Detecting the presence of over-age players in age-related tournaments has been a difficult challenge for many sports organisations. “Age-doping” is a form of cheating that involves falsification of information about the age of a player to gain advantage in the sport. This clearly contradicts the ethics of sport and fair play.

Until now, the age of competitors has generally been proven by official documents such as birth certificates. In some regions of the world, however, births are registered at police stations or rural health clinics, or by village elders. Since births do not take place at established hospitals, their registration is often delayed because of cultural, religious and climatic reasons. At times, the large distance between a place of residence and a registration “office” can mean days of travel (and hence delay). Thus, the official “birth certificate” may not reflect the actual date of birth.

In addition to this phenomenon, there is compelling evidence that some players carry documents that are deliberately falsified. In some competitions, officials’ suspicions were raised when an entire team had birthdays in the same month of the year or when numerous players on the team had consecutive serial numbers on their birth certificates. It was also noted that some players appeared to have two sets of travel documents, and officials were bemused when players were shopping for teddy bears for their children in an “under 16” tournament. There was clearly a need to put a stop to this unhealthy practice and bring honour to the sport.

Physical appearances can be deceptive. No scientific tool can accurately match bone age with chronological age. However, skeletal maturation is a reliable variable in evaluating the “tempo” of growth. Evaluation can be based on methods such as development of dentition or the methods described in the Greulich and Pyle Radiological Atlas or by Tanner and Whitehouse. x Rays are commonly used for this purpose for medical or legal indications. Wrist x rays are readily available and cheap, and emit low radiation. However, the use of x ray radiation is illegal in most countries for non-criminal purposes (WHO, IAEA). Member associations of FIFA objected to the use of x rays for this purpose in football players.

In the lead-up to November’s FIFA U-17 World Cup Nigeria 2009, officials were having familiar discussions. “Are all the players on the competing teams really 17 or under?” Competing teams often raise questions about players who look older than expected. FIFA and all member associations are obliged to provide a level playing field for all players participating at FIFA competitions. Over-aged players clearly have an unfair advantage due to their higher physical maturity as compared with players of correct chronological age.

Age determination using MRI of the wrist as an alternative to x rays

In 2003, in response to numerous requests by member associations, FIFA’s Medical Assessment and Research Centre (F-MARC) started to investigate the use of biological markers for age determination.

MRI scans of the wrist were performed in more than 500 football players who had confirmed birth certificates. These players of different ethnical origin (Switzerland, Malaysia, Algeria, Argentina, Senegal) were aged between 14 and 19 years. A six-point grading system for the fusion of the growth plate was developed.1 Based upon the normal population, complete fusion was very unlikely to occur prior to 17 years of age; the probability was below 1%. In other words, if MRI shows complete fusion of a player’s wrist, the player is likely to be older than 17 years with a certainty of more than 99%. F-MARC then performed MRI scans of the wrist on players selected randomly at the FIFA U-17 World Cups 2003, 2005 and 2007. The MRI scans of these players showed far higher rates of fusion (up to 35%) than the reference populations2 (fig 1).

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Figure 1

MRI of the wrist of football players: (A) a 15- year-old player with a completely open growth plate; (B) a 16-year-old player with partially fused growth plate; (C) a 19-year-old player with completely fused growth plate.

To tackle this potential problem of overage players, FIFA will conduct an MRI of the wrist at the FIFA U-17 World Cup in November. Randomly selected players will be tested in Nigeria under the supervision of FIFA’s medical experts. It is noteworthy that following this announcement, some teams who qualified for the competition replaced up to 15 players from the original squad!