ePoster #743 - ISHA Annual Scientific Meeting 2016

Symptomatic FAI And Dysplasia In Women's Professional Soccer

Joshua David Harris, MD, Houston, TX UNITED STATES
Ali Qadeer, MD, Houston, TX UNITED STATES
Brayden J. Gerrie, BS, Houston, TX UNITED STATES
Ronald J Mitchell, MD, Houston, TX UNITED STATES
Kevin E Varner, MD, Houston, TX UNITED STATES
David M Lintner, MD, Houston, TX UNITED STATES
Patrick C. McCulloch, MD, Houston, TX UNITED STATES

Houston Methodist Orthopedics & Sports Medicine, Houston, TX, UNITED STATES

FDA Status Not Applicable

Summary: There is a high radiographic prevalence of both FAI and dysplastic morphologies in women’s professional soccer and one out of three hips demonstrates impingement on physical examination

Abstract:
Purpose: In female professional soccer players, to determine: 1) the prevalence of symptomatic femoroacetabular impingement (FAI) and dysplasia morphologies; 2) the plain radiographic parameters that are significantly associated with hip range of motion (ROM). Methods: An IRB-approved cross-sectional investigation of adult female professional soccer players was performed. Players were recruited and assessed for eligibility at a single pre-season physical examination date for a single professional team in a large metropolitan city. Adult (>18 years of age) female players without prior hip surgery were eligible. Hip ROM (flexion, abduction, internal rotation [IR], external rotation [ER]) was measured using a digital photograph. Hip impingement physical examination was performed (anterior, subspine, lateral, posterior) and recorded as positive or negative. Four plain radiographs were obtained (standing AP pelvis, bilateral false profile, supine Dunn 45°). Cam and pincer FAI and dysplasia were defined. Multiple plain radiographic parameters were measured on available radiographs. Descriptive statistics were calculated. Kolmogorov-Smirnov analysis was performed for data normality and Pearson’s (parametric) or Spearman’s (non-parametric) performed to assess correlation of ROM and radiographs. Binary logistic regression was performed to ascertain the effects of multiple radiographic parameters on the likelihood that soccer players have a positive anterior impingement test. Results: Twenty-four players (48 hips) were analyzed (25.4+/-3.0 years of age; 2.8+/-2.2 years professional experience). Fifty-four percent of hips demonstrated cam morphology, 52% pincer morphology, 23% dysplastic, and 50% borderline dysplastic. All but two hips were Tonnis grade 0 (mean joint space [medial, middle, lateral sourcil] 3.8+/-0.7 mm). The following mean radiographic parameters were observed: Dunn 45° alpha angle 57.8+/-7.8°; head-neck offset 5.2+/-1.4 mm; head-neck offset ratio 11.0+/-3.0%; neck-shaft angle 128.4+/-4.4°; lateral center edge angle (CEA) 23.5+/-5.0°; anterior CEA 28.6+/-4.0°; Tonnis angle 6.8+/-3.1°; femoral head extrusion index 15.9+/-6.4%; 69% crossover sign; 48% posterior wall sign; 38% prominent ischial spine sign; 60% coxa profunda. The following ROM values were observed: flexion 128°, abduction 71°, IR 28°, ER 38°, IR+ER sum 66°. Thirty-one (65%) hips had a type I anterior inferior iliac spine. Sixteen hips (33%) had a positive anterior impingement test. For the left hip, the logistic regression model was statistically significant, ?2(13) 29.0, p=0.0066. The model was able to correctly predict 100% of cases. Left hip IR (p<0.001), ER (p<0.001), and IR+ER (p<0.001) all contributed significantly to the prediction of a positive anterior impingement test (left). For the right hip, the logistic regression model was not statistically significant, ?2(13), p=0.72. The model was able to correctly predict 75% of cases. However, as with the left hip, right hip IR (p<0.001), ER (p<0.001), and IR+ER (p<0.001) all contributed significantly to the prediction of a positive anterior impingement test (right). Neck-shaft angle was the only radiographic parameter that demonstrated a strong significant correlation with any ROM for both left and right hips (flexion; R=-0.45, p=0.03 left; R=-0.41, p=.04 right). Conclusions: There is a high radiographic prevalence of both FAI and dysplastic morphologies in women’s professional soccer. One out of three hips demonstrates impingement on physical examination. Neck-shaft angle is significantly associated with hip motion.