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. 2022 May;50(6):1727-1741.
doi: 10.1177/03635465211023500. Epub 2021 Aug 24.

Does the Type of Sport Influence Morphology of the Hip? A Systematic Review

Chantelle Doran  1 , Matthew Pettit  1 , Yash Singh  1 , Karadi Hari Sunil Kumar  2 , Vikas Khanduja  2
Affiliations

Does the Type of Sport Influence Morphology of the Hip? A Systematic Review

Chantelle Doran et al. Am J Sports Med. 2022 May.

Abstract

Background: Femoroacetabular impingement (FAI) has been extensively investigated and is strongly associated with athletic participation.

Purpose: To assess (1) the prevalence of cam-type FAI across various sports; (2) whether kinematic variation among sports influences hip morphology; and (3) whether performance level, duration, and frequency of participation or other factors influence hip morphology in a sporting population.

Study design: Systematic review; Level of evidence, 4.

Methods: A systematic search of Embase, PubMed, and the Cochrane Library was undertaken following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Prospective and retrospective case series, case reports, and review articles published after 1999 were screened, and those that met the inclusion criteria decided a priori were included for analysis.

Results: The literature search identified 58 relevant articles involving 5683 participants. A total of 49 articles described a higher prevalence of FAI across various "hip-heavy" sports, including soccer, basketball, baseball, ice hockey, skiing, golf, and ballet. In studies including nonathlete controls, a greater prevalence of FAI was reported in 66.7% of studies (n = 8/12). The highest alpha angle was identified at the 1-o'clock position (n = 9/9) in football, skiing, golf, ice hockey, and basketball. The maximum alpha angle was located in a more lateral position in goalkeepers versus positional players in ice hockey (1 vs 1:45 o'clock). A positive correlation was also identified between the alpha angle and both age and activity level (n = 5/8 and n = 2/3, respectively) and between prevalence of FAI and both age and activity level (n = 2/2 and n = 4/5).

Conclusion: Hip-heavy sports show an increased prevalence of FAI, with specific sporting activities influencing hip morphology. There is some evidence to suggest that a longer duration and higher level of training also result in an increased prevalence of FAI.

Registration: CRD4202018001 (PROSPERO).

Keywords: anatomy; athletic training; femoroacetabular impingement; hip; young adult.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: V.K. has received education support from Smith & Nephew and Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Search process. FAI, femoroacetabular impingement.
Figure 2.
Figure 2.
Prevalence of cam-type FAI per individual in athletes vs controls. The term events here refers to the occurrence of cam morphology in athletes and controls. For example, in the 2012 study by Agricola et al, 23 experimental events implies that 23 athletes were reported to have cam morphology out of the 89 athletes studied. Of the 92 controls assessed, 16 had cam-type FAI. FAI, femoroacetabular impingement; M-H, Mantel-Haenszel.
Figure 3.
Figure 3.
Prevalence of cam-type FAI per hip in athletes vs controls. The term events here refers to the occurrence of cam morphology per hip in athletes and controls. For example, in the 2019 study by Sveen et al, 13 experimental events implies that 13 hips had cam morphology out of the 40 hips assessed. Of the 20 assessed control hips, 9 had cam-type FAI. FAI, femoroacetabular impingement; M-H, Mantel-Haenszel.
Figure 4.
Figure 4.
Standardized mean difference in alpha angle of athletes vs controls. IV, inverse variance.
Figure 5.
Figure 5.
Effect of increased frequency and/or duration of training on cam morphology. M-H, Mantel-Haenszel.
See this image and copyright information in PMC

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