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Ethnic differences in bony hip morphology: A cohort of 445 professional soccer players
e88
Abstracts / Journal of Science and Medicine in Sport 20S (2017) e67–e105
Methods: A systematic review of the literature was conducted in accordance with the PRISMA Statement. The modified Downs and Black checklist was used for quality appraisal. Studies of adults aged 18–50 years with symptomatic FAI that examined range of motion, hip muscle function and functional tasks were included. Standardized mean differences (SMDs) were calculated where possible or best evidence synthesis and study conclusions were presented. Results: Twenty-two studies fulfilled all inclusion criteria (819 patients with FAI; range 7–112). Methodological quality varied (47–82% using Downs & Black Appraisal Criteria). Hip joint ROM did not differ in people with symptomatic FAI compared to control subjects. People with symptomatic FAI demonstrated deficits in all directions of hip muscle strength, except extension, and reduced dynamic balance on one leg compared to control subjects. No RCTs evaluated the effect of different types of interventions for symptomatic patients with symptomatic FAI. For hip joint ROM there were no significant within-group differences between pre and post intervention time points. All directions of hip muscle strength except abduction improved significantly from pre- to posthip arthroscopy in a single case series. Discussion: People with symptomatic FAI demonstrate deficits in hip muscle strength compared to the normal population and pre/post treatment interventions, as well as reduced dynamic balance on one leg. Hip joint ROM did not appear altered in people with symptomatic FAI compared to control subjects. In the papers assessed, there was no compromise of function in squatting, total daily strides or static balance. This information may assist therapists in providing targeted rehabilitation programs for people with FAI and associated pathology. Further research is needed to determine whether symptomatic FAI affects other aspects of functional performance; and to evaluate whether targeted strength training or skill acquisition interventions can improve hip muscle strength and physical function in symptomatic FAI. http://dx.doi.org/10.1016/j.jsams.2017.01.050 202 Ethnic differences in bony hip morphology: A cohort of 445 professional soccer players A. Mosler 1,2,3,4,5,∗ , K. Crossley 1,2,3,4,5 , J. Waarsing 4 , N. Jomaah 1 , A. Weir 1 , P. HÓ§lmich 1,2,3,4,5 , R. Agricola 1,2,3,4,5 1
study, we aimed to investigate whether the prevalence of specific bony hip morphological abnormalities differed between professional soccer players of diverse ethnic background. Methods: Professional soccer players from an entire league who attended pre-participation screening, were invited to participate. Ethnicity was registered and standardized anteroposterior pelvic and Dunn X-ray views were obtained. Cam and pincer deformity, and acetabular dysplasia were quantified using the alpha angle, triangular index and lateral center edge angle. Regression analyses with generalized estimating equations were used to determine prevalence differences in bony hip morphology. Results: A total of 445 soccer players (890 hips) participated in the study, aged 25 (±4.9) years and representing the following ethnic groups: Arabic (59%), Black (24%), Persian (7%), Caucasian (6%), East Asian (2%) and other (2%). The prevalence of cam deformity (alpha angle > 60◦ ) ranged from 57.5% to 71.7% across four of the ethnic groups, but East Asians had a significantly lower prevalence (18.8%, p = 0.035). Large cam deformity (alpha angle > 78◦ ) was more prevalent in Caucasian (33.3%) than Black soccer players (17.8%, p = 0.041) and absent in East Asian participants. Pincer deformity (lateral center edge angle > 40◦ ) was uncommon (3%) in all ethnicities. The prevalence of acetabular dysplasia (lateral center edge angle < 20◦ ) ranged from 8.0% to 16.7%, apart from the Caucasian group where prevalence was only 1.9% (p = 0.036). Discussion: This is the first study to describe the prevalence of bony hip morphological abnormalities in soccer players of Arabic, Persian and East Asian ethnicity. We found a high prevalence of cam deformity and low prevalence of pincer deformity, and differences between ethnicities in the prevalence of cam deformity, large cam deformity and acetabular dysplasia. These ethnic differences were present in our soccer players despite presumed similarities in the amount of soccer played during adolescence. These findings imply that the biomechanical response of the proximal femoral physis to high impact load during adolescence may also differ between ethnicities. Furthermore, these ethnic differences in bony morphology correlate somewhat with observed geographic differences in hip OA prevalence, thereby suggesting that bony hip mechanics may help explain these geographic differences in hip OA rates. http://dx.doi.org/10.1016/j.jsams.2017.01.051 203 Is the cam lesion (alpha angle) size related to symptoms and impairments in people with symptomatic femoroacetabular impingement?
Aspetar Orthopaedic and Sports Medicine Hospital, Australia 2 University of Queensland, Australia 3 La Trobe University, Australia 4 Erasmus University Medical Centre, The Netherlands 5 Copenhagen University Hospital, Denmark
ACRISP, Federation University Australia, Australia La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia
Introduction: 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. BACKGROUND: The prevalence of a cam-type deformity in athletes and its association with vigorous sports activities during and after the growth period is unknown. QUESTIONS/PURPOSES: We therefore compared the prevalence and occurrence of a cam-type deformity by MRI in athletes during childhood and adolescence with an age-matched control group. PATIENTS AND METHODS: We retrospectively reviewed 72 hips in 37 male basketball players with a mean age of 17.6 years (range, 9–25 years). However, it is unknown whether bony morphology differs between ethnicities in athletes participating in high impact sport. In this cross-sectional cohort
Background: Cam-type femoroacetabular impingement (FAI) is a common cause of hip and groin pain in active, young and middle aged adults. Previous studies have shown that larger cam lesions are associated with increased risk of hip osteoarthritis (OA) and progression to hip arthroplasty. It is also unclear whether a relationship exists between cam lesion size and the severity of symptoms and impairments. This study aimed to determine if cam lesion size is associated with symptoms, quality of life (QOL) and physical impairments in people with symptomatic cam-type FAI. Methods: People aged 18–50 years who had no previous hip surgery, with symptomatic cam-type FAI (hip pain >3 months during activity; painful hip impingement testing; alpha angle ≥60◦ on antero-posterior (AP) or Dunn 45◦ radiographs) were recruited. Alpha angle was evaluated on both AP and Dunn 45 radiographs
J. Kemp 1,∗ , D. Jones 2 , S. Coburn 2 , K. Crossley 2 1
2
Abstracts / Journal of Science and Medicine in Sport 20S (2017) e67–e105
Methods: A systematic review of the literature was conducted in accordance with the PRISMA Statement. The modified Downs and Black checklist was used for quality appraisal. Studies of adults aged 18–50 years with symptomatic FAI that examined range of motion, hip muscle function and functional tasks were included. Standardized mean differences (SMDs) were calculated where possible or best evidence synthesis and study conclusions were presented. Results: Twenty-two studies fulfilled all inclusion criteria (819 patients with FAI; range 7–112). Methodological quality varied (47–82% using Downs & Black Appraisal Criteria). Hip joint ROM did not differ in people with symptomatic FAI compared to control subjects. People with symptomatic FAI demonstrated deficits in all directions of hip muscle strength, except extension, and reduced dynamic balance on one leg compared to control subjects. No RCTs evaluated the effect of different types of interventions for symptomatic patients with symptomatic FAI. For hip joint ROM there were no significant within-group differences between pre and post intervention time points. All directions of hip muscle strength except abduction improved significantly from pre- to posthip arthroscopy in a single case series. Discussion: People with symptomatic FAI demonstrate deficits in hip muscle strength compared to the normal population and pre/post treatment interventions, as well as reduced dynamic balance on one leg. Hip joint ROM did not appear altered in people with symptomatic FAI compared to control subjects. In the papers assessed, there was no compromise of function in squatting, total daily strides or static balance. This information may assist therapists in providing targeted rehabilitation programs for people with FAI and associated pathology. Further research is needed to determine whether symptomatic FAI affects other aspects of functional performance; and to evaluate whether targeted strength training or skill acquisition interventions can improve hip muscle strength and physical function in symptomatic FAI. http://dx.doi.org/10.1016/j.jsams.2017.01.050 202 Ethnic differences in bony hip morphology: A cohort of 445 professional soccer players A. Mosler 1,2,3,4,5,∗ , K. Crossley 1,2,3,4,5 , J. Waarsing 4 , N. Jomaah 1 , A. Weir 1 , P. HÓ§lmich 1,2,3,4,5 , R. Agricola 1,2,3,4,5 1
study, we aimed to investigate whether the prevalence of specific bony hip morphological abnormalities differed between professional soccer players of diverse ethnic background. Methods: Professional soccer players from an entire league who attended pre-participation screening, were invited to participate. Ethnicity was registered and standardized anteroposterior pelvic and Dunn X-ray views were obtained. Cam and pincer deformity, and acetabular dysplasia were quantified using the alpha angle, triangular index and lateral center edge angle. Regression analyses with generalized estimating equations were used to determine prevalence differences in bony hip morphology. Results: A total of 445 soccer players (890 hips) participated in the study, aged 25 (±4.9) years and representing the following ethnic groups: Arabic (59%), Black (24%), Persian (7%), Caucasian (6%), East Asian (2%) and other (2%). The prevalence of cam deformity (alpha angle > 60◦ ) ranged from 57.5% to 71.7% across four of the ethnic groups, but East Asians had a significantly lower prevalence (18.8%, p = 0.035). Large cam deformity (alpha angle > 78◦ ) was more prevalent in Caucasian (33.3%) than Black soccer players (17.8%, p = 0.041) and absent in East Asian participants. Pincer deformity (lateral center edge angle > 40◦ ) was uncommon (3%) in all ethnicities. The prevalence of acetabular dysplasia (lateral center edge angle < 20◦ ) ranged from 8.0% to 16.7%, apart from the Caucasian group where prevalence was only 1.9% (p = 0.036). Discussion: This is the first study to describe the prevalence of bony hip morphological abnormalities in soccer players of Arabic, Persian and East Asian ethnicity. We found a high prevalence of cam deformity and low prevalence of pincer deformity, and differences between ethnicities in the prevalence of cam deformity, large cam deformity and acetabular dysplasia. These ethnic differences were present in our soccer players despite presumed similarities in the amount of soccer played during adolescence. These findings imply that the biomechanical response of the proximal femoral physis to high impact load during adolescence may also differ between ethnicities. Furthermore, these ethnic differences in bony morphology correlate somewhat with observed geographic differences in hip OA prevalence, thereby suggesting that bony hip mechanics may help explain these geographic differences in hip OA rates. http://dx.doi.org/10.1016/j.jsams.2017.01.051 203 Is the cam lesion (alpha angle) size related to symptoms and impairments in people with symptomatic femoroacetabular impingement?
Aspetar Orthopaedic and Sports Medicine Hospital, Australia 2 University of Queensland, Australia 3 La Trobe University, Australia 4 Erasmus University Medical Centre, The Netherlands 5 Copenhagen University Hospital, Denmark
ACRISP, Federation University Australia, Australia La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia
Introduction: 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. BACKGROUND: The prevalence of a cam-type deformity in athletes and its association with vigorous sports activities during and after the growth period is unknown. QUESTIONS/PURPOSES: We therefore compared the prevalence and occurrence of a cam-type deformity by MRI in athletes during childhood and adolescence with an age-matched control group. PATIENTS AND METHODS: We retrospectively reviewed 72 hips in 37 male basketball players with a mean age of 17.6 years (range, 9–25 years). However, it is unknown whether bony morphology differs between ethnicities in athletes participating in high impact sport. In this cross-sectional cohort
Background: Cam-type femoroacetabular impingement (FAI) is a common cause of hip and groin pain in active, young and middle aged adults. Previous studies have shown that larger cam lesions are associated with increased risk of hip osteoarthritis (OA) and progression to hip arthroplasty. It is also unclear whether a relationship exists between cam lesion size and the severity of symptoms and impairments. This study aimed to determine if cam lesion size is associated with symptoms, quality of life (QOL) and physical impairments in people with symptomatic cam-type FAI. Methods: People aged 18–50 years who had no previous hip surgery, with symptomatic cam-type FAI (hip pain >3 months during activity; painful hip impingement testing; alpha angle ≥60◦ on antero-posterior (AP) or Dunn 45◦ radiographs) were recruited. Alpha angle was evaluated on both AP and Dunn 45 radiographs
J. Kemp 1,∗ , D. Jones 2 , S. Coburn 2 , K. Crossley 2 1
2