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Machado JKS, Guimarães GHDS, Ferreira MDC, Nogueira JG. Relationship between Femoroacetabular Impingement and Pubalgia in Professional Soccer Players. Rev Bras Ortop 2023; 58:e862-e868. [PMID: 38077776 PMCID: PMC10708980 DOI: 10.1055/s-0043-1776772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/29/2023] [Indexed: 08/03/2024] Open
Abstract
Objective To analyze the relationship between pubalgia and femoroacetabular impingement (FAI) in professional athletes of a soccer club, defining the prevalence of these conditions in the sample studied. Methods It is an epidemiological, cross-sectional, and analytical study including 90 professional soccer players active from 2019 to 2021. We accessed the medical records of the subjects to retrieve information from the modified Pre-Competition Medical Assessment (PCMA) protocol, orthopedic physical examination, and anteroposterior pelvic radiographs to assess pubalgia and FAI, respectively. Inclusion criteria were athletes playing in the professional soccer club in the 2019 to 2021 season, who underwent a modified PCMA upon admission, and who signed an informed consent form. Results FAI was highly prevalent (85.6%) in the sample. This prevalence may occur because, in Brazil, people start playing sports early, not always in suitable fields, or with no proper equipment and supervision. In addition, the CAM-type impingement was the most frequent (62.2%). These injuries are related to high-intensity movements, including those associated with soccer. Furthermore, there is no dependency correlation between pubalgia and FAI. FAI was present in only 20% of athletes with pubalgia complaints. Conclusion There was a high prevalence of FAI in professional soccer players in the studied population (85.6%) but with no relationship between FAI and pubalgia.
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Affiliation(s)
- Jean Klay Santos Machado
- Coordenador do Serviço de Ortopedia e Traumatologia pelo Hospital Porto Dias, Belém Pará, Brasil
| | | | | | - Jaime Gomes Nogueira
- Residente em Ortopedia e Traumatologia pelo Hospital Porto Dias, Belém Pará, Brasil
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Candela V, De Carli A, Longo UG, Sturm S, Bruni G, Salvatore G, Denaro V. Hip and Groin Pain in Soccer Players. JOINTS 2021; 7:182-187. [PMID: 34235383 PMCID: PMC8253608 DOI: 10.1055/s-0041-1730978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 04/18/2021] [Indexed: 10/29/2022]
Abstract
Purpose The aim of this article is to illustrate the recent framework necessary to standardize studies on groin pain and review the existing literature on groin pain in football. Methods The common pathological processes underlying groin pain such as muscle, tendon or ligament strain, bone injury or fracture, sport hernia, bursitis, osteitis pubis, and hip-related diseases have been reviewed and current management options have been considered. Results Groin pain is considered a pain in pubic or lower abdominal or adductors region which can be monolateral or bilateral. It is common in high-intensity team sports and can negatively affect an athlete's professional carrier, causing serious disruption in the performance. Despite a high prevalence of groin pain in athletes, diagnosis and management of the underlying pathological processes remain a challenge for surgeons, radiologists, and physiotherapists alike. Conclusion A multidisciplinary approach is essential for patients with groin pain allowing prompt diagnosis and initiation of treatment thus facilitating more rapid return to play and preventing potential long-term sequelae of chronic groin pathology.
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Affiliation(s)
- Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Angelo De Carli
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza," Italy
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Sofia Sturm
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Giorgio Bruni
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza," Italy
| | - Giuseppe Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
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Morales-Avalos R, Tapia-Náñez A, Simental-Mendía M, Elizondo-Riojas G, Morcos-Sandino M, Tey-Pons M, Peña-Martínez VM, Barrera FJ, Guzman-Lopez S, Elizondo-Omaña RE, Vílchez-Cavazos F. Prevalence of Morphological Variations Associated With Femoroacetabular Impingement According to Age and Sex: A Study of 1878 Asymptomatic Hips in Nonprofessional Athletes. Orthop J Sports Med 2021; 9:2325967120977892. [PMID: 33614808 PMCID: PMC7874354 DOI: 10.1177/2325967120977892] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Radiographic findings related to the cam and pincer variants of femoroacetabular impingement (FAI) include measurements of the alpha angle and lateral center-edge angle (LCEA). The function of these radiographic findings has been put into question because of high heterogeneity in reported studies. Purpose: The aim of this study was 3-fold: (1) to determine the prevalence of cam and pincer variants according to sex and age on anteroposterior (AP) pelvic radiographs from an asymptomatic nonathletic population, (2) to identify the most common radiographic signs of cam- and pincer-type variants, and (3) to determine if there are variations in the prevalence of these radiographic signs according to sex and age. Study Design: Cross-sectional study; Level of evidence, 3. Methods: There were 3 independent observers who retrospectively analyzed the 939 AP pelvic radiographs (1878 hips) of patients aged 18 to 50 years who did not have hip symptoms and who were not professional athletes. The prevalence of the cam and pincer variants according to the alpha angle and LCEA, respectively, and the presence of other radiographic signs commonly associated with these variables were determined in the overall population and by subgroup according to sex and age group (18-30, 31-40, and 41-50 years). Descriptive and inferential statistics were used to analyze the study sample. Results: The mean age of the included population was 31.0 ± 9.2 years, and 68.2% were male. The prevalence of the cam-type variant was 29.7% (558/1878), and that of the pincer-type variant was 24.3% (456/1878). The radiographic signs that were most associated with the cam and pincer variants were a pistol-grip deformity and the crossover sign, respectively. Significant differences (P < .001) in the prevalence of these variants were identified between men and women in both variants. No differences were observed in the alpha angle or LCEA according to sex or age. Conclusion: Radiographic findings suggestive of FAI had significant variations with respect to sex and age in this study sample. This study provides information to determine the prevalence of these anatomic variants in the general population.
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Affiliation(s)
- Rodolfo Morales-Avalos
- Department of Orthopedic Surgery and Traumatology, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México.,Department of Human Anatomy, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Adriana Tapia-Náñez
- Department of Orthopedic Surgery and Traumatology, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México.,Department of Human Anatomy, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Mario Simental-Mendía
- Department of Orthopedic Surgery and Traumatology, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Guillermo Elizondo-Riojas
- Department of Radiology, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | | | - Marc Tey-Pons
- Department of Orthopedic Surgery, Hospitals del Mar i l'Esperança, Barcelona, Spain
| | - Víctor M Peña-Martínez
- Department of Orthopedic Surgery and Traumatology, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Francisco J Barrera
- Department of Human Anatomy, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Santos Guzman-Lopez
- Department of Human Anatomy, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Rodrigo E Elizondo-Omaña
- Department of Human Anatomy, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Félix Vílchez-Cavazos
- Department of Orthopedic Surgery and Traumatology, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
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Langner JL, Black MS, MacKay JW, Hall KE, Safran MR, Kogan F, Gold GE. The prevalence of femoroacetabular impingement anatomy in Division 1 aquatic athletes who tread water. J Hip Preserv Surg 2020; 7:233-241. [PMID: 33163207 PMCID: PMC7605769 DOI: 10.1093/jhps/hnaa009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/22/2020] [Indexed: 12/15/2022] Open
Abstract
Femoroacetabular impingement (FAI) is a disorder that causes hip pain and disability in young patients, particularly athletes. Increased stress on the hip during development has been associated with increased risk of cam morphology. The specific forces involved are unclear, but may be due to continued rotational motion, like the eggbeater kick. The goal of this prospective cohort study was to use magnetic resonance imaging (MRI) to identify the prevalence of FAI anatomy in athletes who tread water and compare it to the literature on other sports. With university IRB approval, 20 Division 1 water polo players and synchronized swimmers (15 female, 5 male), ages 18-23 years (mean age 20.7 ± 1.4), completed the 33-item International Hip Outcome Tool and underwent non-contrast MRI scans of both hips using a 3 Tesla scanner. Recruitment was based on sport, with both symptomatic and asymptomatic individuals included. Cam and pincer morphology were identified. The Wilcoxon Signed-Rank/Rank Sum tests were used to assess outcomes. Seventy per cent (14/20) of subjects reported pain in their hips yet only 15% (3/20) sought clinical evaluation. Cam morphology was present in 67.5% (27/40) of hips, while 22.5% (9/40) demonstrated pincer morphology. The prevalence of cam morphology in water polo players and synchronized swimmers is greater than that reported for the general population and at a similar level as some other sports. From a clinical perspective, acknowledgment of the high prevalence of cam morphology in water polo players and synchronized swimmers should be considered when these athletes present with hip pain.
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Affiliation(s)
| | - Marianne S Black
- Department of Radiology
- Department of Mechanical Engineering, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA
| | - James W MacKay
- Department of Radiology
- Department of Radiology, Cambridge University, The Old Schools, Trinity Ln, Cambridge CB2 1TN, UK
| | | | | | | | - Garry E Gold
- Department of Radiology
- Department of Orthopaedic Surgery
- Department of Bioengineering, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA
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Ng KG, El Daou H, Bankes MJ, Rodriguez y Baena F, Jeffers JR. Hip Joint Torsional Loading Before and After Cam Femoroacetabular Impingement Surgery. Am J Sports Med 2019; 47:420-430. [PMID: 30596529 PMCID: PMC6360484 DOI: 10.1177/0363546518815159] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical management of cam femoroacetabular impingement (FAI) aims to preserve the native hip and restore joint function, although it is unclear how the capsulotomy, cam deformity, and capsular repair influence joint mechanics to balance functional mobility. PURPOSE To examine the contributions of the capsule and cam deformity to hip joint mechanics. Using in vitro, cadaveric methods, we examined the individual effects of the surgical capsulotomy, cam resection, and capsular repair on passive range of motion and resistance of applied torque. STUDY DESIGN Descriptive laboratory study. METHODS Twelve cadaveric hips with cam deformities were skeletonized to the capsule and mounted onto a robotic testing platform. The robot positioned each intact hip in multiple testing positions: (1) extension, (2) neutral 0°, (3) flexion 30°, (4) flexion 90°, (5) flexion-adduction and internal rotation (FADIR), and (6) flexion-abduction and external rotation. Then the robot performed applicable internal and external rotations, recording the neutral path of motion until a 5-N·m of torque was reached in each rotational direction. Each hip then underwent a series of surgical stages (T-capsulotomy, cam resection, capsular repair) and was retested to reach 5 N·m of internal and external torque again after each stage. During the capsulotomy and cam resection stages, the initial intact hip's recorded path of motion was replayed to measure changes in resisted torque. RESULTS Regarding changes in motion, external rotation increased substantially after capsulotomies, but internal rotation only further increased at flexion 90° (change +32%, P = .001, d = 0.58) and FADIR (change +33%, P < .001, d = 0.51) after cam resections. Capsular repair provided marginal restraint for internal rotation but restrained the external rotation compared with the capsulotomy stage. Regarding changes in torque, both internal and external torque resistance decreased after capsulotomy. Compared with the capsulotomy stage, cam resection further reduced internal torque resistance during flexion 90° (change -45%, P < .001, d = 0.98) and FADIR (change -37%, P = .003, d = 1.0), where the cam deformity accounted for 21% of the intact hip's torsional resistance in flexion 90° and 27% in FADIR. CONCLUSION Although the capsule played a predominant role in joint constraint, the cam deformity provided 21% to 27% of the intact hip's resistance to torsional load in flexion and internal rotation. Resecting the cam deformity would remove this loading on the chondrolabral junction. CLINICAL RELEVANCE These findings are the first to quantify the contribution of the cam deformity to resisting hip joint torsional loads and thus quantify the reduced loading on the chondrolabral complex that can be achieved after cam resection.
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Affiliation(s)
- K.C. Geoffrey Ng
- Department of Mechanical Engineering,
Imperial College London, London, UK
| | - Hadi El Daou
- Department of Mechanical Engineering,
Imperial College London, London, UK
| | - Marcus J.K. Bankes
- Department of Orthopaedics, Guy’s and
St. Thomas’ NHS Foundation Trust, London, UK,Fortius Clinic, London, UK
| | | | - Jonathan R.T. Jeffers
- Department of Mechanical Engineering,
Imperial College London, London, UK,Jonathan R.T. Jeffers, PhD,
Department of Mechanical Engineering, Imperial College London, City and Guilds
Building, Room 715, SW7 2AZ, UK (
)
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