictors of reduced hip-related quality of life.

Etiology of Femoroacetabular Impingement in Athletes: A Review of Recent Findings

The relationship between hip deformities and osteoarthritis has recently received a lot of attention. In particular, it has been shown that both osteoarthritis and its precursors, such as the hip deformities that lead to femoroacetabular impingement (FAI), are more prevalent in elite athletes compared with the general population. However, the etiology of the above-mentioned types of hip deformity is not currently well understood. Many recent studies have attempted to shed light on the etiology of this disease. In this article, the main clinical, radiological, mechanobiological, and biomechanical findings of relevance to understanding the etiology of hip deformities leading to FAI are reviewed. Based on these findings, a consistent biomechanical theory explaining the development of hip deformities in athletes is then presented. According to the presented theory, the repetitive, impact-like musculoskeletal loads that athletes experience, particularly when they undertake extreme ranges of hip motion, cause the development of hip deformities. According to this theory, these musculoskeletal loads trigger abnormal growth patterns during the years of skeletal development and cause the formation of hip deformities. A number of hypotheses based on the proposed theory are then formulated that could be tested in future studies to ascertain whether the proposed theory could sufficiently describe the development of hip deformities in athletes.

Which factors differentiate athletes with hip/groin pain from those without? A systematic review with meta-analysis

Background

Hip and groin injuries are common in many sports. Understanding the factors differentiating athletes with hip/groin pain from those without these injuries could facilitate management and prevention.

Objective

Conduct a systematic review and meta-analysis of the literature on factors differentiating athletes with and without hip/groin pain.

Methods

The review was registered as PROSPERO CRD42014007416 and a comprehensive, systematic search was conducted in June 2014. Inclusion criteria were: cross-sectional, cohort or case–control study designs of n>10 that examined outcome measures differentiating athletes with and without hip/groin pain. Two authors independently screened search results, assessed study quality, and performed data extraction. Methodological heterogeneity was determined and data pooled for meta-analysis when appropriate. A best evidence synthesis was performed on the remaining outcome measures.

Results

Of 2251 titles identified, 17 articles were included of which 10 were high quality. Sixty two different outcome measures were examined, 8 underwent meta-analysis. Pooled data showed strong evidence that athletes with hip/groin pain demonstrated: pain and lower strength on the adductor squeeze test, reduced range of motion in hip internal rotation and bent knee fall out; however, hip external rotation range was equivalent to controls. Strong evidence was found that lower patient-reported outcome (PRO) scores, altered trunk muscle function, and moderate evidence of bone oedema and secondary cleft sign were associated with hip/groin pain.

Conclusions

PROs, pain and reduced strength on the adductor squeeze test, reduced range of motion in internal rotation and bent knee fall out are the outcome measures that best differentiate athletes with hip/groin pain from those without this pain.

Imaging prevalence of femoroacetabular impingement in symptomatic patients, athletes, and asymptomatic individuals: A systematic review

BACKGROUND

There is a wide discrepancy in reported prevalence rates for cam, pincer, and mixed femoroacetabular impingement (FAI), particularly among distinct populations, namely asymptomatic or symptomatic subjects and athletes. No systematic analysis to date has yet compared studies among these groups to determine differences in radiographic signs of FAI.

METHODS

A systematic review of existing literature was performed to determine the prevalence of radiographic signs of FAI among athletes, asymptomatic subjects, and symptomatic patients. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied to systematically search PubMed, MEDLINE, CINAHL, and Cochrane databases.

RESULTS

We identified 361 studies in our literature search. After considering the exclusion criteria, 60 were included in this systematic review: 15 in athletes, 10 in purely asymptomatic patients, and 35 in symptomatic, non-athlete populations. Cam impingement was significantly (p=0.0003) more common in athletes versus asymptomatic subjects but not compared to symptomatic patients (p=0.107). In addition, cam FAI was significantly more common in symptomatic versus asymptomatic cases (p=0.009). The percentage of patients with cam-type FAI showed significant differences across groups (p=0.006). No significant differences were found between pincer-type FAI morphology prevalence when comparing athletes to symptomatic patients. However, mixed-type FAI was significantly more common in athletes versus asymptomatic subjects (p=0.03) and in asymptomatic versus symptomatic subjects (p=0.015). The percentage of patients with mixed-type FAI showed significant differences across groups (p=0.041). The mean alpha angle was significantly greater in the symptomatic group versus either the asymptomatic or athlete group (p<0.001). Significant differences in mean alpha angles were noted across groups (p=0.0000).

CONCLUSIONS

Imaging suspicion of FAI is common among athletes, asymptomatic, and symptomatic populations. However, significant differences in type and imaging signs of FAI exist among these groups that need to be considered in patients' decision making.

[Femoroacetabular impingement in athletes: pathology, diagnostics and operative therapy options]

Femoroacetabular impingement (FAI) and its therapy has gained importance in the last decade and several studies could show that if untreated it may lead to osteoarthritis of the hip joint. In this article an overview of the pathology of FAI, the diagnosis and treatment options are presented. A closer look is taken at the treatment of elite athletes regarding the different techniques. The first own clinical and radiological results of 91 patients treated by the arthroscopically-assisted anterior mini-open approach are presented with very good results and significant postoperative improvement regarding the hip injury and osteoarthritis outcome score (HOOS), the Western Ontario and McMasters University (WOMAC) osteoarthritis index and the University of California Los Angeles (UCLA) activity score, as well as alpha angle correction. This technique which is poorly represented in the literature can be used as a treatment option for FAI. The rehabilitation program is comparable to hip arthroscopy.