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Length of time playing elite-level tennis increases risk for FAI in young athletes
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A high prevalence of young elite-level tennis players were at risk for femoroacetabular impingement based on clinical evaluation, according to recently presented data.
Investigators found a risk for femoroacetabular impingement (FAI) was highest among players who first started playing tennis at an early age, which lends support to the idea that increased years in sports at a young age may predispose athletes to this risk.
"Femoroacetabular impingement (FAI) has been well described in the literature as a source of hip pain in elite-level athletes," Robert E. Boykin, MD, of the Steadman Philippon Research Institute in Vail, Colo., said during his presentation. "It is associated with structural abnormalities including cam lesions of the femur and pincer lesions of the acetabulum. [The] injuries seen may be due to repetitive motion and overuse in sports."
Boykin and his colleagues set out to determine how many young athletes have abnormal findings on clinical examination of the hip. Long-term, they hope to develop a strategy to prevent hip injuries in young tennis players.
The researchers enrolled 148 tennis players from an elite academy in Barcelona, Spain. Players had an average age of 15.1 years. The study, which was done in collaboration with the Clinica Mapfre de Medicina del Tenis in Barcelona, included 58 girls and 90 boys. Six players reported a previous hip injury and three reported a previous sports hernia, leaving 139 players for analysis.
Boykin and colleagues assessed players’ range of motion including flexion, extension, adduction, abduction, internal rotation and external rotation. They also measured Faber distance, and checked for anterior and posterior impingement signs. A hip "at-risk" for FAI was defined as one with a positive anterior impingement sign (pain with flexion, adduction and internal rotation), a decreased internal rotation of one side compared with the other of greater than 5° or an increased Faber distance.
Players had an average age of 6 years when they began playing tennis. Overall, they played in 20 tournaments a year and averaged 47 weeks per year of playing competitively.
Players at risk for FAI included 21% with a positive anterior impingement test, 23% with an increased Faber distance and 36% with unequal internal rotation.
"Considering an at-risk hip to include having any one of these signs, overall, 62% of these players are identified as having a hip that would be considered at-risk for FAI," Boykin said.
Comparing at-risk hips with those not found to be at risk, Boykin and colleagues found no difference in age, tournaments played per year or weeks played per year. However, "the subjects with an at-risk hip had played tennis longer — on average 9.5 years compared with those without any clinical signs of risk at 8.6 years — and this was statistically significant," he said.
"We believe this study further supports the idea that increased years in sports at a young age may predispose athletes to a risk for developing FAI," he said.
Boykin and his colleagues plan to continue enrolling patients and studying the risk in this population to develop modified techniques and training regimens to prevent hip injuries. – by Tina DiMarcantonio
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Disclosure: Boykin has no relevant financial disclosures.