In the JournalsPerspective

Higher rate of subspine impingement seen in soccer players vs athletes who played non-kicking sports

Investigators of this retrospective review of patients who underwent arthroscopic hip surgery for femoroacetabular impingement found a significantly higher rate of subspine impingement among high-level soccer players than athletes who played non-kicking sports, such as basketball, track and hockey.

Using a prospective hip registry, researchers identified 26 soccer players and 87 non-kicking athletes who had 2-year follow-up after surgery. Investigators collected demographic data and plain radiographs and CT scans to evaluate parameters and anterior inferior iliac spine (AIIS) morphology. At 6 months, 1 year, 2 years and 3 years postoperatively, the modified Harris Hip score, Hip Outcome Score – activities of daily living (HOS-ADL) and HOS-sport-specific subscale and the International Hip Outcome Tool-33 (iHOT-33) were collected.

Danyal Nawabi

Results showed abnormality of the AIIS extending to or below the anterior acetabular rim in 84% of the soccer players vs. 52% of the non-kicking athletes. Investigators noted the outcome scores significantly improved in both groups between preoperation and postoperation at the mean follow-up of 35 months. Investigators found comparable outcome scores between soccer players and non-kicking athletes except for iHOT-33. – by Monica Jaramillo

Disclosures: Nawabi reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.





 

Investigators of this retrospective review of patients who underwent arthroscopic hip surgery for femoroacetabular impingement found a significantly higher rate of subspine impingement among high-level soccer players than athletes who played non-kicking sports, such as basketball, track and hockey.

Using a prospective hip registry, researchers identified 26 soccer players and 87 non-kicking athletes who had 2-year follow-up after surgery. Investigators collected demographic data and plain radiographs and CT scans to evaluate parameters and anterior inferior iliac spine (AIIS) morphology. At 6 months, 1 year, 2 years and 3 years postoperatively, the modified Harris Hip score, Hip Outcome Score – activities of daily living (HOS-ADL) and HOS-sport-specific subscale and the International Hip Outcome Tool-33 (iHOT-33) were collected.

Danyal Nawabi

Results showed abnormality of the AIIS extending to or below the anterior acetabular rim in 84% of the soccer players vs. 52% of the non-kicking athletes. Investigators noted the outcome scores significantly improved in both groups between preoperation and postoperation at the mean follow-up of 35 months. Investigators found comparable outcome scores between soccer players and non-kicking athletes except for iHOT-33. – by Monica Jaramillo

Disclosures: Nawabi reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.





 

    Perspective
    Jeffrey J. Nepple

    Jeffrey J. Nepple

    Our understanding of FAI continues to evolve as we attempt to improve the outcomes of FAI procedures. Subspine impingement has recently been recognized as another component of the FAI spectrum. In this study, Nawabi and colleagues found an increased prevalence of AIIS deformity among soccer athletes (84%) undergoing FAI treatment compared to non-kicking athletes (52%). This finding would suggest that kicking stresses the AIIS apophysis and plays a role in the development of its ultimate bony morphology. However, a limitation of the current study is the lack of an apparent dose-relationship, as detailed information regarding sporting participation during skeletal immaturity was not available. Similar to other aspects of FAI, the high prevalence of AIIS deformity, even in the control group, reminds of us of challenge of identifying which patients have symptomatic subspine impingement. Unlike cam-type impingement, we have no evidence of the role of subspine impingement in osteoarthritis, but it may play a role in some kicking and high-flexion athletes. 

    In the second part of the study, Nawabi and colleagues demonstrate similar patient-reported outcomes between both groups which had subspine decompression in the presence of AIIS deformity.  Further studies will be needed to determine the role of subspine decompression, independent of the other components of FAI treatment, as the current study does not answer this question. 

    • Jeffrey J. Nepple, MD
    • Assistant Professor of Orthopedic Surgery Washington University School of Medicine St. Louis

    Disclosures: Nepple reports he is a consultant to and does research for Smith & Nephew, and does research for Zimmer.