Original Article
Radiographic Findings of Femoroacetabular Impingement in National Football League Combine Athletes Undergoing Radiographs for Previous Hip or Groin Pain

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Purpose

The purpose of this study was to investigate the prevalence of radiographic findings of femoroacetabular impingement (FAI) in elite football players with a history of hip pain or groin injury who underwent radiographs.

Methods

We performed a retrospective review of athletes undergoing hip radiography at the National Football League Combine from 2007 to 2009. Radiographs were obtained in athletes with a history of hip pain or injury. Anteroposterior pelvis and frog-lateral radiographs were obtained in 123 hips (107 players) that met our inclusion criteria. Radiographic indicators of cam-type FAI (alpha angle, head-neck offset ratio) and pincer-type FAI (acetabular retroversion, center-edge angle, acetabular inclination) were recorded. Findings were correlated with clinical factors (previous groin/hip pain, position, race, and body mass index).

Results

The most common previous injuries included groin strain (n = 57) and sports hernia/abdominal strain (n = 21). Markers of cam- and/or pincer-type FAI were present in 94.3% of hips (116 of 123). Radiographic evidence of combined cam- and pincer-type FAI was the most common (61.8%, 76 hips), whereas isolated cam-type FAI (9.8%, 12 hips) and pincer-type FAI (22.8%, 28 hips) were less common. The most common deformities included acetabular retroversion (71.5%) and an abnormal alpha angle (61.8%). A body mass index greater than 35 was associated with the presence of global overcoverage (46.2% v 17.3%, P = .025).

Conclusions

Radiographic indicators of FAI are very common among athletes evaluated at the National Football League Scouting Combine subjected to radiographic examination for the clinical suspicion of hip disease. Elite football athletes with significant or recurrent pain about the hip should be evaluated clinically and radiographically for FAI, because pain from FAI may be falsely attributed to or may be present in addition to other disorders.

Level of Evidence

Level IV, therapeutic case series.

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Methods

We performed a retrospective radiographic review of athletes evaluated at the NFL National Invitational Camp, commonly referred to as the Scouting Combine, from 2007 to 2009. The NFL Scouting Combine database was used to identify athletes in whom anteroposterior (AP) pelvis and frog-lateral hip radiographs were obtained. AP pelvis and frog-lateral radiographs were obtained in 183 hips (154 players) (15.5% of all players) during the study period. Among all NFL Scouting Combine participants

Results

AP pelvis and frog-lateral hip radiographs of 123 hips in 107 players were obtained, and these patients were included in the study. Of the players, 86 (80.4%) were African American whereas 21 (19.6%) were white/non–African American. The mean age of the players was 22.7 years (range, 20 to 25 years). Of the players, 43 had right hip radiographs, 48 had left hip radiographs, and 16 had bilateral radiographs. The mean BMI was 29.8 (range, 23.8 to 43.3). Among these athletes, the most common

Discussion

Our study documents a very high rate of radiographic findings of FAI in a large cohort of athletes undergoing hip radiographs at the NFL Combine for a history of previous hip or groin dysfunction. During the study period, over 15% of all athletes underwent radiographic evaluation of the hip/pelvis. Players in our study had a history of pain around the hip most often attributed to a soft-tissue disorder such as a groin strain, sports hernia, hip flexor strain, or hamstring strain. A standardized

Conclusions

Radiographic indicators of FAI are very common among athletes evaluated at the NFL Scouting Combine subjected to radiographic examination for the clinical suspicion of hip disease. Elite football athletes with significant or recurrent pain about the hip should be evaluated clinically and radiographically for FAI, because pain from FAI may be falsely attributed to or may be present in addition to other disorders.

References (45)

  • J.W. Byrd et al.

    Hip arthroscopy in athletes

    Clin Sports Med

    (2001)
  • J.J. Nepple et al.

    Clinical and radiographic predictors of intra-articular hip disease in arthroscopy

    Am J Sports Med

    (2011)
  • V.Y. Ng et al.

    Efficacy of surgery for femoroacetabular impingement: A systematic review

    Am J Sports Med

    (2010)
  • J.C. Clohisy et al.

    Surgical treatment of femoroacetabular impingement: A systematic review of the literature

    Clin Orthop Relat Res

    (2010)
  • M. Philippon et al.

    Femoroacetabular impingement in 45 professional athletes: Associated pathologies and return to sport following arthroscopic decompression

    Knee Surg Sports Traumatol Arthrosc

    (2007)
  • R. Ganz et al.

    Femoroacetabular impingement: A cause for osteoarthritis of the hip

    Clin Orthop Relat Res

    (2003)
  • K.A. Siebenrock et al.

    The cam-type deformity of the proximal femur arises in childhood in response to vigorous sporting activity

    Clin Orthop Relat Res

    (2011)
  • R.O. Murray et al.

    Athletic activity in adolescence as an etiological factor in degenerative hip disease

    J Bone Joint Surg Br

    (1971)
  • K.A. Siebenrock et al.

    Effect of pelvic tilt on acetabular retroversion: A study of pelves from cadavers

    Clin Orthop Relat Res

    (2003)
  • H.P. Nötzli et al.

    The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement

    J Bone Joint Surg Br

    (2002)
  • J.C. Clohisy et al.

    A systematic approach to the plain radiographic evaluation of the young adult hip

    J Bone Joint Surg Am

    (2008)
  • T.C. Pollard et al.

    Femoroacetabular impingement and classification of the cam deformity: The reference interval in normal hips

    Acta Orthop

    (2010)
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    The authors report that they have no conflicts of interest in the authorship and publication of this article.

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