Protocol for a multicenter prospective cohort study evaluating sport activity and development of femoroacetabular impingement in the adolescent hip

Abstract

Background: Femoroacetabular impingement (FAI) is an important cause of hip pain in young and active individuals and occurs as a result of size and shape mismatch between the femoral head and acetabulum. Open physes in children can make hips more susceptible to injury, and high impact forces have been suggested to affect the developing femur. The diagnosis of FAI has recently risen, especially within adolescent populations, and there is an increasing trend towards yearround participation in sports with early specialization. The PREVIEW study is an international longitudinal study designed to determine the association between sport specialization in adolescence and the development of hip impingement. Methods: This is a multicentre prospective cohort study evaluating 200 participants between the ages of 12-14 that include sport specialists at the moderate to vigorous physical activity (MVPA) level and non-sport specialists at any activity level. We will monitor physical activity levels of all participants using an activity log and a wrist-mounted activity tracker, with synced data collected every 3 months during the study period. In addition, participants will be evaluated clinically at 6, 12, and 18 months and radiographically at the time of enrolment and 24 months. The primary outcome is the incidence of FAI between groups at 2 years, determined via MRI. Secondary outcomes include hip function and health-related quality of life between subjects diagnosed with FAI versus no FAI at 2 years, as determined by the Hip Outcome Score (HOS) and Pediatric Quality of Life (PedsQL) questionnaires. Discussion: It is important to mitigate the risk of developing hip deformities at a young age. Our proposed prospective evaluation of the impact of sport activity and hip development is relevant in this era of early sport specialization in youth. Improving the understanding between sport specialization and the development of pre-arthritic hip disease such as FAI can lead to the development of training protocols that protect the millions of adolescents involved in sports annually. Trial registration: PREVIEW is registered with clinicaltrials.gov (NCT03891563).

Qualidade de vida de crianças e adolescentes praticantes de esportes: uma revisão sistemática

“…Por fi m, foram selecionados 17 estudos para a revisão sistemática, que foram lidos por completo para a extração de resultados. Optou-se por retirar da revisão o estudo proposto por Raj et al (2017) 11 :"Chronic kidney disease and sports participation by children and adolescents", por se tratar de uma revisão, além do estudo sugerido por Öhlin et al (2020) 12 : "Protocol for a multicenter prospective cohort study evaluating sport activity and development of femoroacetabular impingement in the adolescent hip", por ser um estudo prévio. Finalizou-se com 15 estudos selecionados.…”

Prospective evaluation of sport activity and the development of femoroacetabular impingement in the adolescent hip (PREVIEW): results of the pilot study

“…To promote complete data collection and improve participant retention, we added interim follow-up visits every 3 months and introduced an activity log and wrist-worn tracker to improve the collection of physical activity data over the 2-year period. The definitive study protocol has been published [ 29 ].…”

“…Because this was a pilot to help determine feasibility and generate hypotheses, we were unable to make any definitive conclusions at this time due to the small sample size. We did not meet all of our pre-defined feasibility criteria but were able to adjust the protocol to help ensure the success of the definitive prospective cohort study [ 29 ]. In addition, we expect a higher follow-up rate as the definitive study continues post-COVID-19 pandemic.…”

“…The HAES quantifies the duration, in hours, of 4 levels of activity ranging from very inactive (lying down, napping), somewhat inactive (sitting, reading, watching television, playing video games), somewhat active (walking, light chores), to very active (running, bicycling, activities leading to sweating or breathing hard) over a complete waking day [ 28 ]. The cut-off of 180 min in a given category was used according to prior sport specialization criteria and plans for the definitive trial [ 29 ]. The HAES is designed for administration in the pediatric population and has been shown to be both a valid and reliable form of quantifying levels of physical activity [ 28 ].…”

Early Sport Specialization

“…Most studies published to date on this topic have been cross-sectional survey studies, with only a few examples of high-quality prospective studies 21,22,59 . We are aware of 1 currently ongoing multicenter prospective trial that aims to compare children from 12 to 14 years old who are sport specialists and nonspecialists with respect to the incidence of femoroacetabular impingement (NCT04243447) 60 . A few studies with Level-II and III evidence (Table I) have suggested a possible link between early sport specialization and injury, but this is limited to just 2 prospective studies 21,22 .…”