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Anwander H, Beck M, Büchler L. Influence of evolution on cam deformity and its impact on biomechanics of the human hip joint. J Orthop Res 2018; 36:2071-2075. [PMID: 29405367 DOI: 10.1002/jor.23863] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 01/24/2018] [Indexed: 02/04/2023]
Abstract
Anatomy and biomechanics of the human hip joint are a consequence of the evolution of permanent bipedal gait. Habitat and behaviour have an impact on hip morphology and significant differences are present even within the same biological family. The forces acting upon the hip joint are mainly a function of gravitation and strength of the muscles. Acetabular and femoral anatomy ensure an inherently stable hip with a wide range of motion. The femoral head in first human ancestors with upright gait was spherical (coxa rotunda). Coxa rotunda is also seen in close human relatives (great apes) and remains the predominant anatomy of present-day humans. High impact sport during adolescence with open physis however can activate an underlying genetic predisposition for reinforcement of the femoral neck, causing an epiphyseal extension and the formation of an osseous asphericity at the antero-superior femoral neck (cam deformity). The morphology of cam deformity is similar to the aspherical hips of quadrupeds (coxa recta), with the difference that in quadrupeds the asphericity is posterior. It has been postulated that this is due to the fact that humans bear weight on the extended leg, while quadrupeds bear weight at 90-100° flexion. The asphericity alters the biomechanical properties of the joint and as it is forced into the acetabulum leading to secondary cartilage damage. It is considered a risk factor for later development of osteoarthritis of the hip. Clinically this presents as reduced range of motion, which can be an indicator for the structural deformity of the hip. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 9999:XX-XX, 2018.
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Affiliation(s)
- Helen Anwander
- Clinic for Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Luzern, Switzerland
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Beck
- Clinic for Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Luzern, Switzerland
| | - Lorenz Büchler
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Abstract
Cam morphology of the proximal femur is an abnormal contour of the femoral head-neck junction present in approximately 15% to 25% of the asymptomatic population, predominantly in males. Alpha angle and femoral head-neck offset ratio are 2 objective measurement tools that define cam morphology. Both primary (idiopathic) and secondary cam deformity develops through distinct mechanisms. The cause of primary (idiopathic) cam morphology remains incompletely understood. Mounting evidence suggests that idiopathic cam morphology develops during adolescence through alterations in the capital femoral epiphysis in response to participation in vigorous sporting activity. While the exact cause of epiphyseal extension has not yet been determined, preliminary evidence suggests that epiphyseal extension may reflect a short-term adaptive response to provide stability to the physis at the long-term cost of the development of cam morphology. Commonly recognized causes of secondary cam deformity include frank slipped capital femoral epiphysis, Legg-Calve-Perthes disease, and deformity after fracture of the proximal femur. Recent studies also support subtle slipped capital femoral epiphysis as a unique and silent cause of a small percentage of subjects previously thought to have idiopathic cam deformity.
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Affiliation(s)
- William Z Morris
- Department of Orthopaedic Surgery, University Hospitals, Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ryan T Li
- Department of Orthopaedic Surgery, University Hospitals, Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Raymond W Liu
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospitals at Case Western Reserve University, Cleveland, Ohio, USA
| | - Michael J Salata
- University Hospitals Sports Medicine Institute, Cleveland, Ohio, USA
| | - James E Voos
- University Hospitals Sports Medicine Institute, Cleveland, Ohio, USA
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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. Int J Sports Phys Ther 2017; 12:1078-1086. [PMID: 29234559 DOI: 10.26603/ijspt20171078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
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.
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Palmer A, Fernquest S, Gimpel M, Birchall R, Judge A, Broomfield J, Newton J, Wotherspoon M, Carr A, Glyn-Jones S. Physical activity during adolescence and the development of cam morphology: a cross-sectional cohort study of 210 individuals. Br J Sports Med 2017; 52:601-610. [PMID: 28798039 PMCID: PMC5909766 DOI: 10.1136/bjsports-2017-097626] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 11/16/2022]
Abstract
Introduction Cam morphology is a strong risk factor for the development of hip pain and osteoarthritis. It is increasingly thought to develop in association with intense physical activity during youth; however, the aetiology remains uncertain. The study aim was to characterise the effect of physical activity on morphological hip development during adolescence. Methods Cross-sectional study of individuals aged 9–18 years recruited from Southampton Football Club Academy (103 male) with an age-matched control population (52 males and 55 females). Assessments included questionnaires and 3 Tesla MRI of both hips. Alpha angle, epiphyseal extension and epiphyseal tilt were measured on radial images. Results Alpha angle and epiphyseal extension increased most rapidly between ages 12 and 14 years. Soft-tissue hypertrophy at the femoral head-neck junction preceded osseous cam morphology and was first evident at age 10 years. The greatest increase and highest absolute values of alpha angle and epiphyseal extension were colocalised at 1 o’clock. Maximum alpha angles were 6.7 degrees greater in males than females (p=0.005). Compared with individuals who play no regular sport, alpha angles were 4.0 degrees higher in individuals who play sport for a school or club (p=0.041) and 7.7 degrees higher in individuals competing at a national or international level (p=0.035). There was no association with leg dominance. Conclusions Sporting activity during adolescence is strongly associated with the development of cam morphology secondary to epiphyseal hypertrophy and extension with a dose-response relationship. Males participating in competitive sport are at particularly elevated risk of developing cam morphology and secondary hip pathology.
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Affiliation(s)
- Antony Palmer
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Scott Fernquest
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mo Gimpel
- Southampton Football Club, Southampton, UK
| | | | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - John Broomfield
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Julia Newton
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sion Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Abstract
Impingement syndromes are increasingly recognised as significant causes of hip pain and dysfunction. A broad spectrum of intraarticular and extraarticular conditions has been implicated in their pathophysiology. Physical examination is often inconclusive as clinical findings may be unclear or misleading, often simulating other disorders. With current improvements in imaging techniques and better understanding of hip impingement related pathomechanisms, these entities can be accurately diagnosed. In addition, preoperative imaging has allowed for targeted treatment planning. This article provides an overview of the various types of hip impingement, including femoroacetabular impingement, ischiofemoral impingement, snapping hip syndrome, greater trochanteric-pelvic and subspine impingement. Current literature data regarding their pathogenesis, clinical manifestation and imaging work-up are discussed.
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Marin-Peña O, Tey-Pons M, Perez-Carro L, Said HG, Sierra P, Dantas P, Villar RN. The current situation in hip arthroscopy. EFORT Open Rev 2017; 2:58-65. [PMID: 28507776 PMCID: PMC5420826 DOI: 10.1302/2058-5241.2.150041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hip arthroscopy is an evolving surgical technique that has recently increased in popularity. Although femoroacetabular impingement was an important launch pad for this technique, extra-articular pathology has been described through hip endoscopy. Good clinical results in the medium term will allow improvements in this technique and increase its indications.
Cite this article: EFORT Open Rev 2017;2:58-65. DOI: 10.1302/2058-5241.2.150041
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Affiliation(s)
- Oliver Marin-Peña
- Orthopedic Surgery and Traumatology, University Hospital Infanta Leonor, Madrid, Spain
| | | | | | | | - Pablo Sierra
- Madrid. University Hospital Torrejon, Madrid, Spain
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Smith T, de Medici A, Oduoza U, Hakim A, Paton B, Retter G, Haddad F, Macgregor A. National survey to evaluate musuloskeletal health in retired professional ballet dancers in the United Kingdom. Phys Ther Sport 2017; 23:82-85. [DOI: 10.1016/j.ptsp.2016.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 07/08/2016] [Accepted: 07/27/2016] [Indexed: 01/29/2023]
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Mosler AB, Crossley KM, Waarsing JH, Jomaah N, Weir A, Hölmich P, Agricola R. Ethnic Differences in Bony Hip Morphology in a Cohort of 445 Professional Male Soccer Players. Am J Sports Med 2016; 44:2967-2974. [PMID: 27492971 DOI: 10.1177/0363546516656163] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Participation in high-impact athletic activities has recently been associated with a higher prevalence of cam deformity. Bony hip morphology has also emerged as an important factor in the development of hip osteoarthritis. However, it is unknown whether bony morphology differs between ethnicities in athletes participating in high-impact sports. PURPOSE To investigate whether the prevalence of specific bony hip morphological abnormalities differed between professional male soccer players of diverse ethnic backgrounds. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Professional male soccer players from an entire league attending preparticipation screening were invited to participate in this study. Ethnicity was registered, and standardized radiographs of anteroposterior pelvic and Dunn views were obtained. Cam and pincer deformity, and acetabular dysplasia were quantified using the alpha angle, triangular index, and lateral center-edge angle (LCEA). Regression analyses with generalized estimating equations were used to determine prevalence differences in bony hip morphology. RESULTS A total of 445 male soccer players (890 hips; mean age ± SD, 25 ± 4.9 years) participated in the study, representing the following ethnic groups: Arabic (59%), black (24%), Persian (7%), white (6%), East Asian (2%), and other (2%). The prevalence of cam deformity (alpha angle >60°) ranged from 57.5% to 71.7% across 4 of the groups, but East Asians had a significantly lower prevalence (18.8%; P ≤ .032). A large cam deformity (alpha angle >78°) was more prevalent in white (33.3%) compared with black soccer players (17.8%; P = .041) and was absent in East Asian players. Pincer deformity (LCEA >40°) was uncommon (3%) in all ethnicities. The prevalence of acetabular dysplasia (LCEA <20°) ranged from 8.0% to 16.7%, apart from the white group, in which prevalence was only 1.9% (P = .03). CONCLUSION The prevalence of a cam deformity and acetabular dysplasia differed between ethnicities in this cohort of professional male soccer players. These findings suggest that there may be ethnic differences in both acetabular morphology and femoral bony response to athletic load.
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Affiliation(s)
- Andrea B Mosler
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar .,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia.,School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Kay M Crossley
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia.,School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Jan H Waarsing
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Nabil Jomaah
- Radiology Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Adam Weir
- Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Per Hölmich
- Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Sports Orthopedic Research Center-Copenhagen, Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Rintje Agricola
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, the Netherlands.,Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Dickenson E, O'Connor P, Robinson P, Campbell R, Ahmed I, Fernandez M, Hawkes R, Charles H, Griffin D. Hip morphology in elite golfers: asymmetry between lead and trail hips. Br J Sports Med 2016; 50:1081-6. [DOI: 10.1136/bjsports-2016-096007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2016] [Indexed: 11/04/2022]
Abstract
AimDuring 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.MethodsA 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.Results55 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.ConclusionsGolfers’ 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.
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60
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Dickenson E, Wall PDH, Robinson B, Fernandez M, Parsons H, Buchbinder R, Griffin DR. Prevalence of cam hip shape morphology: a systematic review. Osteoarthritis Cartilage 2016; 24:949-61. [PMID: 26778530 DOI: 10.1016/j.joca.2015.12.020] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/07/2015] [Accepted: 12/27/2015] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
| | - P D H Wall
- University Hospitals Coventry and Warwickshire, United Kingdom.
| | - B Robinson
- University Hospitals Coventry and Warwickshire, United Kingdom.
| | - M Fernandez
- University Hospitals Coventry and Warwickshire, United Kingdom.
| | - H Parsons
- Warwick Medical School, United Kingdom.
| | - R Buchbinder
- Monash University Department of Clinical Epidemiology, Australia.
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Read PJ, Oliver JL, De Ste Croix MBA, Myer GD, Lloyd RS. The scientific foundations and associated injury risks of early soccer specialisation. J Sports Sci 2016; 34:2295-2302. [PMID: 27120711 DOI: 10.1080/02640414.2016.1173221] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Early specialisation is characterised by formal participation in a single sport at the exclusion of others. Limited data are available to support this approach in the development of soccer players who attain elite status later in life. Of growing concern is the associated increased risk of injury and suggestions that single sport specialisation is a risk factor independent of age, growth, biological maturation and training volumes. In the United Kingdom, elite soccer organisations have recently adopted an early sport specialisation approach following the introduction of the Elite Player Performance Plan. A key tenet of this programme is increased opportunities for training through a marked rise in the specified on-pitch hours per week. The accumulation of high training hours may be less of a relevant marker for success, and the impact of such a significant increase in training volume for young athletes who are experiencing a range of growth and maturational processes is currently unknown. This critical commentary includes an evidence-based discussion of the effectiveness of early sport specialisation and the potential injury risks associated with such programmes placing a specific focus on elite male youth soccer players. Available data indicate that modifications to the existing Elite Player Performance Plan framework could enhance players' development and reduce injury risk. Proposed alterations include reduced volume of soccer-specific training at key stages of growth and maturation and guidelines for the provision of a greater variety of physical activities that are integrated within other programme components.
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Affiliation(s)
- Paul J Read
- a School of Sport, Health and Applied Science , St Mary's University , London , UK
| | - Jon L Oliver
- b Youth Physical Development Unit, School of Sport , Cardiff Metropolitan University , Cardiff , UK.,c Sport Performance Research Institute, New Zealand (SPRINZ) , AUT University , Auckland , New Zealand
| | | | - Gregory D Myer
- e Division of Sports Medicine , Cincinnati Children's Hospital , Cincinnati , OH , USA.,f Department of Pediatrics and Orthopaedic Surgery , College of Medicine, University of Cincinnati , Cincinnati , OH , USA.,g The Micheli Center for Sports Injury Prevention , Boston , MA , USA.,h Department of Orthopaedics , University of Pennsylvania , Philadelphia , PA , USA
| | - Rhodri S Lloyd
- b Youth Physical Development Unit, School of Sport , Cardiff Metropolitan University , Cardiff , UK.,c Sport Performance Research Institute, New Zealand (SPRINZ) , AUT University , Auckland , New Zealand
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Abstract
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.
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Affiliation(s)
- Amir A Zadpoor
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Mekelweg 2, Delft, 2628 CD, The Netherlands,
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de Silva V, Swain M, Broderick C, McKay D. Does high level youth sports participation increase the risk of femoroacetabular impingement? A review of the current literature. Pediatr Rheumatol Online J 2016; 14:16. [PMID: 26968690 PMCID: PMC4788845 DOI: 10.1186/s12969-016-0077-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/07/2016] [Indexed: 11/10/2022] Open
Abstract
Sports participation can be an integral part of adolescent development with numerous positive short and long-term effects. Despite these potential benefits very high levels of physical activity, during skeletal maturation, have been proposed as a possible cause of cam-type femoroacetabular impingement (FAI). The influence of physical activity on the developing physis has been previously described both in animal studies and epidemiological studies of adolescent athletes. It is therefore important to determine whether the development of FAI is secondary to excessive physical activity or a combination of a vulnerable physis and a set level of physical activity. A review of the current literature suggests that adolescent males participating in ice-hockey, basketball and soccer, training at least three times a week, are at greater risk than their non-athletic counterparts of developing the femoral head-neck deformity associated with femoroacetabular impingement.
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Affiliation(s)
- Viran de Silva
- Territory Sports Medicine, Darwin, Northern Territory Australia
| | - Michael Swain
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia ,Department of Chiropractic, Faculty of Science, Macquarie University, Sydney, 2109 Australia
| | - Carolyn Broderick
- Children’s Hospital Institute of Sports Medicine, The Sydney Children’s Hospitals Network, Sydney, Australia ,School of Medical Sciences, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Damien McKay
- Children's Hospital Institute of Sports Medicine, Locked Bag 4001, Westmead, Sydney, New South Wales, 2145, Australia.
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Tak I, Glasgow P, Langhout R, Weir A, Kerkhoffs G, Agricola R. Hip Range of Motion Is Lower in Professional Soccer Players With Hip and Groin Symptoms or Previous Injuries, Independent of Cam Deformities. Am J Sports Med 2016; 44:682-8. [PMID: 26673034 DOI: 10.1177/0363546515617747] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Soccer (football) players often have hip and groin symptoms (HGS), and a previous groin injury is a risk factor for a relapse. Decreased hip range of motion (HROM) has been related to both hip and groin pain and the presence of a cam deformity. How these factors interact is unknown. PURPOSE The first aim was to study whether HGS are associated with HROM. The second aim was to study the association of the presence of a cam deformity with HROM. Additionally, the influence of a cam deformity on the relationship between HGS and HROM was examined. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Seasonal screening data of 2 professional soccer clubs were used. Variables for HGS were current hip or groin pain, the Copenhagen Hip and Groin Outcome Score (HAGOS), and previous hip- and groin-related time-loss injuries (HGTIs). HROM was determined for hip internal rotation (IR), external rotation, and total rotation (TR) in the supine position and for the bent knee fall out (BKFO) test. A cam deformity was defined by an alpha angle >60° on standardized anteroposterior pelvic and frog-leg lateral radiographs. RESULTS Sixty players (mean [±SD] age, 23.1 ± 4.2 years) were included. All were noninjured at the time of screening. Current hip or groin pain was not associated with HROM. Hips of players in the lowest HAGOS interquartile range (thus most affected by complaints; n = 12) showed less IR (23.9° ± 8.7° vs 28.9° ± 7.8°, respectively; P = .036) and TR (58.2° ± 13.5° vs 65.6° ± 11.8°, respectively; P = .047) than those in the highest interquartile range (n = 29). No such differences were found for BKFO (P = .417). Hips of players with a previous HGTI showed less IR (21.1° ± 6.8° vs 28.3° ± 8.9°, respectively; P < .001) and TR (56.0° ± 8.2° vs 64.5° ± 13.6°, respectively; P < .001) than those without a previous HGTI. This was independent of the presence of a cam deformity. BKFO did not differ between groups (P = .983). Hips with a cam deformity showed less but nonsignificant IR (25.5° ± 10.3° vs 29.0° ± 7.1°, respectively; P = .066) and TR (P = .062) and higher but nonsignificant BKFO values (17.1 cm ± 3.4 cm vs 14.2 cm ± 4.6 cm, respectively; P = .078) than those without a cam deformity. CONCLUSION Decreased HROM in professional soccer players is associated with more hip- and groin-related symptoms and with previous injuries, independent of the presence of a cam deformity.
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Affiliation(s)
- Igor Tak
- Sports Rehabilitation and Manual Therapy Department, Physiotherapy Utrecht Oost, Utrecht, the Netherlands Department of Orthopaedics, Academic Medical Centre, Amsterdam, the Netherlands Academic Centre for Evidence based Sports Medicine (ACES), Amsterdam, the Netherlands Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, the Netherlands
| | - Philip Glasgow
- Sports Institute of Northern Ireland, Belfast, Northern Ireland Sports Medicine Department, Ulster University, Belfast, Northern Ireland
| | - Rob Langhout
- Sports and Manual Therapy, Physiotherapy Dukenburg, Nijmegen, the Netherlands
| | - Adam Weir
- Sports Medicine Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Gino Kerkhoffs
- Department of Orthopaedics, Academic Medical Centre, Amsterdam, the Netherlands Academic Centre for Evidence based Sports Medicine (ACES), Amsterdam, the Netherlands Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, the Netherlands
| | - Rintje Agricola
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Sansone M, Ahldén M, Jonasson P, Thomeé C, Swärd L, Collin D, Baranto A, Karlsson J, Thomeé R. Outcome of hip arthroscopy in patients with mild to moderate osteoarthritis-A prospective study. J Hip Preserv Surg 2015; 3:61-7. [PMID: 27026820 PMCID: PMC4808260 DOI: 10.1093/jhps/hnv079] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 09/21/2015] [Accepted: 11/20/2015] [Indexed: 11/12/2022] Open
Abstract
Osteoarthritis (OA) of the hip is a common cause of hip pain. The arthroscopic management of patients with femoro-acetabular impingement (FAI) has been reported to yield good outcomes. The purpose of this study was to report on outcome following the arthroscopic treatment of patients with FAI in the presence of mild to moderate OA. Seventy-five patients undergoing arthroscopic surgery for FAI, all with preoperative radiological signs of mild to moderate OA were prospectively included in this study. A 2-year follow-up, using web-based patient-reported outcome measures, including the International Hip Outcome Tool (iHOT-12), Copenhagen Hip and Groin Outcome (HAGOS), EQ-5D, Hip Sports Activity Scale (HSAS) for physical activity level and a visual analogue scale (VAS) for overall hip function, was performed, complemented by a radiographic evaluation. At follow-up (mean 26 months, SD 5), five patients (7%) had undergone total hip arthroplasty, leaving 70 patients for the analysis. Preoperative scores compared with those obtained at the 2-year follow-up revealed significant improvements (P < 0.0001) for all measured outcomes; the iHOT-12 (42 versus 65), VAS for global hip function (48 versus 68), HSAS (2.5 versus 3), EQ5D index (0.62 versus 0.76), EQ VAS (69 versus 75) and different HAGOS subscales (54 versus 72, 47 versus 67, 56 versus 75, 40 versus 61, 33 versus 56, 31 versus 55). At follow-up, 56 (82%) patients reported that they was satisfied with the outcome of surgery. Arthroscopic treatment for patients with FAI in the presence of mild to moderate OA resulted in statistically significant and clinically relevant improvements in outcome measures related to pain, symptoms, function, physical activity level and quality of life in the majority of patients.
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Affiliation(s)
- Mikael Sansone
- 1. Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden,; 3. Orthocenter/IFK-Kliniken, Gothenburg, Sweden
| | - Mattias Ahldén
- 1. Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden,; 3. Orthocenter/IFK-Kliniken, Gothenburg, Sweden
| | - Pall Jonasson
- 1. Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Christoffer Thomeé
- 1. Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Leif Swärd
- 3. Orthocenter/IFK-Kliniken, Gothenburg, Sweden
| | - David Collin
- 4. Department of Radiology, Sahlgrenska University, Hospital/Mölndal, Mölndal, Sweden
| | - Adad Baranto
- 1. Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Jón Karlsson
- 1. Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Roland Thomeé
- 2. Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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66
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Agricola R, Weinans H. What causes cam deformity and femoroacetabular impingement: still too many questions to provide clear answers. Br J Sports Med 2015; 50:263-4. [DOI: 10.1136/bjsports-2015-094773] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2015] [Indexed: 11/03/2022]
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67
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Serner A, Tol JL, Jomaah N, Weir A, Whiteley R, Thorborg K, Robinson M, Hölmich P. Diagnosis of Acute Groin Injuries: A Prospective Study of 110 Athletes. Am J Sports Med 2015; 43:1857-64. [PMID: 25977522 DOI: 10.1177/0363546515585123] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acute groin injuries are common in high-intensity sports, but there are insufficient data on injury characteristics such as injury mechanisms and clinical and radiological findings. PURPOSE To describe these characteristics in a cohort of athletes. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 110 male athletes (mean age, 25.6 ± 4.7 years) with sports-related acute groin pain were prospectively included within 7 days of injury from August 2012 to April 2014. Standardized history taking, a clinical examination, magnetic resonance imaging (MRI), and/or ultrasound (US) were performed. RESULTS The most frequent injury mechanism in soccer was kicking (40%), and change of direction was most frequent in other sports (31%). Clinically, adductor injuries accounted for 66% of all injuries and primarily involved the adductor longus on imaging (91% US, 93% MRI). The iliopsoas and proximal rectus femoris were also frequently injured according to all examination modalities (15%-25%). Acute injury findings were negative in 22% of the MRI and 25% of the US examinations. Of the clinically diagnosed adductor injuries, 3% (US) and 6% (MRI) showed a radiological injury in a different location compared with 35% to 46% for clinically diagnosed iliopsoas and proximal rectus femoris injuries. CONCLUSION Adductor injuries account for the majority of acute groin injuries. Iliopsoas and proximal rectus femoris injuries are also common. More than 1 in 5 injuries showed no imaging signs of an acute injury. Clinically diagnosed adductor injuries were often confirmed on imaging, whereas iliopsoas and rectus femoris injuries showed a different radiological injury location in more than one-third of the cases. The discrepancy between clinical and radiological findings should be considered when diagnosing acute groin injuries.
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Affiliation(s)
- Andreas Serner
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Johannes L Tol
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Nabil Jomaah
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Adam Weir
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Rodney Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | | | - Per Hölmich
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
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68
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Faigenbaum AD, Lloyd RS, MacDonald J, Myer GD. Citius, Altius, Fortius: beneficial effects of resistance training for young athletes: Narrative review. Br J Sports Med 2015; 50:3-7. [PMID: 26089321 DOI: 10.1136/bjsports-2015-094621] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2015] [Indexed: 11/04/2022]
Abstract
The motto of the Olympic Games is Citius, Altius, Fortius which is Latin for 'Faster, Higher, Stronger'. It is a clarion call to all competitors, including the youngest, to engage in training strategies that prepare athletes to be the best in the world. Existing research indicates that various forms of resistance training can elicit performance improvements in young athletes. Stronger young athletes will be better prepared to learn complex movements, master sport tactics, and sustain the demands of training and competition. An integrative training programme grounded in resistance training and motor skill development can optimise a young athlete's potential to maximise their athletic and sporting performance, while reducing the risk of a sports-related injury. Resistance training may be especially important for modern-day young athletes who are more likely to specialise in one sport at an early age at the expense of enhancing general physical fitness and learning diversified sport skills. Structured interventions that include qualified instruction; targeted movement practice; and strength and conditioning activities that are developmentally appropriate, progressive and technique driven are needed to attain a level of athleticism that is consistent with the Olympic motto.
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Affiliation(s)
- Avery D Faigenbaum
- Department of Health and Exercise Science, The College of New Jersey, Ewing, New Jersey, USA
| | - Rhodri S Lloyd
- School of Sport, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - James MacDonald
- Department of Paediatrics and Family Medicine, The Ohio State University, Columbus, Ohio, USA Division of Sports Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Gregory D Myer
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA Departments of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA The Sports Health and Performance Institute, OSU Sports Medicine, Ohio State University Medical Centre, Columbus, Ohio, USA
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