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• W2138520246 abstract "Purpose: Femoroacetabular impingement (FAI) is a cause of pain and osteoarthritis. The pathogenesis of this condition remains poorly understood and this limits the ability to develop treatment strategies. Cam morphology is thought to develop during adolescence, often in association with intense sporting activity. Postulated mechanisms include a subclinical slipped upper femoral epiphysis (SUFE) or extension of the epiphysis along the anterosuperior femoral neck. Cam morphology has an extremely high prevalence amongst professional footballers making them an ideal cohort to study disease pathogenesis. Methods: Players at an English Premiership Football (Soccer) Club Academy were invited to participate using a randomisation algorithm within each age group. The cross-sectional cohort was loaded towards the youngest age groups to enhance a future longitudinal study. 20 players were selected from the U10 and U11 teams, and 10 players from the U12, U13, U14, U15, U16, and U18 teams (n=100). Assessments were performed mid-season and included morphological MRI of both hips at 3T (in addition to a questionnaire, clinical examination, urine collection and physiological MRI). Morphological measurements were performed on 30 degree radial slices using Hipmorf software and included i) alpha angle measuring outline of bone ii) alpha angle measuring outline of cartilage iii) anterosuperior physeal extension (distance from medial femoral head to lateral extent of physis parallel with neck axis and divided by femoral head diameter) iv) metaphysis-neck offset (distance from metaphysis to outer border of femoral head perpendicular to neck axis and divided by femoral head diameter). Results: Maximum alpha angle measured on all radial slices increased with age (bone alpha angle r = 0.47 p<0.0001, cartilage alpha angle r=0.63 p<0.0001) and was higher in players with any degree of physeal closure (mean 78.6 degrees) compared with players with an open physis (mean 64.0 degrees) (p<0.0001). Alpha angle was highest at the 1 O’Clock position. Using a threshold of 60 degrees at this position, alpha angles were first raised for cartilage at 10 years of age and bone at 13 years of age. In the youngest age groups, raised cartilage alpha angles were secondary to hypertrophy of the outer border of the physis. Beyond 13 years of age, alpha angles were raised secondary to epiphyseal extension at the same site. The prevalence of cam morphology in participants aged over 16 years of age was 75% for bone alpha angle (mean 73.3) and 82% for cartilage alpha angle (mean 77.3). Cam morphology was bilateral in 91% cases and there was no statistically significant difference in the alpha angle between left and right hips. Alpha angle correlated with anterosuperior epiphyseal extension (cartilage r=0.702 p<0.0001, bone r=0.500 p<0.0001) but not metaphysis-neck offset (cartilage r=0.040 p=0.569, bone r=0.041 p=0.564). Absolute offset increased linearly with age at every radial slice (r = 0.88 p<0.0001) and there was no evidence of SUFE. Conclusions: Cartilaginous hypertrophy at the femoral head-neck junction precedes the appearance of an ossified cam lesion. This is consistent with findings from studies that show internal rotation is lost prior to radiographic evidence of FAI. Early morphological changes appear to represent the novel finding of hypertrophy at the groove of Ranvier and perichondral ring of LaCroix that is followed by epiphyseal migration along the anterosuperior femoral neck. It is this mechanism that gives rise to cam morphology within this cohort and not SUFE. We hypothesise that this represents a physiological response to loading and this is compatible with the bilateral nature of the condition. We have now finished recruitment of an age-matched local population control group that will give further insight into cam lesion development." @default.
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• W2138520246 date "2015-04-01" @default.
• W2138520246 modified "2023-09-26" @default.
• W2138520246 title "Pathogenesis of cam morphology in english premiership footballers" @default.
• W2138520246 doi "https://doi.org/10.1016/j.joca.2015.02.121" @default.
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