Alpha Angle is Predictive of Athletic-Related “Hip” and
“Groin” Pain in Collegiate National Football Prospects

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.

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

by: Nicole Cattano
by: Jeffrey Driban

Related Posts:

Larson CM, Sikka RS, Sardelli MC, Byrd JW, Kelly BT, Jain RK, & Giveans MR (2013). Increasing Alpha Angle is Predictive of Athletic-Related “Hip” and “Groin” Pain in Collegiate National Football League Prospects. Arthroscopy PMID: 23357573