Cam morphology is associated with MRI-defined cartilage defects and labral tears: a case-control study of 237 young adult football players with and without hip and groin pain

Abstract

Objective: Football players are at risk of developing hip osteoarthritis (OA). Cam morphology (present in almost two of every three football players) may explain this heightened risk, but there is limited research on its role in hip OA development in younger athletes. Knowledge of this relationship will advance our understanding of the aetiology of hip OA in football players. We aimed to study the relationship between cam morphology size and MRI-defined cartilage defects and labral tears, and if this relationship differs by symptomatic state in young adult football players.

Methods: For this case-control study, 182 (288 hips) symptomatic (hip and/or groin pain >6 months and positive flexion-adduction-internal-rotation (FADIR) test) and 55 (110 hips) pain-free football players (soccer or Australian football) underwent anteroposterior and Dunn 45° radiographs, and 3-Tesla MRI. Cam morphology size was defined using alpha angle, and cartilage defects and labral tears were scored semiquantitatively. Presence, location and score (severity) of cartilage defects and labral tears were determined. Each participant completed the International Hip Outcome Tool 33 and Copenhagen Hip and Groin Outcome Score.

Results: Greater alpha angle was associated with cartilage defects (OR 1.03, 95% CI 1.01 to 1.04) and labral tears (OR 1.02, 95% CI 1.01 to 1.04). Greater alpha angle was associated with superolateral cartilage defects (OR 1.03, 95% CI 1.02 to 1.05) and superior labral tears (OR 1.03, 95% CI 1.02 to 1.05). The association of alpha angle with MRI-defined cartilage defects and labral tears was no greater in football players with symptoms than in those without (p=0.189-0.937).

Conclusion: Cam morphology size was associated with cartilage defects and labral tears in young adult football players with and without pain. This study provides evidence that cam morphology may contribute to the high prevalence of hip OA in football players. Prospective studies of football players are now needed to establish if cam morphology causes progression of cartilage defects and labral tears and development of hip OA.

Keywords: football; hip; rehabilitation; soccer.

Figure 1

Probability plots from 0 (0%) to 1 (100%) of cartilage defects and labral tears (presence) for values of alpha angle in 5° increments in all hips (hip and/or groin pain and control hips combined). (A) Cartilage defect (anteroposterior alpha angle); (B) cartilage defect (Dunn 45° alpha angle); (C) labral tear (anteroposterior alpha angle); (D) labral tear (Dunn 45° alpha angle).

Figure 2

Probability plots from 0 (0%) to 1 (100%) of cartilage defects and labral tears (location) for values of alpha angle in 5° increments in all hips (hip and/or groin pain and control hips combined). (A) Superolateral cartilage defect (anteroposterior alpha angle); (B) superolateral cartilage defect (Dunn 45° alpha angle); (C) superior labral tear (anteroposterior alpha angle); (D) superior labral tear (Dunn 45° alpha angle).