The Development of the Non-Perfect Hip in Young Athletes

This thesis contains research about normal values of hip muscle strength, hip range of motion and hip and groin related symptoms of professional football and field hockey players. In addition, research is conducted on the development of the hip joint and the association between an abnormal hip shape (cam morphology, classified by alpha angle >60 degrees) and limited range of motion, symptoms, other radiological parameters and hip osteoarthriti

The prevalence of cam and pincer morphology and its association with development of hip osteoarthritis

Our understanding of femoroacetabular impingement syndrome is slowly improving. The number of studies on all aspects (etiology, prevalence, pathophysiology, natural history, treatment, and preventive measures) of femoroacetabular impingement syndrome has grown exponentially over the past few years. This commentary provides the latest updates on the prevalence of cam and pincer hip morphology and its relationship with development of hip osteoarthritis (OA). Cam and pincer morphology is highly prevalent in the general population and in this paper is presented for different subgroups based on age, sex, ethnicity, and athletic activity. Methodological issues in determining prevalence of abnormal hip morphology are also discussed. Cam morphology has been associated with development of hip OA, but the association between pincer morphology and hip OA is much less clear. Results from reviewed studies, as well as remaining gaps in literature on this topic, are critically discussed and put into perspective for the clinician

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

Background: Conflicting and limited high-quality prospective data are available on the associations between cam morphology and hip and groin symptoms and range of motion (ROM). Objectives: This cross-sectional cohort study investigated associations between cam morphology presence, size and duration and symptoms and ROM. Methods: Academy male football players (n = 49, 17-24 years) were included. Standardized antero-posterior pelvic and frog-leg lateral radiographs were obtained at baseline, 2.5- and 5-year follow-up. The femoral head-neck junction was quantified by: Visual score. Cam morphology (flattening or prominence), large cam (prominence). Alpha angle.

Normal values for hip muscle strength and range of motion in elite, sub-elite and amateur male field hockey players

Objectives: To determine normal values for hip strength and range of motion (ROM) of elite, sub-elite and amateur male field hockey players and to examine the effect of age, leg dominance, playing position, playing level and non-time-loss groin pain on hip strength and ROM. Design: Cross-sectional study. Setting: Physical testing took place at field hockey clubs. Participants: Male field hockey players competing in the three highest Dutch field hockey leagues (n ¼ 104). Main out

Patient-reported outcome measures for hip-related pain: A review of the available evidence and a consensus statement from the International Hip-related Pain Research Network, Zurich 2018

Hip-related pain is a well-recognised complaint among active young and middle-aged active adults. People experiencing hip-related disorders commonly report pain and reduced functional capacity, including difficulties in executing activities of daily living. Patient-reported outcome measures (PROMs) are essential to accurately examine and compare the effects of different treatments on disability in those with hip pain. In November 2018, 38 researchers and clinicians working in the field of hip-related pain met in Zurich, Switzerland for the first International Hip-related Pain Research Network meeting. Prior to the meeting, evidence summaries were developed relating to four prioritised themes. This paper discusses the available evidence and consensus process from which recommendations were made regarding the appropriate use of PROMs to assess disability in young and middle-aged active adults with hip-related pain. Our process to gain consensus had five steps: (1) systematic review of systematic reviews; (2) preliminary discussion within the working group; (3) update of the more recent high-quality systematic review and examination of the psychometric properties of PROMs according to established guidelines; (4) formulation of the recommendations considering the limitations of the PROMs derived from the examination of their quality; and (5

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

Objectives: Cam 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. Methods: Academy

Classifying Cam Morphology by the Alpha Angle: A Systematic Review on Threshold Values

Background: The alpha angle is the most often used measure to classify cam morphology. There is currently no agreement on which alpha angle threshold value to use. Purpose: To systematically investigate the different alpha angle threshold values used for defining cam morphology in studies aiming to identify this threshold and to determine whether data are consistent enough to suggest an alpha angle threshold to classify cam morphology. Study Design: Systematic review; Level of evidence, 3. Methods: The Embase, Medline (Ovid), Web of Science, Cochrane Central, and Google Scholar databases were searched from database inception to February 28, 2019. Studies aiming at identifying an alpha angle threshold to classify cam morphology were eligible for inclusion. Results: We included 4 case-control studies, 10 cohort studies, and 1 finite-element study from 2437 identified publications. Studies (n = 3) using receiver operating characteristic (ROC) curve analysis to distinguish asymptomatic people from patients with femoroacetabular impingement syndrome consistently observed alpha angle thresholds between 57° and 60°. A 60° threshold was also found to best discriminate between hips with and without cam morphology in a large cohort study based on a bimodal distribution of the alpha angle. Studies (n = 8) using the upper limit of the 95% reference interval as threshold proposed a wide overall threshold range between 58° and 93°. When stratified by sex, thresholds between 63° and 93° in male patients and between 58° and 94° in female patients were reported. Conclusion: Based on the available evidence, mostly based on studies using ROC curve analysis, an alpha angle threshold of ≥60° is currently the most appropriate to classify cam morphology. Further research is required to fully validate this threshold

Do hip and groin muscle strength and symptoms change throughout a football season in professional male football players? A prospective cohort study with repeated measures

Objectives: Groin injuries are common in professional male football and result in significant complaints, time-loss and cost. We aimed to study: 1. Normal values of hip muscle strength and self-reported hip and groin function (Hip And Groin Outcome Score (HAGOS)). 2. Changes in these values throughout the season. 3. If previous (groin) injuries, leg dominance or league were associated with these outcome measures. Design: Prospective cohort study. Methods: 313 professional male football players (11 clubs) participated. Player characteristics and previous injuries were registered. Hip muscle strength (hand-held dynamometer) and HAGOS measurements were done at the start, middle and end of the season. Results: Data from 217 players were analysed. Adduction strength (mean ± standard deviation, Nm/Kg) was 3.40 ± 0.72 (start), 3.30 ± 0.65 (mid) and 3.39 ± 0.74 (end) (p = 0.186). Abduction strength was 3.45 ± 0.67, 3.14 ± 0.57 and 3.28 ± 0.61 (p &lt; 0.001). Adduction/abduction ratio was 1.00 ± 0.21, 1.07 ± 0.22 and 1.05 ± 0.23 (p &lt; 0.001). Statistically, the HAGOS-subscale ‘Pain’ (median [interquartile range]) deteriorated slightly during the season (p = 0.005), especially from mid-season (97.5 [90.6−100.0]) to end-of-season (95.0 [87.5−100.0]) (p = 0.003). Other subscale scores remained unchanged between time points; 85.7 (symptoms), 100.0 (daily living), 96.9 (sports and recreation) 100.0, (physical activities) and 90.0 (quality of life). Previous injuries were associated with lower HAGOS-scores. Dominant legs had higher abduction strength (p &lt; 0.001) and lower adduction/abduction ratio (p &lt; 0.001). No differences between leagues were found for hip muscle strength and HAGOS-scores. Conclusions: In Dutch male professional football players, hip muscle strength and HAGOS-scores remained relatively stable throughout the season. Pain increased slightly, which while statistically significant, was not clinically relevant.</p