Kinematic analysis of hip and knee rotation and other contributors to ballet turnout

Hip Range of Motion and Strength in Young Pre-Professionals Ballet Dancers Versus Non-Dancers

Introduction: Lower-extremity external rotation, commonly known as turnout, is a fundamental skill in dance. Limited data exist regarding joint range of motion and strength in pre-professional young dancers and non-dancers. This study aimed to evaluate the differences in hip range of motion and hip strength between pre-professional ballet dancers and non-dancers. Additionally, the study assessed the variations between the left and right sides within each group. Methods: This observational study assessed 60 pre-professional ballet dancers and 31 non-dancers with an average age of 11.91 ± 1.49. Evaluation included passive hip rotation, tibial torsion, total passive turnout measured with digital goniometers, and total active turnout (both static and dynamic) through standing on paper and rotational discs. Hip rotation strength was measured using a force sensor device. Statistical analyses encompassed student t-tests, Pearson's correlations, and ANCOVA with age and body weight as covariates, applying the Bonferroni correction for multiple comparisons. Results: Ballet dancers exhibited greater passive hip external rotation and lower passive hip internal rotation compared to non-dancers. They also demonstrated superior total active turnout (static and dynamic). After adjusting for age and weight, dancers demonstrated significantly higher hip external rotation strength than non-dancers. Hip internal rotation strength did not differ significantly between the groups. Ballet dancers displayed inherent asymmetry, with the left side showing greater tibial torsion and standing active turnout, while the right side exhibited greater hip external rotation during dynamic active turnout. Non-dancers did not show significant side differences. Conclusions: Young pre-professional ballet dancers exhibited significant hip rotation differences compared to non-dancers, including notable right-left asymmetry. These findings should be considered when planning training, aiming to optimize musculoskeletal attributes and promote balanced hip rotation. Recognizing these asymmetries and addressing muscular imbalances is vital for injury prevention and performance enhancement.

Hallux valgus in preprofessional adolescent dancesport athletes: Prevalence and associated training factors

BACKGROUND

This study aimed to determine the risk factors of hallux valgus angle among preprofessional adolescent dancesport athletes.

METHODS

A total of 275 athletes, (73 males and 202 females) aged between the ages of 11 and 18 years, participated in this study. A cross-sectional questionnaire was used to survey their demographic characteristics (sex and age), training information (starting age, weekly training time, and athletic career [number of years of training at this specific dancesport school]), and measured their height and weight. The hallux valgus angle was measured based on foot photographs. The chi-square test was used to compare the difference with prevalence of hallux valgus between male and female athletes. A normal distribution test was performed, and based on the test results, unpaired t-test and multiple logistic regression were conducted to identify training factors for the hallux valgus in this cohort.

RESULTS

Chi-square test showed higher prevalence of hallux valgus in female elite adolescent dancesport athletes than males. The t-test results did not show any significant differences between the hallux valgus group and non-hallux valgus groups with start age, athletic career, and weekly training time. Multiple logistic regression analysis with hallux valgus as the dependent variable revealed that the female sex was a strong predictor of a higher prevalence of hallux valgus (odds ratio [OR]: 3.954, 95% confidence interval 95% CI: 2.193-7.131, and p < 0.001). Weekly training time was also entered into the multiple logistic regression model (OR: 1.033, 95% CI: 1.001-1.067, and p = 0.041).

CONCLUSIONS

Our findings revealed that the prevalence of hallux valgus in adolescent dancesport athletes was higher in females than in males. Longer weekly training time was also a risk factor for hallux valgus. Training factors should be considered in preventive programs for elite adolescent dancesport athletes, and special attention should be paid to female athletes.

The vertical mobility of the first tarsometatarsal joint during demi-plié with forced turnout in ballet dancers

The forced turnout has a perceived risk of development of hallux valgus (HV) in ballet dancers. We determined how the forced turnout affects the sagittal mobility of the first tarsometatarsal (TMT) joint, which is one of the pathogenic factors of HV development. Seventeen female ballet dancers (body mass index: 18.2 ± 1.8 kg/m2) were included and performed demi-plié in control, functional turnout, and forced turnout conditions. Ultrasound imaging synchronized with a three-dimensional motion analysis system was used for measuring the vertical locations of the first metatarsal and medial cuneiform (MC) to evaluate the first TMT joint mobility. Plantar displacement of MC and the first TMT joint mobility in the forced turnout were the greatest among the 3 conditions. Multiple regression analysis indicated that the greater extent of the forcing angle might increase the displacement of MC and the first TMT joint mobility. Evaluating the sagittal mobility of the first TMT joint in the forced turnout can assist in understanding the association between inappropriate techniques including the forced turnout and HV development in ballet dancers. Since the excessive mobility of the first TMT joint is a factor in HV development, the acquirement of adequate active turnout may have the potential to prevent HV development in ballet dancers.

A kinetic analysis of the triple step in recreational swing dancers

Despite its increasing popularity, swing dancing has not been fully studied biomechanically, imposing challenges in understanding the movement patterns associated with swing dancing. The purpose of this study was to examine the biomechanics of the triple step, one of the most common swing dance elements. We intended to determine whether dancing with a partner affects kinetic measurements and if these measurements are different among the three steps. Eight recreational swing dancers completed three triple steps to the right and the left with and without a partner. The loading rate of the vertical ground reaction force was calculated for each step, and bilateral lower limb joints moments and powers were determined. Results illustrated that dancing with or without a partner has limited effect on the kinetic measurements. However, the outcome measurements differed among the steps: a higher peak vertical ground reaction force during the first and second steps, a greater loading rate during the second step, and the greatest joint power absorption at the ankle and knee during the second step were observed. The findings extend our understanding of the biomechanics of swing dancing, and could provide preliminary guidance for understanding swing dance-related injuries and improving performance of swing dancing.

Clinical outcomes and return to dance after total hip arthroplasty or hip resurfacing in professional dancers

Aims

Professional dancers represent a unique patient population in the setting of hip arthroplasty, given the high degree of hip strength and mobility required by their profession. We sought to determine the clinical outcomes and ability to return to professional dance after total hip arthroplasty (THA) or hip resurfacing arthroplasty (HRA).

Methods

Active professional dancers who underwent primary THA or HRA at a single institution with minimum one-year follow-up were included in the study. Primary outcomes included the rate of return to professional dance, three patient-reported outcome measures (PROMs) (modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR), and Lower Extremity Activity Scale (LEAS)), and postoperative complications.

Results

A total of 49 hips in 39 patients (mean age 56 years (SD 13); 80% female (n = 39)) were included. Mean follow-up was 4.9 years (SD 5.1). Of these 49 hips, 37 THAs and 12 HRAs were performed. In all, 96% of hips returned to professional dance activities postoperatively. With regard to PROMs, there were statistically significant improvements in mHHS, HOOS-JR, and LEAS from baseline to ≥ one year postoperatively. There were complications in 7/49 hips postoperatively (14%), five of which required revision surgery (10%). There were no revisions for instability after the index procedure. Two complications (5.4%) occurred in hips that underwent THA compared with five (42%) after HRA (p = 0.007), though the difference by procedure was not significantly different when including only contemporary implant designs (p = 0.334).

Conclusion

Active professional dancers experienced significant improvements in functional outcome scores after THA or HRA, with a 96% rate of return to professional dance. However, the revision rate at short- to mid-term follow-up highlights the challenges of performing hip arthroplasty in this demanding patient population. Further investigation is required to determine the results of THA versus HRA using contemporary implant designs in these patients.

Sensing Technology for Assessing Motor Behavior in Ballet: A Systematic Review

Background

Human performance in classical ballet is a research field of growing interest in the past decades. Technology used to acquire data in human movement sciences has evolved, and is specifically being applied to evaluate ballet movements to better understand dancers’ profiles. We aimed to systematically review sensing technologies that were used to extract data from dancers, in order to improve knowledge regarding the performance of ballet movements through quantification.

Methods

PubMed, MEDLINE, EMBASE, and Web of Science databases were accessed through 2020. All studies that used motor control tools to evaluate classical ballet movements, and possible comparisons to other types of dance and sports movements were selected. Pertinent data were filled into a customized table, and risk of bias was carefully analyzed.

Results

Eighty studies were included. The majority were regarding classical ballet and with pre-professional dancers. Forty-four studies (55%) used two or more types of technology to collect data, showing that motion capture technique, force plates, electromyography, and inertial sensors are the most frequent ways to evaluate ballet movements.

Discussion

Research to evaluate ballet movements varies greatly considering study design and specific intervention characteristics. Combining two or more types of technology may increase data reliability and optimize the characterization of ballet movements. A lack of studies addressing muscle–brain interaction in dancers were observed, and given the potential of novel insights, further studies in this field are warranted. Finally, using quantitative tools opens the perspective of defining what is considered an elite dancer.

External rotation of the foot position during plantarflexion increases non-uniform motions of the Achilles tendon

The medial (GM) and lateral gastrocnemius (GL) muscles enroll to different subparts of the Achilles tendon to form their respective subtendons. The relative gastrocnemii activations during submaximal plantarflexion contraction depend on the position of the foot in the horizontal plane: with toes-in, GL activation increases and GM activation decreases, compared to toes-out. The aim of the current study was to investigate whether horizontal foot position during submaximal isometric plantarflexion contraction differently affects the subtendons within the Achilles tendon in terms of their (i) length at rest, and (ii) elongations and distal motions. Twenty healthy subjects (12 females/8 males) participated in the study. Three-dimensional ultrasound images were taken to capture subtendon lengths at rest and during isometric contraction. Ultrasound images were recorded at the distal end of Achilles tendon (sagittal plane) during ramped contractions and analyzed using a speckle tracking algorithm. All tasks were conducted twice, ones with toes-in and ones with toes-out. At rest, subtendons were shorter with toes-out compared to toes-in. During contraction, the GM subtendon lengthened more in toes-out, compared to the GL, and vice versa (all p <.01). The relative motions within the Achilles tendon (middle minus top layers displacements) were smaller in toes-in compared to toes-out (p =.05) for higher contraction intensity. Our results demonstrated that the horizontal foot position during plantarflexion contraction impacts Achilles tendon motions. Such findings may be relevant in a clinical context, for example in pathologies affecting Achilles tendon motions such as Achilles tendinopathy.

Applications of Biomechanical Foot Models to Evaluate Dance Movements Using Three-Dimensional Motion Capture: A Review of the Literature

Dance movement requires excessive, repetitive range of motion (ROM) at the foot-ankle complex, possibly contributing to the high rate of injury among dancers. However, we know little about foot biomechanics during dance movements. Researchers are using three-dimensional (3D) motion capture systems to study the in vivo kinematics of joint segments more frequently in dance-medicine research, warranting a literature review and quality assessment evaluation. The purpose of this literature review was to identify and evaluate studies that used 3D motion capture to analyze in vivo biomechanics of the foot and ankle for a cohort of dancers during dance-specific movement. Three databases (PubMed, Ovid MEDLINE, CINAHL) were accessed along with hand searches of dance-specific journals to identify relevant articles through March 2020. Using specific selection criteria, 25 studies were identified. Fifteen studies used single-segment biomechanical foot models originally created to study gait, four used a novel two-segment model, and six utilized a multi-seg- ment foot model. Nine of the studies referenced common and frequently published gait marker sets and four used a dance-specific biomechanical model with purposefully designed foot segments to analyze the dancers' foot and ankle. Description of the biomechanical models varied, reducing the reproducibility of the models and protocols. Investigators concluded that there is little evidence that the extreme total, segmental, and inter-segmental foot and ankle ROM exerted by dancers are being evaluated during dance-specific movements using 3D motion capture. Findings suggest that 3D motion capture is a robust measurement tool that has the capability to assist researchers in evaluating the in vivo, inter-segmental motion of the foot and ankle to potentially discover many of the remaining significant factors predisposing dancers to injury. The literature review synthesis is presented with recommendations for consideration when evaluating results from studies that utilized a 3D biomechanical foot model to evaluate dance-specific movement.

Type of Turnout and Injury Rates in Elite Dancers: A Critically Appraised Topic

Clinical Scenario: Dancers commonly stand in hip external rotation due to the esthetics that ballet requires. Increased external rotation is desired which leads dancers to find ways to compensate to increase their external rotation, an action known as compensated turnout. Dancers commonly rotate at the tibiofemoral joint and/or the talocrural joint to increase external rotation of the entire lower body, placing increased stress on these joints. This critically appraised topic focuses on the relationship between types of turn out and lower-extremity injury in dancers. Clinical Question: In elite dancers, does compensated, anatomical, or functional turnout influence lower-extremity injuries? Summary of Key Findings: Three studies met the inclusion criteria and were included in the analysis. One study demonstrated a relationship between compensated turnout and traumatic injuries, low back pain, and number of injuries in modern dancers. Greater compensated turnout in dancers was associated with a greater number of injuries. Two studies showed no relationship between anatomical or functional turnout and injuries in dancers. Clinical Bottom Line: Based on 3 level 2b studies, there is level C evidence to suggest that increased compensated turnout is associated with increased traumatic lower-extremity injuries, low back pain, and number of injuries in university modern dancers compared with dancers with a reduced angle of compensated turnout. This relationship was not found between anatomical or functional turnout and lower-extremity injuries in elite dancers. Strength of Recommendation: There is weak evidence to suggest that compensated turnout, but not anatomical or functional turnout, is related to lower-extremity musculoskeletal injury. More research is needed to study compensatory mechanisms in a broader range of dancers and the relationship to lower-extremity injury.

Static Balancing Ability and Lower Body Kinematics Examination of Hungarian Folk Dancers: A Pilot Study Investigating the “Kalocsai Mars” Dance Sequence

Folk dance is a collection of traditional dances that requires years of practicing to perform correctly. The aim of the present study was to develop a complex biomechanical measurement procedure that investigated Hungarian folk dancers’ balancing ability and lower body kinematics through a dance movement called “Kalocsai mars”. Therefore, 11 dancers’ motion (5 female and 6 male; age: 20.5 ± 2.5 years; height: 173.82 ± 7.82 cm; weight: 64.77 ± 8.67 kg) was recorded with an optical-based motion capture system and force platforms simultaneously. Before and after the dancing session, static balancing tests were performed, examining bipedal stance with eyes opened and closed conditions. The ANOVA results showed that the values of the range of motions of the knee joint flexion-extension angles and hip flexion averaged for sessions increased significantly (p=0.044, p=0.003, p=0.005) during the dancing sessions. The deviation in the joint angle was greater in the nondominant legs, suggesting that the nondominant side requires more attention to execute the dance steps correctly. The results of the balance tests showed that the oscillation in the posterior direction increased significantly after dancing (p=0.023). In comparison, the visual feedback had no significant effect on the dancers’ balancing ability.

Malalignment sign on knee magnetic resonance imaging: a new predictor for excessive femoral anteversion in patients with patellar dislocation

PURPOSE

To evaluate the clinical relevance of the newly identified malalignment sign in predicting excessive femoral anteversion in patients with patellar dislocations.

METHODS

A total of 55 patients with patellar dislocation who underwent surgical treatment between 2016 and 2019 were included in this study. Femoral anteversion, tibial torsion, and the femorotibial index were measured via a CT scan. The malalignment sign on the knee MRI was defined as a malalignment between the lateral side of the intercondylar fossa of the femur and the lateral intercondylar eminence of the tibial plateau.

RESULTS

A positive malalignment sign was observed in 36 of the 55 patients. Increased femoral anteversion was significantly correlated with the number of frames with a positive malalignment sign (r = 0.511, P < 0.001). The value of femoral anteversion was significantly greater in the group with a positive malalignment sign (P = 0.02). For a femoral anteversion value of 32°, the sensitivity and specificity of the malalignment sign reached the maximal level of 89.5% and 47.2%, respectively.

CONCLUSION

Increased femoral anteversion correlated significantly with a positive malalignment sign on knee MRI. However, tibial torsion did not affect the malalignment sign. A positive malalignment sign is evidence for femoral derotation osteotomy.

LEVEL OF EVIDENCE

Level IV.

Does forced or compensated turnout lead to musculoskeletal injuries in dancers? A systematic review on the complexity of causes

Injury prevalence in dancers is high, and misaligned turnout (TO) is claimed to bear injury risk. This systematic review aimed to investigate if compensating or forcing TO leads to musculoskeletal injuries. A systematic literature review was conducted according to the PRISMA Guidelines using the databases of PubMed, Embase, Emcare, Web of Science, Cochrane Library, Academic Search Premier, and ScienceDirect. Studies investigating the relationship between compensated or forced TO and injuries in all genders, all ages, and levels of dancers were included. Details on misaligned TO measurements and injuries had to be provided. Screening was performed by two researchers, data extraction and methodological quality assessment executed by one researcher and checked by another. 7 studies with 1293 dancers were included. Methodological quality was low due to study designs and a general lack of standardised definition of pathology and methods of assessment of misaligned TO. The studies investigating the lower extremities showed a hip-focus only. Non-hip contributors as well as their natural anatomical variations were not accounted for, limiting the understanding of injury mechanisms underlying misaligned TO. As such no definite conclusions on the effect of compensating or forcing TO on musculoskeletal injuries could be made. Total TO is dependent on complex motion cycles rather than generalised (hip) joint dominance only. Objective dual assessment of maximum passive joint range of motion through 3D kinematic analysis in combination with physical examination is needed to account for anatomical variations, locate sites prone to (overuse)injury, and investigate underlying injury mechanisms.

On the track of the ideal turnout: Electromyographic and kinematic analysis of the five classical ballet positions

The turnout of the lower extremities is the major component of the classical ballet positions (CPs) and correctly is initiated in the hips. The aim of this research was to determine the differences in the electromyographic and kinematic variables in the five CPs in ballet students with greater and lesser amount of passive hip external rotation (HER). A group of 14 female pre-professional ballet dancers 11–16 years of age participated in the study. Based on the amount of passive HER, participants with higher values made up greater rotation group (n = 7) whereas those with lesser values formed lesser rotation group (n = 7). Electromyographic activity of 14 muscles from right side of the trunk and right lower extremity was recorded with the surface electrodes while subjects were standing in all five CPs (CP1-CP5). The external rotation of the hips, knees and feet were recorded with the motion capture system. The kinematic differences between the groups were revealed in asymmetric positions CP4 and CP5 where foot progression angle was significantly lesser in forward than backward setting only in lesser rotation group. In lesser rotation group the ankle and back muscles were more engaged in CPs while abdominal and hip muscles less when compared with greater rotation group. This finding suggests that in the group with lesser passive HER the mechanism of forced turnout was employed. The most remarkable finding in our work was that various electromyographic patterns can be observed between groups in all CPs, while kinematic differences may be marked only in asymmetric positions.

Evaluation of Professional Ballet Dancers Body Posture During Barre Movements

Ballet dancers have finite careers due to the demands placed upon their bodies throughout years of training, study, and performance. The average age a dancer retires is 34 due to persistent stress on their joints and injuries due to mechanical overload or overuse. Proper form is crucial to prevent injury. The aim of this study was to establish benchmarks for normal movement patterns among professional dancers. Ten professional ballerinas were studied. Reflective markers were placed on the pelvis, left and right anterior superior iliac spine (ASIS), and posterior iliac spine (PSIS) to evaluate motion during Barre movements: plié, grand battement, and développé. Pelvis flexion/extension, mediolateral rotation, and torsion were analyzed. These motions test different skills. The plié is a controlled coordinated motion using both legs. The grand battement and développé both require leg extension, one with a quick motion that creates momentum and one using controlled motion that requires strength. Each requires core and pelvis stability to perform accurately and with less injury. Dancers' motions were consistent. Maximum pelvis range of motion for the plié, grand battement, and développé were 8.0, 42, and 50 deg, respectively. This represents usable benchmarks with which other dancers may be compared, for example, those who are at different levels of training, injured, predisposed to injury, or recovering from injury. Early recognition of pathologic movement patterns could benefit professional and amateur dancers by helping to prevent injuries, and potentially improve the quality and length of their careers.

Prevalence and unique patterns of lower limb hypermobility in elite ballet dancers

OBJECTIVES

Determine the prevalence of lower limb hypermobility in elite dancers and secondarily to describe the patterns of mobility.

DESIGN

Cross sectional.

SETTING

Self-report questionnaires and physical assessments were undertaken at a tertiary dance institution and a professional ballet company.

PARTICIPANTS

Fifty-seven pre-professional and 29 professional ballet dancers (21±4years, 64% female, mean 13.7years training) were recruited.

MAIN OUTCOME MEASURES

Lower Limb Assessment Score (LLAS) was used to assess hypermobility. Prevalence was determined by descriptive statistics, between-leg and -group comparisons were analysed using the chi-square statistic and the pattern of mobility by cluster analyses.

RESULTS

The right leg was significantly more hypermobile than the left for the whole cohort (44% vs 40% meeting ≥7/12 for the LLAS; LLAS mean/12(SD): right:5.0(2.4) and 7.6(1.9); left:4.8(2.1) and 6.7(2.0) in pre-professionals and professionals respectively (p = 0.02)). Subtalar pronation (p < 0.001) and hip abduction/external rotation (left:p = 0.01; right:p < 0.001) were significantly more hypermobile bilaterally in professionals. Three hypermobility profiles on the left and four on the right lower limb were identified.

CONCLUSIONS

This paper presents unique lower limb hypermobility profiles identified in elite dancers.

Dynamic hip kinematics during recreational classical ballet and hula dance after total hip arthroplasty: two case reports

Background

The in vivo assessment of the three-dimensional kinematics of the hip during dance activities in patients after total hip arthroplasty has not been previously reported. We evaluated the replaced hip kinematics during recreational classical ballet and hula dance using radiographic-based image-matching techniques.

Case presentation

A 58-year-old Japanese woman (patient 1; height, 157 cm; weight, 74.5 kg) and a 73-year-old Japanese woman (patient 2; height, 153 cm; weight, 48 kg) were still doing classical ballet and hula dance, respectively, after primary total hip arthroplasty. For ballet, there were gradual three-dimensional hip movements with 48° flexion, 36° abduction, and 49° external rotation in développé and 34° flexion, 29° abduction, and 43° external rotation in plié. For hula, there were small three-dimensional hip movements with 31° flexion, 15° adduction, and 11° external rotation in kao and 17° flexion, 11° adduction, and 11° external rotation in kaholo. No liner-to-neck contact was found in any dance activities.

Conclusion

Both classical ballet and hula dance produced complex ranges of hip movements and activity-dependent kinematics. These kinematic data could be useful for recommending each patient with total hip arthroplasty to continue recreational dance activities.

The Physical Attributes Most Required in Professional Ballet: A Delphi Study

Background It is commonly accepted that dancers are undoubtedly athletes, with ballet perhaps the most demanding dance form. No previous study has sought to define the physical attributes most desired for classical ballet by professional companies and vocational schools. These are likely to include both aesthetic features and attributes that reduce the risk of injury as well as enhance performance. Method An initial survey question using the modified Delphi technique was sent using Opinio Survey Software to a selected international expert panel. This was drawn both from those involved in selection of elite professional ballet dancers, and the international medical professionals involved in the care of dancers. The first questionnaire was open-ended to scope for all the physical attributes most favoured by the professional experts. Results There were 148 responses from the panel of international experts. In total 34 physical attributes were suggested. The 2 most recommended physical criteria for selection into the profession were overall flexibility and overall strength. These results are discussed in the context of the published literature on the mechanics, anatomy and physiology of ballet. Conclusion Flexibility and strength are the 2 features most sought after in elite ballet dancers.

Lower leg and foot contributions to turnout in female pre-professional dancers: A 3D kinematic analysis

Turnout is a central element of classical ballet which involves sustained external rotation of the lower limbs during dance movements. Lower leg and foot compensation mechanisms which are often used to increase turnout have been attributed to the high incidence of lower limb injury in dancers. Evaluation of dancers' leg posture is needed to provide insight into the lower limb kinematic strategies used to achieve turnout. The primary purpose of this study was to use 3D kinematic analyses to determine the lower leg and foot compensations that are incorporated by female university dancers to accentuate their turnout. Active and passive external tibiofemoral rotation (TFR) was also measured. A moderate-strong negative relationship was observed between hip external rotation (HER) and foot abduction in the three first position conditions. A moderate negative relationship was found between passive TFR and foot abduction in all first position conditions. Our findings suggest dancers are more likely to pronate, than rotate the knee to compensate for limited HER. Dancers with a limited capacity to pronate may force additional rotation via the knee. Ongoing research would benefit from more in-depth analyses of the foot/ankle complex using a multi-segment foot model.

Cam morphology and inguinal pathologies: is there a possible connection?

Background

To analyse the prevalences of the cam and pincer morphologies in a cohort of patients with groin pain syndrome caused by inguinal pathologies.

Materials and methods

Forty-four patients (40 men and 4 women) who suffered from groin pain syndrome were enrolled in the study. All the patients were radiographically and clinically evaluated following a standardised protocol established by the First Groin Pain Syndrome Italian Consensus Conference on Terminology, Clinical Evaluation and Imaging Assessment in Groin Pain in Athlete. Subsequently, all of the subjects underwent a laparoscopic repair of the posterior inguinal wall.

Results

The study demonstrated an association between the cam morphology and inguinal pathologies in 88.6% of the cases (39 subjects). This relationship may be explained by noting that the cam morphology leads to biomechanical stress at the posterior inguinal wall level.

Conclusions

Athletic subjects who present the cam morphology may be considered a population at risk of developing inguinal pathologies.

Level of evidence

Level IV, Observational cross-sectional study.