Artikel
Do high impact sport promote proximal femoral pathomorphology before the growth spurt? – Preliminary results of a longitudinal, prospective, controlled study
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Autoren
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Markus Hanke
- Inselspital Bern, Universität Bern, Klinik für Orthopädische Chirurgie und Traumatologie, Bern, Switzerland
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Florian Schmaranzer
- Inselspital Bern, Universität Bern, Klinik für Orthopädische Chirurgie und Traumatologie, Bern, Switzerland
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Simon Steppacher
- Inselspital Bern, Universität Bern, Klinik für Orthopädische Chirurgie und Traumatologie, Bern, Switzerland
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Stefan Werlen
- Klinik Sonnenhof, Bern, Switzerland
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Moritz Tannast
- Inselspital Bern, Universität Bern, Klinik für Orthopädische Chirurgie und Traumatologie, Bern, Switzerland
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Klaus-Arno Siebenrock
- Inselspital Bern, Klinik für Orthopädische Chirurgie und Traumatologie, Bern, Switzerland
| Veröffentlicht: | 6. November 2018 |
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Gliederung
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Objectives: Femoroacetabular impingement (FAI) is a leading cause for pain and early osteoarthritis in the young patient and can be differentiated in cam FAI and pincer FAI. Young men typically present with an aspherical extension of the epiphyseal scar which is referred to as "idiopathic" cam deformity. Preliminary studies have suggested that the alteration of the epiphyseal growth plate may be triggered by high-impact sporting activity (e.g. ice hockey, basketball). However longitudinal studies comparing development of femoral morphology in competitive athletes to a control group a currently lacking.
The purpose of this study was to compare the proximal femoral anatomy before the beginning of the growth spurt of young boys playing ice hockey on a competitive level to a control group without the impact of competitive sport.
Methods: We report the preliminary results of a longitudinal, prospective, controlled study involving 25 boys (25 hips) at the age of 12 years playing ice hockey on the highest national level of their age to a age matched control group of 10 boys (10 hips) not competing in a sport activity. Extension of the study is planned for 3 years. All children underwent native MRI of the hip. We assessed the proximal femoral anatomy on radial proton density images around the "clock-face": epiphyseal angle, epiphyseal tilt angle, epiphyseal extension and alpha angle. Pairwise comparison was performed with independent t-tests for normally distributed data and with the Mann-Whitney U test nonnormally distributed data.
Results and conclusion: We found comparable values for both groups for the epiphyseal angle (p-values: ranging from 0.072 to 0.857), epiphyseal extension (p-values: 0.209 - 0.836), and epiphyseal tilt angle (p-values: 0.142 - 0.970) circumferentially around the clock face. The ice hockey group showed decreased alpha angles at the anterior and anterior-superior portion of the femur (e.g. 3 o'clock position: 37.8° ± 2.4; control group: 45.1° ± 7.1; p-value: 0.010)
Before the growth spurt there is no evidence of an altered growth of the proximal femoral epiphysis. No abnormalities of the epiphyseal growth plate are present in skeletal immature athletes. These results suggest that the previously reported high incidence of idiopathic cam deformities develops during the growth spurt. However the planned followup is needed to confirm these preliminary results.
