In the JournalsPerspective

Football players with hip pain history commonly present evidence of FAI

NFL athletes with a history of groin injury or hip pain show evidence of markers for cam and pincer-type femoroacetabular impingement in more than 94% of cases, according to this study.

“Radiographic indicators of [femoroacetabular impingement] FAI are very common among athletes evaluated at the National Football League Scouting Combine subjected to radiographic examination for the clinical suspicion of hip disease,” Jeffrey J. Nepple, MD, and colleagues stated in the study abstract. “Elite football athletes with significant or recurrent pain about the hip should be evaluated clinically and radiographically for FAI because pain from FAI may be falsely attributed to or may be present in addition to other disorders.”

Nepple and colleagues found radiographic evidence of combined pincer and cam-type FAI in 61.8% of cases; markers for both FAI types presented in 94.3% of hips, according to the abstract. Evidence of cam-type and pincer-type FAI were individually present in 9.8% and 22.8% of cases.

Nepple and colleagues noted that acetabular reversion was common in 71.5% of hips and an abnormal alpha angle in 61.8%, according to the abstract.

NFL athletes with a history of groin injury or hip pain show evidence of markers for cam and pincer-type femoroacetabular impingement in more than 94% of cases, according to this study.

“Radiographic indicators of [femoroacetabular impingement] FAI are very common among athletes evaluated at the National Football League Scouting Combine subjected to radiographic examination for the clinical suspicion of hip disease,” Jeffrey J. Nepple, MD, and colleagues stated in the study abstract. “Elite football athletes with significant or recurrent pain about the hip should be evaluated clinically and radiographically for FAI because pain from FAI may be falsely attributed to or may be present in addition to other disorders.”

Nepple and colleagues found radiographic evidence of combined pincer and cam-type FAI in 61.8% of cases; markers for both FAI types presented in 94.3% of hips, according to the abstract. Evidence of cam-type and pincer-type FAI were individually present in 9.8% and 22.8% of cases.

Nepple and colleagues noted that acetabular reversion was common in 71.5% of hips and an abnormal alpha angle in 61.8%, according to the abstract.

    Perspective
    Charles A. Bush - Joseph

    Charles A. Bush - Joseph

    The study by Nepple and co-authors highlights the high degree of radiographic impingement findings in elite athletes and seen even more so when the athlete has a history of groin or lower abdominal symptoms (94%). In this retrospective review, 15% of NFL combine attendees over the study period required hip/pelvic radiographs because of an abnormal history or abnormal physical exam findings. This is clearly a select patient population so these results cannot be generalized to all patients. The second point highlighted by this study is our lack of understanding of the normal variation of hip bony anatomy in various populations.  We will need to come to a better consensus on the true definition of hip impingement to compare outcomes of treatment.

    • Charles A. Bush - Joseph, MD
    • Midwest Orthopaedics at Rush University Medical Center Chicago

    Disclosures: Bush-Joseph has no relevant financial disclosures.

    Perspective

    The study by Nepple and colleagues on X-ray findings on NFL combine players with a previous history of groin injury underscores the emerging notion that femoroacetabular impingement (FAI) may predispose the athlete to soft tissue injury. The keyword is “previous” injury and it is indeed likely that the athletes suffered from prior sports hernia, adductor strains and hamstring injury. Active pain would suggest ongoing FAI or intra-articular pathology.

    FAI is found to be increasingly associated with soft tissue pelvic injury. It is reasoned that decreased hip range of motion due to bony constraints (FAI) lessens the hip’s ability to dissipate torsional stress. Thus, energy is transferred to other elements of the kinetic chain such as the adductor tendon, inguinal floor, rectus muscle and hamstring origin. The work of Chris Larson and Bryan Kelly add credence to the notion that FAI goes “hand-in-hand” with pelvic girdle soft tissue trauma.

    Persistent or chronic groin pain in an athlete should alert the practitioner to the likelihood of some element of femoral or acetabular bony constraint. Of interest is the association of BMI and acetabular over coverage. It appears likely that larger framed athletes induce more bone remodeling changes during development.

    • John D. Kelly IV, MD
    • ORTHOPEDICS TODAY Editorial Board member University of Pennsylvania Philadelphia

    Disclosures: Kelly has no relevant financial disclosures.