Increasing Alpha Angle is Predictive of Athletic-Related "Hip" and "Groin" Pain in Collegiate National Football Prospects
Larson CM, Sikka RS, Sardelli MC, Byrd JWT, Kelly BT, Jain RK, & Giveans MR. Arthroscopy. 2013, E-pub ahead of print.
Take Home Message: High-level football players often have femoroacetabular impingement. Furthermore, cam-type deformities may be related to hip symptoms.
Femoracetabular impingement (FAI) is a common radiographic abnormality, particularly among high-level athletes (50 to 95% of athletes) but it remains unclear if FAI is related to symptoms or patient characteristics. Therefore the purpose of this study was to assess hip radiographic abnormalities (including FAI) among National Football League prospects and correlate these findings with symptoms, position, and body mass index. At the National Football League’s Scouting Combine, staff collected 125 players’ demographic information medical histories, as well as pelvis and bilateral hip radiographs. A player underwent hip and pelvis radiographs if a hip was symptomatic, there was a history of contusion, or the player was in an “at-risk” position (e.g., kickers, punters). A player’s hip was classified as symptomatic if there was prior or current activity-related groin pain, groin strains, sports hernia symptoms, or prior surgery. A player’s hip was classified as asymptomatic if there was no history of any activity-related symptoms. Characteristic of FAI was found in 112 players (90%) and 207 hips (87%). Interestingly, only 31% of the hips (75 of 239) were classified as symptomatic, with the remainder being asymptomatic. Symptoms were more common in hips with some form of cam-type FAI compared to the rest of the cohort. Furthermore, as the extent of cam deformity increased (greater alpha angle) athletes tended to reporter greater hip/groin pain. The authors found no relationship between FAI and body mass index, player position, or if the player was drafted.
Clinically, many elite football players have radiographic hip abnormalities but most do not have a history of groin/hip pain. This study is the second that we have reviewed on SMR that suggested that over 90% of collegiate football players have FAI. The competitive football populations are clearly more likely to have radiographic hip abnormalities. The question remains what to do about it and what are the implications of these findings. In this current study, symptoms were more common in those with some form of cam-type FAI. It would be interesting to follow these athletes over time to determine if more of these athletes eventually develop symptoms. This seems likely since a recent study found that cam-type deformities are associated with hip osteoarthritis. Now that we are aware of the large number of football players with radiographic hip abnormalities one lingering question is whether we should target this population to prevent the onset of symptomatic and radiographic changes? If so, then what interventions would be appropriate? How do you treat patients with symptomatic FAI?
Written by: Nicole Cattano
Reviewed by: Jeffrey Driban