The Development of Cam-Type Deformity
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]

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%).

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?

Written
by: Meghan Miller
Reviewed
by: Jeffrey Driban

Related
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