Skip to main content

Comparative study of the femoroacetabular impingement (FAI) prevalence in male semiprofessional and amateur soccer players

Abstract

Introduction

Femoroacetabular impingement (FAI) represents a novel approach to the mechanical etiology of hip osteoarthritis. The cam-type femoroacetabular impingement deformity occurs frequently in young male athletes. The aim of our study was to evaluate the prevalence of FAI in male semiprofessional soccer players using clinical examination and magnetic resonance imaging (MRI), compared to amateur soccer players. In MRI, the α angle of Nötzli is determined for quantifying FAI.

Materials and methods

According to power analysis, a total of 22 asymptomatic semiprofessional soccer players with a median of 23.3 years of age (range 18–30 years) and 22 male amateur soccer players with a median of 22.5 years of age (control group, range 18–29 years) underwent an MRI to measure the hip α angle of Nötzli. The α angle of the kicking legs of the semiprofessional group and the amateur group were analyzed. The study group was moreover evaluated by the Hip Outcome Score (HOS) and a clinical hip examination including range of motion (ROM) and impingement tests.

Results

In the semiprofessional group, 19 soccer players had a right kicking leg and 1 soccer player had a left kicking leg. 2 soccer players kicked with two feet. In the semi-professional group, the mean value of the α angle of the kicking leg (57.3 ± 8.2°) was significantly higher than in the amateur group (51.7 ± 4.8°, P = 0.008). In the semi-professional group, 15 (62.5 %) of 24 kicking legs had an increased α angle >55°, while 5 (27.3 %) kicking legs of the amateur group had an α angle >55°. Five semi professional soccer players had findings in clinical examination, whereof 4 had an increased α angle >55°. No participant of the amateur group showed pathological results in the clinical examination (P = 0.0484). Overall, semiprofessional soccer players had a higher proportion of an increased α angle than the amateur group.

Conclusions

Semiprofessional players have a higher prevalence of an increased α angle in the kicking leg than the amateur group at the same age. The kicking leg is predisposed for FAI.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Abbreviations

ADL:

Activities of daily living

CEA:

Center edge angle

FAI:

Femoroacetabular impingement

FOV:

Field of view

HOS:

Hip outcome score

MRI:

Magnetic resonance imaging

ROM:

Range of motion

TE:

Echo times

TR:

Repetition times

References

  1. Ayeni OR, Banga K, Bhandari M, Maizlin Z, de Sa D, Golev D, Harish S, Farrokhyar F (2014) Femoroacetabular impingement in elite ice hockey players. Knee Surg Sports Traumatol Arthrosc 22(4):920–925

    Article  PubMed  Google Scholar 

  2. Barton C, Salineros MJ, Rakhra KS, Baulé PE (2011) Validity of the alpha angle measurement on plain radiographs in the evaluation of cam-type femoroacetabular impingement. Clin Orthop Relat Res 469(2):464–469

    Article  PubMed Central  PubMed  Google Scholar 

  3. Beaulé PE, Zaragoza E, Motamedi K, Copelan N, Dorey FJ (2005) Three-dimensional computed tomography of the hip in the assessment of femoroacetabular impingement. J Orthop Res 23(6):1286–1292

    Article  PubMed  Google Scholar 

  4. Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R (2004) Anterior femoroacetabular impingement: part II: midterm results of surgical treatment. Clin Orthop Relat Res 418:67–73

    Article  PubMed  Google Scholar 

  5. Beck M, Kalhor M, Leunig M, Ganz R (2005) Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritits of the hip. J Bone Joint Surg Br 87(7):1012–1018

    Article  CAS  PubMed  Google Scholar 

  6. Brunner A, Hamers AT, Fitze M, Herzog RF (2010) The plain beta-angle measured on radiographs in the assessment of femoroacetabular impingement. J Bone Joint Surg Br 92(9):1203–1208

    Article  CAS  PubMed  Google Scholar 

  7. Clohisy JC, Nunley RM, Otto RJ, Schoenecker PL (2007) The frog-leg lateral radiographic accurately visualized hip cam impingement abnormalities. Clin Orthop Relat Res 462:115–121

    Article  PubMed  Google Scholar 

  8. Czemy C, Oschatz E, Neuhold A, Tschauner C, Hofmann S, Kramer J (2002) MR arthrography of the hip joint. Radiologe 42(6):451–456 Review

    Article  Google Scholar 

  9. Dudda M, Albers C, Mamisch TC, Werlen S, Beck M (2009) Do normal radiograph exclude asphericity of the femoral head–neck junction? Clin Orthop Relat Res 476(3):651–659

    Article  Google Scholar 

  10. Eijer H, Myers SR, Ganz R (2001) Anterior femoroacetabular impingement after femoral neck fractures. J Orthop Trauma 15(7):475–481

    Article  CAS  PubMed  Google Scholar 

  11. Epstein DM, Mc Hugh M, Yorio M, Neri B (2013) Intra-articular hip injuries in national hockey league players: a descriptive epidemiological study. Am J Sports Med 41(2):343–348

    Article  PubMed  Google Scholar 

  12. Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 417:112–120

    PubMed  Google Scholar 

  13. Ganz R, Leunig M, Leunig-Ganz K, Harris WH (2008) The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res 466(2):264–272

    Article  PubMed Central  PubMed  Google Scholar 

  14. Jenkins PJ, Clement ND, Hamilton DF, Gaston P, Patton JT, Howie CR (2013) Predicting the cost-effectiveness of total hip and knee replacements: a health economic analysis. Bone Joint J 95-B(1):115–121

    Article  CAS  PubMed  Google Scholar 

  15. Johnson AC, Shaman MA, Ryan TG (2012) Femoroacetabular impingement in former high-level youth soccer players. Am J Sports Med 40(6):1342–1346

    Article  PubMed  Google Scholar 

  16. Kapron AL, Anderson AE, Aoki SK, Phillips LG, Petron DJ, Toth R, Peters CL (2011) Radiographic prevalence of femoroacetabular impingement in collegiate football players: AAOS exhibit selection. J Bone Joint Surg Am 93(11):e111-10

    Google Scholar 

  17. Kassarjian A, Yoon LS, Belzile E, Connolly SA, Millis MB, Palmer WE (2005) Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Radiology 236(2):588–592

    Article  PubMed  Google Scholar 

  18. Kim WY, Hutchinson CE, Andrew JG, Allen PD (2006) The relationship between acetabular retroversion and osteoarthritis of the hip. J Bone Joint Surg Br 88(6):727–729

    Article  CAS  PubMed  Google Scholar 

  19. Lahner M, Jahnke NL, Zirke S, Teske W, Vetter G, von Schulze Pellengahr C, Daniilidis K, Hagen M, von Engelhard LV (2013) The deviation of the mechanical leg axis correlates with an increased hip alpha angle and could be a predictor for femoroacetabular impingement. Inter Orthop 38(1):19–25

    Article  Google Scholar 

  20. Leunig M, Casillas MM, Hamlet M, Hersche O, Notzli H, Slongo T, Ganz R (2000) Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysic. Acta Orthop Scand 71(4):370–375

    Article  CAS  PubMed  Google Scholar 

  21. Leunig M, Ganz R (2005) Femoroacetabular impingement. A common cause of hip complaints leading to arthrosis. Unfallchirurg 108(1):9–10

    Article  CAS  PubMed  Google Scholar 

  22. Martin RL, Kelly BT, Philippon MJ (2006) Evidence of validity for the hip outcome score. Arthroscopy 22(12):1304–1311

    Article  PubMed  Google Scholar 

  23. Martin RL, Sekiya JK (2008) The interrater reliability of 4 clinical tests used to assess individuals with musculoskeletal hip pain. J Orthop Sports Phys Ther 38(2):71–77

    Article  PubMed  Google Scholar 

  24. Myers SR, Eijer H, Ganz R (1999) Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop Relat Res 363:93–99

    Article  PubMed  Google Scholar 

  25. Nepple JJ, Brophy RH, Matava MJ, Wright RW, Clohisy JC (2012) Radiographic findings of femoroacetabular impingement in National Football League Combine athletes undergoing radiographs for previous hip or groin pain. Arthroscopy 28(10):1396–1403

    Article  PubMed  Google Scholar 

  26. Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J (2002) The contour of the femoral head–neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 84(4):556–560

    Article  PubMed  Google Scholar 

  27. Pivec R, Johnson AJ, Mears SC, Mont MA (2012) Hip arthroplasty. Lancet 380(9855):1768–1777

    Article  PubMed  Google Scholar 

  28. Philippon MJ, Ho CP, Briggs KK, Stull J, LaPrade RF (2013) Prevalence of increased alpha angles as a measure of cam-type femoroacetabular impingement in youth ice hockey players. Am J Sports Med 41(6):1357–1362

    Article  PubMed  Google Scholar 

  29. Rakhra KS, Seikh AM, Allen D, Beaulé PE (2009) Comparison of MRI alpha angle measurement planes in femoroacetabular impingement. Clin Orthop Relat Res 467(3):660–665

    Article  PubMed Central  PubMed  Google Scholar 

  30. Reichenbach S, Jüni P, Werlen S, Nüesch E, Pfirmann CW, Trelle S, Odermatt A, Hofstetter W, Ganz R, Leunig M (2010) Prevalence of cam-type deformity on hip magnetic resonance imaging in young males: a cross-selectional study. Arthritis Care Res (Hoboken). 62(9):1319–1327

    Article  PubMed  Google Scholar 

  31. Rolfson O, Ström O, Kärrholm J, Malchau H, Garellick G (2012) Costs related to hip disease in patients eligible for total hip arthroplasty. J Arthroplasty 27(7):1261–1266

    Article  PubMed  Google Scholar 

  32. Siebenrock KA, Wahab KH, Werlen S, Kalhor M, Leunig M, Ganz R (2004) Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop Relat Res 418:54–60

    Article  PubMed  Google Scholar 

  33. Silvis ML, Mosher TJ, Smetana BS, Chinchilli VM, Flemming DJ, Walker EA, Black KP (2011) High prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. Am J Sports Med 39(4):715–721

    Article  PubMed  Google Scholar 

  34. Snow SW, Keret D, Scarangella S, Bowen JR (1993) Anterior impingement of the femoral head: a late phenomenon of Legg-Calvé-Perthes’ disease. J Pediatr Orthop 13(3):286–289

    Article  CAS  PubMed  Google Scholar 

  35. Strehl A, Ganz R (2005) Anterior femoroacetabular impingement after healed femoral neck fractures. Unfallchirurg 108(4):263–273

    Article  CAS  PubMed  Google Scholar 

  36. Wyss TF, Clark JM, Weishaupt D, Nötzli HP (2007) Correlation between internal rotation and bony anatomy in the hip. Clin Orthop Relat Res 460:152–158

    PubMed  Google Scholar 

Download references

Acknowledgments

Parts of this study were presented and awarded at the conference 2013 of the German Speaking Association for Arthroscopy (AGA). The authors thank Priv.-Doz. Dr. Nina Lahner for linguistic support and preparation of the manuscript. The authors acknowledge Dr. Andreas Falarzik, Coach André Pawlak and the soccer players of the Sportgemeinschaft Wattenscheid 09.

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Matthias Lahner.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lahner, M., Walter, P.A., von Schulze Pellengahr, C. et al. Comparative study of the femoroacetabular impingement (FAI) prevalence in male semiprofessional and amateur soccer players. Arch Orthop Trauma Surg 134, 1135–1141 (2014). https://doi.org/10.1007/s00402-014-2008-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-014-2008-6

Keywords

  • Femoroacetabular impingement
  • α angle
  • Magnetic resonance imaging
  • Kicking leg
  • Soccer player