Are cam morphology size and location associated with self‐reported burden in football players with FAI syndrome?

The relationship between cam morphology and hip and groin symptoms and signs in young male football players

Scandinavian Journal of Medicine and Science in Sports ◽

10.1111/sms.13660 ◽

2020 ◽

Vol 30 (7) ◽

pp. 1221-1231 ◽

Cited By ~ 2

Author(s):

Pim Klij ◽

Abida Z. Ginai ◽

Marinus P. Heijboer ◽

Jan A. N. Verhaar ◽

Jan H. Waarsing ◽

...

Keyword(s):

Young Male ◽

Football Players ◽

The Relationship ◽

Cam Morphology ◽

Symptoms And Signs

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Cam morphology in young male football players mostly develops before proximal femoral growth plate closure: a prospective study with 5-yearfollow-up

British Journal of Sports Medicine ◽

10.1136/bjsports-2018-099328 ◽

2018 ◽

Vol 53 (9) ◽

pp. 532-538 ◽

Cited By ~ 13

Author(s):

Pim van Klij ◽

Marinus P Heijboer ◽

Abida Z Ginai ◽

Jan A N Verhaar ◽

Jan H Waarsing ◽

...

Keyword(s):

Growth Plate ◽

Alpha Angle ◽

Football Players ◽

Growth Plates ◽

Time Points ◽

Open Growth Plate ◽

Morphology Development ◽

Open Growth ◽

Cam Morphology

ObjectivesCam morphology is not completely understood. The aim of this study was threefold: (1) to investigate if cam morphology development is associated with growth plate status; (2) to examine whether cam morphology continues to develop after growth plate closure; and (3) to qualitatively describe cam morphology development over 5-year follow-up.MethodsAcademy male football players (n=49) participated in this prospective 5-year follow-up study (baseline 12–19 years old). Anteroposterior and frog-leg lateral views were obtained at baseline (142 hips), 2.5-year (126 hips) and 5-year follow-up (98 hips). Cam morphology on these time points was defined as: (A) visual scores of the anterior head-neck junction, classified as: (1) normal, (2) flattening, and (3) prominence; and (B) alpha angle ≥60°. Proximal femoral growth plates were classified as open or closed. Cam morphology development was defined as every increase in visual score and/or increase in alpha angle from <60° to ≥60°, between two time points. This resulted in 224 measurements for cam morphology development analysis.ResultsCam morphology development was significantly associated with open growth plates based on visual score (OR: 10.03, 95% CI 3.49 to 28.84, p<0.001) and alpha angle (OR: 2.85, 95% CI 1.18 to 6.88, p=0.020). With both definitions combined, cam developed in 104 of 142 hips during follow-up. Of these 104 hips, cam developed in 86 hips (82.7%) with open growth plate and in 18 hips (17.3%) with a closed growth plate. Cam morphology developed from 12 to 13 years of age until growth plate closure around 18 years.ConclusionCam morphology of the hip is more likely to develop with an open growth plate.

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A longitudinal cohort study of adolescent elite footballers and controls investigating the development of cam morphology

Scientific Reports ◽

10.1038/s41598-021-97957-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Scott Fernquest ◽

Antony Palmer ◽

Mo Gimpel ◽

Richard Birchall ◽

John Broomfield ◽

...

Keyword(s):

Femoral Head ◽

Growth Plate ◽

Football Players ◽

Activity Levels ◽

Lateral Growth ◽

Male And Female ◽

Morphology Development ◽

Head Morphology ◽

Cam Morphology

AbstractCam morphology describes an asphericity of the femoral head that develops during adolescence, is highly prevalent in athletes, and predisposes individuals to future osteoarthritis. However, it’s aetiology remains poorly understood. The aim of this study was to perform 3-year longitudinal follow-up of a control population and football club academy cohort to compare the change in hip and growth plate anatomy between athletes and controls. MRI and questionnaires were used to characterise change in hip and growth plate anatomy and quantify activity levels. 121 male academy footballers and 107 male and female controls participated at baseline. Footballers experienced significantly greater increases in femoral head asphericity (4.83 degrees (95% CI: 2.84 to 6.82), p < 0.001) than controls. A positive correlation existed between activity levels and change in femoral head morphology (coefficient 0.79, p ≤ 0.001). Greatest morphological change occurred in individuals aged 11–12 years at baseline, with no significant change in individuals aged 14 years and older at baseline. Cam morphology development was secondary to soft tissue hypertrophy and lateral growth plate extension. In conclusion, excessive loading of the hip joint through exercise prior to 14 years of age may result in growth plate adaptations causing cam morphology. Potential interventions may include training type and load modification in young adolescent football players.

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Muscle and Hip Contact Forces in Asymptomatic Men With Cam Morphology During Deep Squat

Frontiers in Sports and Active Living ◽

10.3389/fspor.2021.716626 ◽

2021 ◽

Vol 3 ◽

Author(s):

Danilo S. Catelli ◽

Erik Kowalski ◽

Paul E. Beaulé ◽

Mario Lamontagne

Keyword(s):

Muscle Contraction ◽

Muscle Force ◽

Contact Forces ◽

Muscle Forces ◽

Control Groups ◽

Biceps Femoris Muscle ◽

Deep Squat ◽

And Control ◽

Cam Morphology ◽

Fai Syndrome

Cam morphology is defined as an aspherical femoral head-neck junction that causes abnormal contact of the acetabular rim with the anterior hip. Imaging confirmation of the cam morphology, associated with clinical signs and pain in the hip or groin, is characterized as femoroacetabular impingement (FAI) syndrome. Although some individuals with cam morphology do not experience any symptoms, sparse studies have been done on these individuals. Understanding the way asymptomatic individuals generate muscle forces may help us to better explain the progression of the degenerative FAI process and discover better ways in preventing the onset or worsening of symptoms. The purpose of this study was to compare the muscle and hip contact forces of asymptomatic cam morphology (ACM) and FAI syndrome men compared to cam-free healthy controls during a deep squat task. This prospective study compared 39 participants, with 13 in each group (ACM, FAI, and control). Five deep squatting trials were performed at a self-selected pace while joint trajectories and ground reaction forces were recorded. A generic model was scaled for each participant, and inverse kinematics and inverse dynamics calculated joint angles and moments, respectively. Muscle and hip contact forces were estimated using static optimization. All variables were time normalized in percentage by the total squat cycle and both muscle forces and hip contact forces were normalized by body weight. Statistical non-parametric mapping analyses were used to compare the groups. The ACM group showed increased pelvic tilt and hip flexion angles compared to the FAI group during the descent and ascent phases of the squat cycle. Muscle forces were greater in the ACM and control groups, compared to the FAI group for the psoas and semimembranosus muscles. Biceps femoris muscle force was lower in the ACM group compared to the FAI group. The FAI group had lower posterior hip contact force compared to both the control and ACM groups. Muscle contraction strategy was different in the FAI group compared to the ACM and control groups, which caused different muscle force applications during hip extension. These results rebut the concept that mobility restrictions are solely caused by the presence of the cam morphology and propose evidence that symptoms and muscle contraction strategy can be the origin of the mobility restriction in male patients with FAI.

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Cam morphology is associated with early hip OA features in young adult football players with and without hip and groin pain

Journal of Science and Medicine in Sport ◽

10.1016/j.jsams.2021.09.039 ◽

2021 ◽

Vol 24 ◽

pp. S12

Author(s):

R. Agricola ◽

K. Crossley ◽

J. Heerey ◽

J. Kemp ◽

M. King ◽

...

Keyword(s):

Young Adult ◽

Groin Pain ◽

Football Players ◽

Cam Morphology

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Cam morphology is associated with MRI-defined cartilage defects and labral tears: a case–control study of 237 young adult football players with and without hip and groin pain

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2021-001199 ◽

2021 ◽

Vol 7 (4) ◽

pp. e001199

Author(s):

Joshua Heerey ◽

Joanne Kemp ◽

Rintje Agricola ◽

Ramya Srinivasan ◽

Anne Smith ◽

...

Keyword(s):

Young Adult ◽

Groin Pain ◽

Case Control Study ◽

Alpha Angle ◽

Case Control ◽

Cartilage Defects ◽

Football Players ◽

Labral Tears ◽

Cam Morphology ◽

Control Study

ObjectiveFootball players are at risk of developing hip osteoarthritis (OA). Cam morphology (present in almost two of every three football players) may explain this heightened risk, but there is limited research on its role in hip OA development in younger athletes. Knowledge of this relationship will advance our understanding of the aetiology of hip OA in football players. We aimed to study the relationship between cam morphology size and MRI-defined cartilage defects and labral tears, and if this relationship differs by symptomatic state in young adult football players.MethodsFor this case–control study, 182 (288 hips) symptomatic (hip and/or groin pain >6 months and positive flexion-adduction-internal-rotation (FADIR) test) and 55 (110 hips) pain-free football players (soccer or Australian football) underwent anteroposterior and Dunn 45° radiographs, and 3-Tesla MRI. Cam morphology size was defined using alpha angle, and cartilage defects and labral tears were scored semiquantitatively. Presence, location and score (severity) of cartilage defects and labral tears were determined. Each participant completed the International Hip Outcome Tool 33 and Copenhagen Hip and Groin Outcome Score.ResultsGreater alpha angle was associated with cartilage defects (OR 1.03, 95% CI 1.01 to 1.04) and labral tears (OR 1.02, 95% CI 1.01 to 1.04). Greater alpha angle was associated with superolateral cartilage defects (OR 1.03, 95% CI 1.02 to 1.05) and superior labral tears (OR 1.03, 95% CI 1.02 to 1.05). The association of alpha angle with MRI-defined cartilage defects and labral tears was no greater in football players with symptoms than in those without (p=0.189–0.937)ConclusionCam morphology size was associated with cartilage defects and labral tears in young adult football players with and without pain. This study provides evidence that cam morphology may contribute to the high prevalence of hip OA in football players. Prospective studies of football players are now needed to establish if cam morphology causes progression of cartilage defects and labral tears and development of hip OA.

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