Original Article
Increasing Alpha Angle is Predictive of Athletic-Related “Hip” and “Groin” Pain in Collegiate National Football League Prospects

https://doi.org/10.1016/j.arthro.2012.10.024Get rights and content

Purpose

The first purpose was to evaluate radiographic pathomorphology/abnormalities in a cohort of high-level collegiate football players screened with hip radiographs. The second purpose was to define the radiographic predictors of athletic-related “hip” and “groin” symptoms in this cohort of high-level athletes.

Methods

The study population included all male collegiate football players undergoing evaluation and hip radiography at the National Football League (NFL) Scouting Combine in 2009 and 2010. All radiographs were evaluated with a detailed evaluation for hip pathomorphology. Symptoms were recorded as symptomatic or asymptomatic with respect to athletic-related groin/hip pain for comparative purposes.

Results

There were 125 players (239 hips) who had hip radiographs and were included in the final cohort. Ninety percent of players (87% of hips) in this cohort had at least 1 finding consistent with cam-type and/or pincer-type femoroacetabular impingement (FAI). There were 75 hips in the symptomatic group and 164 hips in the asymptomatic group. Although the symptomatic group had a greater prevalence of cam-type FAI (P = .009), combined-type FAI (P < .001), and osteitis pubis (P = .014), increasing alpha angle (larger cam deformities) was the only independent predictor of athletic-related groin pain (P = .01). There was no correlation, however, between FAI and body mass index (P = .659), player position (P = .166), or whether a player was drafted by an NFL team (P = .430).

Conclusions

Radiographic signs of FAI were frequently seen in collegiate NFL prospects who were screened with hip radiographs. Although patients with radiographic evidence of osteitis pubis, cam- and combined-type FAI, and larger cam deformities showed a statistically higher prevalence of symptoms, increasing alpha angle (larger cam deformity) was the only independent predictor of athletic-related hip/groin pain.

Level of Evidence

Level IV, therapeutic case series.

Section snippets

Methods

The study population included all male collegiate football players undergoing a history, physical examination, and hip radiography at the NFL Scouting Combine in 2009 and 2010 before participation in the NFL. All players with anteroposterior (AP) bilateral pelvic and frog-lateral plain radiographs of the hip were included in the study. Players who did not have plain radiographs of the hip were excluded. In addition, players/hips with improperly aligned AP pelvic radiographs, AP radiographs of

Results

There were 660 players who participated in the NFL Combines during the study period. There were 132 players (261 hips) with hip radiographs obtained during the study period. Radiographs of the hip were not obtained for 535 players, and these players were therefore excluded. In addition, 4 players (8 hips) had improperly aligned AP radiographs and 3 players (3 hips) had AP radiographs of a single hip and were thus excluded. Moreover, 11 players (11 hips) did not have a lateral view of the femur

Discussion

This study evaluated an elite group of athletes (collegiate NFL football prospects). It showed that 90% of players (87% of hips) with available radiographs had evidence of pincer-type and/or cam-type FAI on radiographs. This is consistent with recent reports in young athletic patients.7, 11, 14, 15, 16 The majority of athletes in our study had radiographic evidence of either cam-type FAI (75%) or pincer-type FAI (76%) due to acetabular retroversion (47%) or focal anterior overcoverage (39%).

Conclusions

Radiographic signs of FAI were frequently seen in collegiate NFL prospects who were screened with hip radiographs. Although patients with radiographic evidence of osteitis pubis, cam- and combined-type FAI, and larger cam deformities showed a statistically higher prevalence of symptoms, increasing alpha angle (larger cam deformity) was the only independent predictor of athletic-related hip/groin pain.

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    • Cited by (0)

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

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