How does the cam morphology develop in athletes? A systematic review and meta-analysis

Pettit, Matthew; Doran, Chantelle; Singh, Yashvir; Saito, Masayoshi; Kumar, Karadi Hari Sunil; Khanduja, Vikas

doi:10.1016/j.joca.2021.02.572

Cited by 11 publications

(7 citation statements)

References 52 publications

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“…This is young compared with a recent analysis of NCAA Division I athletes in which the age of sport specialization was 14.9 years on average, 15.5 ± 1.52 years for team sports. 27 With the literature supporting cartilaginous alpha angle increase at age 10 years and bony cam development at age 12 years in addition to identified hip kinematics during skating that may predispose to cam-type impingement, 20,26 the earlier mean age of specialization in our cohort raises concern regarding the long-term health of the hip joint within the hockey community. Particular focus has been placed on ice hockey goaltenders and their on-ice mechanics during the butterfly technique.…”

Section: Discussionmentioning

confidence: 79%

“…It has been established that participation in high impact sports before skeletal maturity is associated with the development of cam deformity through repetitive loading and shear forces across epiphyseal growth plates. 16,20 This has been well documented particularly in male athletes. 14,19,21,25 Genetic predisposition has been discussed in the literature as playing a role in cam deformity development.…”

Section: Discussionmentioning

confidence: 96%

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Moderate and High Sport Specialization Level in Ice Hockey Athletes Is Associated With Symptomatic Cam Deformity

Nguyen

Bixby

Yen

et al. 2022

Sports Health: A Multidisciplinary Approach

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Background: There is a known association between ice hockey and cam deformity in growing athletes. Similarly, the association between sport specialization and overuse injury in youth athletes has been well established. Limited research exists examining the relationship between cam deformity and sport specialization. Hypothesis/Purpose: Our hypothesis was that there would be a positive association with cam deformity and sport specialization category. Study Design: Retrospective chart review and cross-sectional questionnaire study. Level of Evidence: Level 4. Methods: Study participants included athletes aged 15 to 25 years with symptomatic femoroacetabular impingement (FAI) and considered ice hockey as their primary sport. All participants had completed Dunn lateral radiographs or hip magnetic resonance imaging as part of their clinical evaluation. All participants completed a survey regarding sport specialization level. Multivariable linear regression analysis controlling for sex was used to analyze the association between degree of sport specialization, age of sport specialization, position played, and level played. Comparisons in radiographic parameters across ice hockey groups were conducted using Student t tests and chi-square tests. Results: Sixty-six ice hockey participants made up the cohort. The majority reported high sport specialization (41/66, 62%). The mean age of sport specialization was 10.7 years (SD 3.5). Participants with moderate specialization had 25 times the odds of a cam deformity (odds ratio [OR] 25.2; 95% CI 1.5-410.7; P = 0.02) and those with high specialization had 9 times the odds of cam deformity (OR 9.3; 95% CI 1.2-74.2; P = 0.04) compared with those with a low degree of specialization, controlling for patient sex. No association was detected between the age of specialization and the likelihood of cam deformity when controlling for patient sex. Conclusion: Level of sport specialization was associated with a cam deformity in this cohort of youth ice hockey athletes. Clinical Relevance: This study suggests that an association exists.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 96%

Moderate and High Sport Specialization Level in Ice Hockey Athletes Is Associated With Symptomatic Cam Deformity

Nguyen

Bixby

Yen

et al. 2022

Sports Health: A Multidisciplinary Approach

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“…When restricted to female athletes in hip‐risk sports, this representation dropped even further to 3.6% 51 . In studies investigating the development of cam morphology in sport, females comprised only 7.3% of the total sample 52 . To date, none of the cohort studies on cam morphology development involved female athletes; if included at all, females were only in the nonathlete control group 36,53–56 .…”

Section: Figurementioning

confidence: 99%

Lost in research translation: Female athletes are not male athletes, especially at the hip

Lewis,

Shefelbine

2024

Journal Orthopaedic Research

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Altered shape of the proximal femur (cam morphology) or acetabulum (pincer morphology) is indicative of femoroacetabular impingement, which can result in hip pain and osteoarthritis of the hip. As mechanical load during growth affects the resulting bone shape, there is strong evidence in males that cam morphology develops during skeletal growth while physes are open, rather than as an adaptation after growth plates are closed (skeletal maturity). This adaptation is particularly evident in athletes who participate at elite levels prior to skeletal maturity. The research providing this evidence, however, has primarily focused on male athletes. Despite the lack of inclusion in the research, females consistently comprise two thirds of the clinical and surgical populations with structural hip pain or pathology. Knowledge gained from male‐dominated cohorts may not appropriately transfer to female athletes, especially at the hip. This perspectives article briefly reviews differences between females and males in femoral and acetabular structure, hormones, timing of puberty/maturation, hypermobility, activity level and movement control—factors which affect hip structure development and loading. Without female‐focused research, the application of research findings from male athletes to female athletes may lead to ineffective or even inappropriate recommendations and treatments. Thus, there is a critical need for investment in research to promote life‐long hip health for females.

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“…primären (idiopathischen) Cam-Morphologie (Abb. 1 ) gibt es zunehmende Evidenz, dass Stop-and-Go-Sportarten (Fußball, Hockey, Basketball) während des Wachstumsschubs zu einer pathologischen Belastung der Epiphysenfuge führen [ 6 ]. Die pathologische Belastung der Wachstumsfuge führt zu einer Hypertrophie oder Extension der Epiphyse [ 7 ], möglicherweise als Reaktion im Sinne eines Stabilisierungsversuchs gegenüber juxtaphysären Mikrotraumata.…”

Section: Cam-impingementunclassified

Femoroazetabuläres Impingement beim Jugendlichen und Adoleszenten

Noebauer-Huhmann,

Koenig,

Chiari

et al. 2023

Radiologie

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ZusammenfassungDas femoroazetabuläre Impingement-Syndrom (FAIS) wird durch einen repetitiven mechanischen Konflikt zwischen Azetabulum und proximalem Femur insbesondere bei Flexion und Innenrotation hervorgerufen. Beim femoroazetabulären Impingement (FAI) vom Cam-Typ bewirkt eine Asphärizität am femoralen Kopf-Hals-Übergang die Induktion von Scherkräften am Azetabulum. Beim Pincer-Typ kann eine Retroversion der Pfanne und/oder eine vermehrte Überdachung vorliegen. Ein wichtiger mechanischer Einflussfaktor, welcher ein Impingement oder auch Hüftinstabilität verstärken oder kompensieren kann, ist die Femurtorsion. Meistens treten Torsionsstörungen kombiniert mit anderen ossären Deformitäten auf. Zu beachten ist, dass ein hoher Prozentsatz der Adoleszenten mit knöchernen FAI-Morphologien asymptomatisch bleibt. Die Diagnose des FAIS wird daher klinisch gestellt, die Bildgebung zeigt die zugrundeliegende Morphologie. Primäre Bildgebung ist das Röntgenbild in 2 Ebenen zur Beurteilung der Hüftgelenküberdachung und der azetabulären Version. Die vollständige Zirkumferenz des Femurs ist jedoch nur in der Magnetresonanztomographie (MRT) beurteilbar, ebenso Läsionen des Labrums und Knorpels sowie des Knochenmarks und der umgebenden Weichteile. Das MRT-Protokoll sollte routinemäßig eine Bestimmung der Rotation des Femurs beinhalten. Zudem sollten flüssigkeitssensitive Sequenzen des Beckens zum groben Ausschluss degenerativer oder entzündlicher extraartikulärer Veränderungen akquiriert werden.

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How does the cam morphology develop in athletes? A systematic review and meta-analysis

Cited by 11 publications

References 52 publications

Moderate and High Sport Specialization Level in Ice Hockey Athletes Is Associated With Symptomatic Cam Deformity

Moderate and High Sport Specialization Level in Ice Hockey Athletes Is Associated With Symptomatic Cam Deformity

Lost in research translation: Female athletes are not male athletes, especially at the hip

Femoroazetabuläres Impingement beim Jugendlichen und Adoleszenten

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