Characteristics of Soccer Players Undergoing Primary Hip Arthroscopy for Femoroacetabular Impingement: A Sex- and Competitive Level–Specific Analysis

Abstract

Background: Radiographic features of femoroacetabular impingement (FAI) are prevalent in kicking athletes, especially soccer players. However, there remains a paucity of data on the characteristics of symptomatic soccer players with an established diagnosis of FAI. Purpose: To report on patient demographics, injury, and clinical and radiographic characteristics in a large cohort of soccer players who underwent primary hip arthroscopy for FAI and to perform a sex- and competition level–specific analysis of these data. Study Design: Cross-sectional study; Level of evidence, 3. Methods: An institutional hip preservation registry containing 3318 consecutive primary hip arthroscopies for FAI performed between March 2010 and January 2016 was retrospectively reviewed for patients identified as soccer players. Patient demographics, injury characteristics, and clinical and radiographic findings were recorded, and sex- and competition level–specific differences were analyzed. Results: A total of 421 hips (336 soccer players) were identified, including 257 (61.0%) men and 164 (39.0%) women. Of these, 105 (24.9%) were reported as highly competitive, 194 (46.1%) as competitive, 75 (17.8%) as recreational, and 47 (11.2%) did not report a level. The majority of the 336 soccer players (231 hips; 55%) reported chronic hip pain lasting >6 months with no acute injury at the initial visit. Alpha angle, coronal center-edge angle, and femoral version on computed tomography scan measured 64.5°± 12°, 32.3°± 9°, and 13.7°± 10° (mean ± SD), respectively. There were 230 (55%) hips with a type 2 anterior inferior iliac spine (AIIS), 78 (18.5%) with a type 1 AIIS, and 19 (4.5%) with a type 3 AIIS. When compared with male athletes, female athletes had more hip internal rotation on physical examination (14.9° vs 8°; P < .001), lower alpha angles (57.5° vs 68.5°; P < .001), and lower-grade AIIS morphology ( P = .003). Acute injury as the reason for hip symptoms was most likely in the highly competitive group ( P < .001). Conclusion: Female soccer players were more likely to have less severe clinical and radiographic findings than were male soccer players. Acute injury as the cause of hip symptoms was more common in highly competitive players. Clinical Relevance: Focusing on soccer players with an established FAI diagnosis, the findings of this study suggest that there are sex- and competition level–based differences in the presentation, physical examination, and imaging characteristics among the players. These findings can better guide clinicians in the diagnostic evaluation of symptomatic soccer players with FAI and in tailoring treatment recommendations to specific cohorts.

Imaging Diagnosis, Prevalence, and Clinical Outcomes of Arthroscopic Surgery for Anterior Inferior Iliac Spine Impingement: A Systematic Review and Meta-analysis

“…Figure 1 shows a flowchart illustrating study screening and eligibility assessment. This process identified 23 studies, of which 6 were imaging diagnosis studies, 2 , 4 , 6 , 18 , 22 , 35 9 were prevalence studies, 2 , 5 , 21 , 23 – 25 , 27 , 32 , 33 9 reported outcomes after arthroscopic treatment, ∥ and 9 studies ¶ reported on adverse effects after arthroscopic treatment.…”

“…Table 2 shows a summary of the 9 studies 2 , 5 , 21 , 23 – 25 , 27 , 32 , 33 on the prevalence of AIIS impingement. Figure 2 shows the pooled prevalence of AIIS impingement in patients who underwent hip arthroscopy; there were no studies on prevalence in the general population.…”

“…For instance, the prevalence was higher in activities involving high-kicking, such as dancing and soccer. 25 , 27 Thus, special attention needs to be given to the possibility of AIIS impingement in individuals undertaking such sporting activities. In addition, we found a higher prevalence of AIIS impingement in revised hip arthroscopy cases than in primary hip arthroscopy cases.…”

Majority of competitive soccer players return to soccer following hip arthroscopy for femoroacetabular impingement: female and older aged players are less likely to return to soccer

“…Surgical indicators from imaging include elevated alpha angle (measured > 50° on CT scans) and MRI evaluation of labral pathology. Imaging evaluation was performed as described by Marom et al [17].…”

“…Among the diferent sports, soccer has drawn increased interest with regard to FAIS, as it has been shown that soccer players have a higher prevalence of radiographic FAI morphology than athletes in other sports [11]. Additionally, the unique 1 3 sports-speciic characteristics and demands of playing soccer involves maneuvers which are comparable to maneuvers used to provoke FAIS [17].…”