The Size and Prevalence of Bony Hip Morphology Do Not Differ Between Football Players With and Without Hip and/or Groin Pain: Findings From the FORCe Cohort

Heerey, Joshua J; Agricola, Rintje; Smith, Anne; Kemp, Joanne L; Pizzari, Tania; King, M.; Lawrenson, Peter; Scholes, Mark J; Crossley, Kay M

doi:10.2519/jospt.2021.9622

Cited by 26 publications

(26 citation statements)

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“…Cam morphology is a risk factor for hip OA in middle-aged to older populations, 4 22 23 and thought to contribute to early hip disease in active football players. 7 Our findings suggest that cam morphology size is associated with cartilage defects and labral tears in young football players (median age, 26), but that this relationship with joint damage is no greater in football players with symptoms (including a positive FADIR test) than in those without.…”

Section: Cam Morphology and Mri-defined Cartilage Defects And Labral Tears In Football Playersmentioning

confidence: 56%

“…For intraobserver reliability, the intraclass correlation coefficients (ICCs) for alpha angle were 0.92 and 0.93 for AP and Dunn 45°, respectively. 7 Interobserver reliability ICCs were 0.76 for AP and 0.93 for Dunn 45°. 7…”

Section: Cam Morphologymentioning

confidence: 90%

“…7 14 A convenience sample of 55 pain-free subelite football players aged between 18 and 50 years were recruited to match the mean age and sex distribution of the FORCe study and serve as control participants. 7 Symptomatic and control participants competing in the same league/competition level were recruited between August 2015 and October 2018 from sporting clubs or via online and print advertising, with recruitment undertaken in Melbourne and Brisbane, Australia. The data for this study are taken from baseline examination.…”

Section: Study Design and Recruitmentmentioning

confidence: 99%

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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

Heerey

Kemp

Agricola

et al. 2021

BMJ Open Sport Exerc Med

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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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Section: Cam Morphology and Mri-defined Cartilage Defects And Labral Tears In Football Playersmentioning

confidence: 56%

Section: Cam Morphologymentioning

confidence: 90%

Section: Study Design and Recruitmentmentioning

confidence: 99%

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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

Heerey

Kemp

Agricola

et al. 2021

BMJ Open Sport Exerc Med

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“…5 Healthy control participants were recruited from an observational cohort study of football players without hip/groin pain. 12 All participants provided written informed consent before data collection.…”

Section: Participantsmentioning

confidence: 99%

The Validity, Reliability, and Responsiveness of the International Hip Outcome Tool–33 (iHOT-33) in Patients With Hip and Groin Pain Treated Without Surgery

et al. 2021

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Background: The International Hip Outcome Tool–33 (iHOT-33) was developed to evaluate patients seeking surgery for hip and/or groin (hip/groin) pain and may not be appropriate for those seeking nonsurgical treatment. Purpose: To evaluate the psychometric properties of the iHOT-33 total (iHOT-Total) score and all subscale scores in adults with hip/groin pain who were not seeking surgery. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients with hip/groin pain who were not seeking surgery were recruited from 2 ongoing studies in Australia. Semistructured one-on-one interviews assessed content validity. Construct validity was assessed by testing hypothesized correlations between iHOT-33 and Copenhagen Hip and Groin Outcome Score (HAGOS) subscale scores. Test-retest reliability was assessed in patients not undertaking treatment and who reported “no change” in their Global Rating of Change (GROC) score at 6-month follow-up. Scores were reliable at group and individual levels if intraclass correlation coefficients (ICCs) were ≥0.80 and ≥0.90, respectively. Scores were responsive if Spearman rank correlations (ρ) between the change in the iHOT-33 score and the GROC score were ≥0.40. Results: In total, 278 patients with hip/groin pain (93 women; mean age, 31 years) and 55 pain-free control participants (14 women; mean age, 29 years) were recruited. The iHOT-33 demonstrated acceptable content validity. Construct validity was acceptable, with all hypothesized strong positive correlations between iHOT-33 and HAGOS subscale scores confirmed ( r range, 0.60-0.76; P < .001), except for one correlation between the iHOT-Sport and HAGOS-Sport ( r = .058; P < .001). All scores were reliable at the group level, except for the iHOT-33 job subscale (iHOT-Job) (ICC range, 0.78-0.88 [95% CI, 0.60-0.93]). None of the subscales met the criteria for adequate reliability for use at the individual level (all ICCs <0.90). Minimal detectable change values (group level) ranged from 2.3 to 3.7 (95% CI, 1.7-5.0). All iHOT-33 subscale scores were responsive (ρ range, 0.40-0.58; P≤ .001), except for the iHOT-Job in patients not undertaking treatment (ρ = 0.27; P = .001). Conclusion: All iHOT-33 subscale scores were valid for use in patients with hip/groin pain who were not seeking surgery. Acceptable test-retest reliability was found for all subscale scores at the group level, except the iHOT-Job. All subscale scores, excluding the iHOT-Job, were responsive, regardless of undertaking physical therapist–led treatment or no treatment.

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“…Femoroacetabular impingement (FAI) syndrome is a cause of hip and/or groin (hip/groin) pain in football players 1,2 and may contribute to their greater lifetime risk of hip osteoarthritis (OA) when compared to controls. 3 Diagnosis of FAI syndrome requires symptoms, clinical signs, and imaging evidence of cam and/or pincer morphology.…”

Section: Introductionmentioning

confidence: 99%

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

Scholes

Kemp

Mentiplay

et al. 2022

Scandinavian Med Sci Sports

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Cam morphology size and location might affect the severity of reported burden in people with femoroacetabular impingement (FAI) syndrome. We investigated the relationship between cam morphology size (i.e., alpha angle) and selfreported hip/groin burden (i.e., scores for the International Hip Outcome Tool-33 (iHOT-33) and Copenhagen Hip and Groin Outcome Score (HAGOS)), examined separately for the anteroposterior pelvis (AP) and Dunn 45° radiographs in football players with FAI syndrome. In total, 118 (12 women) subelite football (soccer or Australian football) players with FAI syndrome with cam morphology (alpha angle ≥60°) participated. One blinded assessor quantified superior and anterosuperior cam morphology size by measuring alpha angles for the AP and Dunn 45° radiographs, respectively. Linear regression models investigated relationships between alpha angle (continuous independent variable, separately measured for the AP and Dunn 45° radiographs) and iHOT-33 and HAGOS scores (dependent variables). Larger anterosuperior cam morphology (seen on the Dunn 45° radiograph) was associated with lower (i.e., worse) scores for the iHOT-Total, iHOT-Symptoms, iHOT-Job, and iHOT-Social subscales (unadjusted estimate range −0.553 to −0.319 [95% confidence interval −0.900 to −0.037], p = 0.002 to 0.027), but not the iHOT-Sport (p = 0.459) nor any HAGOS scores (p = 0.110 to 0.802). Superior cam morphology size (measured using the AP radiograph) was not associated with any iHOT-33 or HAGOS scores (p = 0.085 to 0.975). Larger anterosuperior cam morphology may be more relevant to pain and symptoms in football players with FAI syndrome than superior cam morphology, warranting investigation of its effects on reported burden and hip disease over time.

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The Size and Prevalence of Bony Hip Morphology Do Not Differ Between Football Players With and Without Hip and/or Groin Pain: Findings From the FORCe Cohort

Cited by 26 publications

References 54 publications

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

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

The Validity, Reliability, and Responsiveness of the International Hip Outcome Tool–33 (iHOT-33) in Patients With Hip and Groin Pain Treated Without Surgery

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

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