Article Text

Download PDFPDF
Cam morphology in young male football players mostly develops before proximal femoral growth plate closure: a prospective study with 5-yearfollow-up
  1. Pim van Klij1,
  2. Marinus P Heijboer1,
  3. Abida Z Ginai2,
  4. Jan A N Verhaar1,
  5. Jan H Waarsing1,
  6. Rintje Agricola1
  1. 1 Department of Orthopaedics, Erasmus Medical Centre, Rotterdam, The Netherlands
  2. 2 Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands
  1. Correspondence to Pim van Klij, Department of Orthopaedics, Erasmus Medical Centre, Rotterdam 3015CE, The Netherlands; p.vanklij{at}


Objectives Cam morphology is not completely understood. The aim of this study was threefold: (1) to investigate if cam morphology development is associated with growth plate status; (2) to examine whether cam morphology continues to develop after growth plate closure; and (3) to qualitatively describe cam morphology development over 5-year follow-up.

Methods Academy male football players (n=49) participated in this prospective 5-year follow-up study (baseline 12–19 years old). Anteroposterior and frog-leg lateral views were obtained at baseline (142 hips), 2.5-year (126 hips) and 5-year follow-up (98 hips). Cam morphology on these time points was defined as: (A) visual scores of the anterior head-neck junction, classified as: (1) normal, (2) flattening, and (3) prominence; and (B) alpha angle ≥60°. Proximal femoral growth plates were classified as open or closed. Cam morphology development was defined as every increase in visual score and/or increase in alpha angle from <60° to ≥60°, between two time points. This resulted in 224 measurements for cam morphology development analysis.

Results Cam morphology development was significantly associated with open growth plates based on visual score (OR: 10.03, 95% CI 3.49 to 28.84, p<0.001) and alpha angle (OR: 2.85, 95% CI 1.18 to 6.88, p=0.020). With both definitions combined, cam developed in 104 of 142 hips during follow-up. Of these 104 hips, cam developed in 86 hips (82.7%) with open growth plate and in 18 hips (17.3%) with a closed growth plate. Cam morphology developed from 12 to 13 years of age until growth plate closure around 18 years.

Conclusion Cam morphology of the hip is more likely to develop with an open growth plate.

  • FAI syndrome
  • cam morphology
  • growth plate
  • hip
  • football

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors PK, RA: study conception/design, data acquisition, data analysis and interpretation, drafting of manuscript. MPH, AZG: data acquisition, data interpretation, critical revision. JANV: study conception/design, data acquisition, critical revision. JHW: study conception/design, data acquisition, data analysis and interpretation, critical revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Approved by the Medical Ethical Committee of Erasmus Medical Centre, Rotterdam, the Netherlands (METC: 2009-235).

  • Provenance and peer review Not commissioned; externally peer reviewed.