The Development of Cam-Type Deformity
in Adolescent and Young Male Soccer Players
in Adolescent and Young Male Soccer Players
Agricola
R, Bessems JH, Ginai AZ, Heijboer MP, van der Heijden RA, Verhaar JA, Weinans
H, Waarsing JH. Am J Sports Med 2012 Mar 13. [Epub ahead of print]
R, Bessems JH, Ginai AZ, Heijboer MP, van der Heijden RA, Verhaar JA, Weinans
H, Waarsing JH. Am J Sports Med 2012 Mar 13. [Epub ahead of print]
A
rise in the frequency of femoroacetabular impingement syndrome (FAI) diagnoses has been
seen in recent years. Two types of
deformities lead to a diagnosis of FAI:
pincer-type and cam-type. Cam-type
deformity is characterized by an abnormal shape seen in the femoral head and is
most commonly seen in young, active males.
The prevalence and age of onset for cam-type deformity has not yet been
determined. The purpose of this study
was to determine the age of onset for cam-type deformity and to examine whether
an increased prevalence of FAI was seen in elite youth soccer players as
compared to age-matched controls. Eighty-nine
boy soccer players between the ages of 12 and 19 years and 92 boys (12 to 19
years) who do not play sports (controls) received x-rays (anteroposterior
pelvic and frog-leg lateral hip views). The authors measured radiographs to
assess the alpha angle (a measure describing a deformity of the femoral
head-neck junction); an angle >60° was considered a positive sign of a
cam-type deformity. A statistical shape
modeling computer software was used to mark and measure the angle on each
radiograph. The authors also evaluated
the hip radiographs for the presence of visual prominences (abnormal shape at
the femoral head-neck junction) and flattening at the femoral head-neck
junction. Positive impingement signs
were seen in 26% of soccer players as compared to 17% of controls (not
significantly different). Abnormal alpha
angles were seen as young as 12 years old in both groups; however, visual
prominences were only seen among soccer players (13%). Both groups had evidence
of flattening at the head-neck junction but it was more common among the soccer
players (53%) compared to the controls (18%). Overall, among soccer players
only 30% had bilateral cam-type deformities. Visual prominences were the radiographic
finding mostly commonly found bilaterally among soccer players (50%).
rise in the frequency of femoroacetabular impingement syndrome (FAI) diagnoses has been
seen in recent years. Two types of
deformities lead to a diagnosis of FAI:
pincer-type and cam-type. Cam-type
deformity is characterized by an abnormal shape seen in the femoral head and is
most commonly seen in young, active males.
The prevalence and age of onset for cam-type deformity has not yet been
determined. The purpose of this study
was to determine the age of onset for cam-type deformity and to examine whether
an increased prevalence of FAI was seen in elite youth soccer players as
compared to age-matched controls. Eighty-nine
boy soccer players between the ages of 12 and 19 years and 92 boys (12 to 19
years) who do not play sports (controls) received x-rays (anteroposterior
pelvic and frog-leg lateral hip views). The authors measured radiographs to
assess the alpha angle (a measure describing a deformity of the femoral
head-neck junction); an angle >60° was considered a positive sign of a
cam-type deformity. A statistical shape
modeling computer software was used to mark and measure the angle on each
radiograph. The authors also evaluated
the hip radiographs for the presence of visual prominences (abnormal shape at
the femoral head-neck junction) and flattening at the femoral head-neck
junction. Positive impingement signs
were seen in 26% of soccer players as compared to 17% of controls (not
significantly different). Abnormal alpha
angles were seen as young as 12 years old in both groups; however, visual
prominences were only seen among soccer players (13%). Both groups had evidence
of flattening at the head-neck junction but it was more common among the soccer
players (53%) compared to the controls (18%). Overall, among soccer players
only 30% had bilateral cam-type deformities. Visual prominences were the radiographic
finding mostly commonly found bilaterally among soccer players (50%).
These
results suggest that cam-type deformity is recognizable as early as 12 years of
age and that this form of impingement is more common in soccer players than
those who do not play sports. This may
also suggest that high-impact activity at a young age may predispose someone to
the development of FAI. The results of
this study are in agreement with previous literature regarding increased
prevalence in an athletic population; however this was the first to study
prevalence at such a young age. Further
studies with a larger sample size should be conducted to determine if an
increased risk of developing cam-deformities at such a young age truly
exists. The study finding is
particularly concerning because FAI has been linked to hip osteoarthritis. This study should bring to mind the
importance of screening for impingement when young athletes complain of hip
pain. Have you yourself seen an increase
in the number of young athletes with hip pain?
What are the most common ages you’ve seen for athletes complaining of
hip pain?
results suggest that cam-type deformity is recognizable as early as 12 years of
age and that this form of impingement is more common in soccer players than
those who do not play sports. This may
also suggest that high-impact activity at a young age may predispose someone to
the development of FAI. The results of
this study are in agreement with previous literature regarding increased
prevalence in an athletic population; however this was the first to study
prevalence at such a young age. Further
studies with a larger sample size should be conducted to determine if an
increased risk of developing cam-deformities at such a young age truly
exists. The study finding is
particularly concerning because FAI has been linked to hip osteoarthritis. This study should bring to mind the
importance of screening for impingement when young athletes complain of hip
pain. Have you yourself seen an increase
in the number of young athletes with hip pain?
What are the most common ages you’ve seen for athletes complaining of
hip pain?
Written
by: Meghan Miller
by: Meghan Miller
Reviewed
by: Jeffrey Driban
by: Jeffrey Driban
Related
Posts:
Posts:
Agricola R, Bessems JH, Ginai AZ, Heijboer MP, van der Heijden RA, Verhaar JA, Weinans H, & Waarsing JH (2012). The Development of Cam-Type Deformity in Adolescent and Young Male Soccer Players. The American Journal of Sports Medicine PMID: 22415206
Very interesting study. My son is a16yr old elite-soccer player with CAM. He has been suffering from severe pain last 12months, with different diagnosis/treatment from different HCPs. We finally decided to get a proper evaluation, and he got diagnosed with CAM. He will go through surgery next week. What has amazed us the most along this journey is the lack of knowledge in regards to this diagnosis among doctors. We have been told that our son should quit playing soccer and that a surgery (due to his age) could give him lifelong problems in growth etc. This coming from doctors!
I think this is a really interesting study that has shed some light on the issues with this pathology. I am a newly certified athletic trainer. I have to admit that I have not heard a ton of information on this pathology in my undergrad studies, however, my graduate studies have made it a point to cover this topic and I am glad I have learned more information about it. This is an important differential diagnosis to keep in the back of our minds when we think about young athletes and hip pain. If we as athletic trainers can become better at recognizing the signs and symptoms of FAI, maybe we can help to further educate the physicians that we work with on this pathology (in reference to the comment posted above) so that they are also more aware of this pathology and how to treat it. I agree that there should be more of an effort made to do more research on FAI to get the word out about this pathology.
Thank you both for your comments. As this is an emerging topic in the literature, it is not uncommon for FAI to be overlooked among physicians and other health care providers specializing in areas other than the hip. As more research is conducted, published, and presented at conferences, so will the awareness of this pathology. Anonymous…it is good to hear your son got the correct diagnosis and treatment for his issue. Unfortunately, the average FAI patient may go 2.5-3 years before receiving a proper diagnosis. This ties in closely with Megan's comment of little exposure to the pathology. Outside of recent graduates, because of the relative novelty of the diagnosis/treatment of FAI, many ATC's, PT's, etc may be unfamiliar with FAI. Many graduated before much was known about FAI, and in turn rely on their educational skills to read and research topics that may be new to them. As the quantity of literature and information regarding this topic increases, the hope is that the rates of misdiagnosis would decrease as the clinician awareness increases. We as researchers are working hard to provide that knowledge, and hope to have more clinically relevant papers published in the very near future.
Great post, Hip replacement surgery can be extremely painful. But now there are many hip replacement alternatives that help to relieve pain and correct the problem faced.I would suggest to see a video on youtube about Femoral Acetabular Impingement or FAI.Check out this video link,https://www.youtube.com/watch?v=hoEifiovQ_s
I'm curious as to the reoccurrence rate of these lesions following surgery in these young athletes. If it is an overuse injury due to repeated trauma to these bony structures, I would think that these types of lesions would reappear after they are shaved down, especially if the athlete continues to elite levels. It would be interesting to look at long term surgical outcomes. Has anyone come across a study like this? I have seen several cases of FAI in older (late 20's, early 30's) elite soccer players, and especially in goalkeepers. Many were surgically corrected, but continue to experience pain.
Also, the video that Dipty posted was really helpful in breaking down some of the basic anatomy. We've been discussing this condition in one of my graduate classes recently, and it's intriguing to learn more about. I think as we increase knowledge about this condition, we'll see it diagnosed more.
Thank you for your comment, Erika. I have not seen any articles examining longitudinal data and long term outcomes. As this is a new diagnosis, I wonder if enough time has passed for those studies to have yet been conducted. I completely agree that this is an area needing to be explored. What I do know, is that it has been suggested that the increased joint forces to the flexed hip are more detrimental to the skeletally immature athlete. As the bones of adolescents are still growing/forming, they also more readily adapt to these increased forces. Therefore, it has been proposed that even if the activity continues, the adult bone will be less compliant. As time goes by, I expect some of the very studies you propose will be published.