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Abstract Objective To analyze the relationship between pubalgia and femoroacetabular impingement (FAI) in professional athletes of a soccer club, defining the prevalence of these conditions in the sample studied. Methods It is an epidemiological, cross-sectional, and analytical study including 90 professional soccer players active from 2019 to 2021. We accessed the medical records of the subjects to retrieve information from the modified Pre-Competition Medical Assessment (PCMA) protocol, orthopedic physical examination, and anteroposterior pelvic radiographs to assess pubalgia and FAI, respectively. Inclusion criteria were athletes playing in the professional soccer club in the 2019 to 2021 season, who underwent a modified PCMA upon admission, and who signed an informed consent form. Results FAI was highly prevalent (85.6%) in the sample. This prevalence may occur because, in Brazil, people start playing sports early, not always in suitable fields, or with no proper equipment and supervision. In addition, the CAM-type impingement was the most frequent (62.2%). These injuries are related to high-intensity movements, including those associated with soccer. Furthermore, there is no dependency correlation between pubalgia and FAI. FAI was present in only 20% of athletes with pubalgia complaints. Conclusion There was a high prevalence of FAI in professional soccer players in the studied population (85.6%) but with no relationship between FAI and pubalgia.

Resumo Objetivo Analisar a relação entre a pubalgia e o impacto femoroacetabular (IFA) em atletas profissionais de um clube de futebol, definindo a prevalência de pubalgia e de impacto femoroacetabular na casuística estudada. Métodos É um estudo epidemiológico, transversal e analítico. Foram selecionados 90 atletas profissionais de futebol atuantes no período de 2019-2021. Foram acessados os prontuários para obtenção do protocolo PCMA modificado, além de exame físico ortopédico e de radiografias da bacia com incidência anteroposterior para avaliação de pubalgia e IFA, respectivamente. Critérios de Inclusão: Atletas que atuaram no clube de futebol de campo profissional na temporada de 2019 a 2021, que foram submetidos a aplicação do PCMA modificado na admissão e que assinaram o TCLE. Resultados O IFA apresentou elevada prevalência na amostra (85.6%), o que pode ocorrer pois, no Brasil, os jovens iniciam a prática esportiva em idade muito precoce, além do fato de os jogadores nem sempre praticarem o esporte em campos adequados ou com equipamentos e supervisão adequada. Ademais, o impacto tipo CAM foi o mais frequente (62.2%). O surgimento dessas lesões é relacionado a movimentos de alta intensidade, como os vistos no futebol. Outrossim, observou-se que não há correlação de dependência entre a pubalgia e o IFA. Foi visto que o IFA estava presente em apenas 20% dos atletas queixosos de pubalgia. Conclusão Há elevada prevalência de IFA em atletas de futebol profissional na população estudada (85.6%) e não houve relação entre o IFA e a presença de pubalgia.

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Introducción: Durante los últimos 20 años el tratamiento del pinzamiento acetabular ha sido quirúrgico, sin embargo, se ha propuesto el manejo conservador y la aplicación de protocolos de fisioterapia individualizada como tratamiento para el pinzamiento femoroacetabular, lo cual es fundamental para reestablecer la función de la articulación. Objetivo: Comparar los resultados entre la fisioterapia de rehabilitación del pinzamiento femoroacetabular y el tratamiento quirúrgico. Métodos: El artículo se dividió en conceptos para facilitar la revisión bibliográfica de los últimos 5 años en la base de datos de Pubmed con el sistema MeSH, Embase, Cochrane Library, Medline y BVS. Se utilizaron las siguientes palabras clave en el buscador, combinadas con el operador AND: femoroacetabular impingement, fhysiotherapy AND femoroacetabular impingement, femoroacetabular impingement treatment, Non-operative Management of Femoroacetabular Impingement. Análisis y síntesis de la información: Se incluyeron en la revisión todos los metaanálisis, ensayos clínicos aleatorizados y controlados, estudios prospectivos y artículos de revisión que comparan el tratamiento quirúrgico versus la fisiopterapia de rehabilitación en el tratamiento del síndrome de pinzamiento femoroacetabular, así como los que proponen la fisioterapia como opción de tratamiento inicial para el pinzamiento femoroacetabular, con la finalidad de evidenciar el grado de beneficio que tiene el manejo con fisioterapia en comparación con el quirúrgico. Conclusiones: La fisioterapia de rehabilitación ofrece un efecto beneficioso para el mejoramiento de la sintomatología, lo que permite, la disminución del dolor de cadera, además de restablecer la función y fuerza de la articulación(AU)

Introduction: During the last 20 years the treatment of acetabular impingement has been surgical; however, conservative management and the application of individualized physiotherapy protocols have been proposed as treatment for femoroacetabular impingement. This is essential to re-establish joint function. Objective: To compare the results between rehabilitation physiotherapy of femoroacetabular impingement and surgical treatment. Methods: The article was divided into concepts to facilitate the bibliographic review of the last 5 years in the Pubmed database with the MeSH system, Embase, Cochrane Library, Medline and BVS. The keywords used in the search engine, combined with the AND operator were femoroacetabular impingement, fhysiotherapy AND femoroacetabular impingement, femoroacetabular impingement treatment, Non-operative Management of Femoroacetabular Impingement. Analysis and synthesis of the information: All meta-analyzes, randomized and controlled clinical trials, prospective studies and review articles comparing surgical treatment versus rehabilitation physiotherapy in the treatment of femoroacetabular impingement syndrome were included in the review, as well as those that propose physiotherapy as an initial treatment option for femoroacetabular impingement, in order to demonstrate the degree of benefit that physiotherapy management has compared to surgery. Conclusions: Rehabilitation physiotherapy offers a beneficial effect for the improvement of symptoms, which allows the reduction of hip pain, in addition to restoring the function and strength of the joint(AU)

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PURPOSE: (1) To estimate the frequency of subspine impingement (SSI) morphology in patients with a diagnosis of femoroacetabular impingement (FAI) and (2) to describe the performance of the alpha angle, range of motion, and femoral and acetabular anteversion for the identification of cases with and without SSI morphology. METHODS: We performed a retrospective observational study of patients with symptomatic FAI evaluated by computed tomography between February 2015 and June 2017. SSI morphology was identified using a 3-dimensional dynamic study with Move Forward software. A case was considered positive if a contact area of the anterior inferior iliac spine with the femoral neck was evidenced. Measurements of acetabular anteversion, femoral anteversion, the lateral center-edge angle, the alpha angle, and the neck-shaft angle, as well as range-of-mobility data, were collected. RESULTS: The study included 135 patients (194 hips), with a mean age of 39.1 ± 13.9 years; 65.2% were women. SSI morphology was found in 23.7% of hips (46 hips) (95% confidence interval, 18.3%-30.2%). Of the hips identified with SSI, 52.2% had a type I anterior inferior iliac spine, 41.3% had type II, and 6.5% had type III. In hips with SSI, median femoral anteversion was 5.6° (interquartile range, 2.1°-7.5°) and values of less than 8° would increase the suspected SSI morphology (81.8% sensitivity, 70.5% specificity). CONCLUSIONS: SSI morphology is a frequent finding in patients with symptomatic FAI through a 3-dimensional dynamic study. A decrease in femoral anteversion could be considered a useful criterion to suspect SSI morphology. LEVEL OF EVIDENCE: Level IV, case series.

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PURPOSE: Femoroacetabular impingement (FAI) syndrome is characterized by a triad: symptoms, clinical signs and imaging findings. Some individuals, especially athletes, have only imaging alterations. The objective of this study was to evaluate the prevalence of cam and pincer morphology in professional soccer players compared with a control group of non-athletes and to investigate the association between the age at which players start playing competitive soccer more than three times per week and duration of the soccer career with the prevalence of these radiographic findings. METHODS: The prevalence of cam and pincer morphology in sixty professional adult male soccer players and thirty-two male controls was determined using pelvic anteroposterior radiography. Data were recorded for all hips and correlated with the age at which the players started competitive soccer practice and with the duration of their soccer career. RESULTS: The prevalence of morphological FAI in the soccer players was 92.5% versus 28.1% in the controls (p < 0.001). The duration of the soccer career was positively correlated with the alpha angle (p = 0.033) and negatively correlated with the retroversion index (p = 0.009). The age at which competitive play began was inversely correlated with the alpha angle (p < 0.001). CONCLUSION: The study showed a high prevalence of cam and pincer morphology in Brazilian professional soccer players compared with controls. The duration of the soccer career was associated with an increased alpha angle and a decreased retroversion index, and the age at which competitive soccer participation began was negatively associated with alpha angle values. Finally, this manuscript provides data about the association between greater exposure to soccer and cam and pincer morphological changes in the hip; specifically, cam morphology was more common in patients who began participating in sports at earlier ages. This information serves as an alert for coaches of youth teams to manage the training load in youth athletes. LEVEL OF EVIDENCE: III.

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BACKGROUND: Femoroacetabular impingement (FAI) is a suggested diagnosis for pain in the hip in the absence of other apparent causes. It is thought to be a cause of progressive arthrosis of the hip. Our objective was to determine the prevalence of radiographic data of FAI in the adult population without hip pathology over a period of six months. MATERIAL AND METHODS: Analytical, observational, multicentric, ambispective and transverse study based on digital X-rays analysis. Measurements of the lateral center-edge angle of Wiberg, acetabular inclination, Tönnis angle and the neck shaft angle of the proximal femur were made; a pistol grip deformity of the femoral head, the triangular index and the shape of the coxofemoral joint were also evaluated. RESULTS: From a total of 212 hips evaluated, 104 were in males and 108 in females, with an average age of 42.81 years; 21 had a pistol grip deformity and a positive triangular index for cam type. The pincer type was found in 12 hips. DISCUSSION: In this multicentric study, the FAI cam type predominated in men on the right side; the pincer type predominated in women on the left side; this is similar to what has been reported in other populations. This study is limited by the wide variation in the femoral rotation; as an advantage, it was randomly carried out and provides some data on the prevalence of deformities of the hip, not previously registered.

INTRODUCCIÓN: El pinzamiento femoroacetabular (PFA) se considera actualmente la causa principal de osteoartritis idiopática o primaria de cadera. Nuestro objetivo fue determinar la prevalencia de datos radiográficos de PFA en la población adulta sin patología coxofemoral en un período de seis meses. MATERIAL Y MÉTODOS: Estudio analítico, observacional, multicéntrico, ambispectivo y transversal realizado en archivos radiográficos digitales. Se midieron los ángulos de cobertura acetabular, cervicodiafisario, inclinación acetabular y ángulo de Tönnis; el tipo de coxa, índice triangular y deformidad en mango de pistola. RESULTADOS: De 212 articulaciones coxofemorales, 49.1% (104/212) correspondieron a hombres y 50.9% (108/212) a mujeres, con edad promedio de 42.81 ± 17.9 años; 21 articulaciones (21/212, 9.9%) presentaron deformidad en mango de pistola más índice triangular positivo para cam. Para determinar el tipo pincer, correlacionamos sobrecobertura acetabular, horizontalización acetabular, ángulo de Tönnis negativo ( 0°) y tipo de coxa profunda y/o protrusio, con una prevalencia de 5.66% de pincer (12/212). DISCUSIÓN: Nuestra población es muy pequeña a pesar de involucrar varias instituciones; la prevalencia del PFA tipo cam predominó en hombres, del lado derecho. El tipo pincer predominó en mujeres, del lado izquierdo. Este estudio está limitado por la amplia variación radiológica de la rotación femoral. Por otro lado, se aportan algunos datos sobre la prevalencia de deformidades de la cadera, previamente no registrada.

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Resumen: Introducción: El pinzamiento femoroacetabular (PFA) se considera actualmente la causa principal de osteoartritis idiopática o primaria de cadera. Nuestro objetivo fue determinar la prevalencia de datos radiográficos de PFA en la población adulta sin patología coxofemoral en un período de seis meses. Material y métodos: Estudio analítico, observacional, multicéntrico, ambispectivo y transversal realizado en archivos radiográficos digitales. Se midieron los ángulos de cobertura acetabular, cervicodiafisario, inclinación acetabular y ángulo de Tönnis; el tipo de coxa, índice triangular y deformidad en mango de pistola. Resultados: De 212 articulaciones coxofemorales, 49.1% (104/212) correspondieron a hombres y 50.9% (108/212) a mujeres, con edad promedio de 42.81 ± 17.9 años; 21 articulaciones (21/212, 9.9%) presentaron deformidad en mango de pistola más índice triangular positivo para cam. Para determinar el tipo pincer, correlacionamos sobrecobertura acetabular, horizontalización acetabular, ángulo de Tönnis negativo (< 0o) y tipo de coxa profunda y/o protrusio, con una prevalencia de 5.66% de pincer (12/212). Discusión: Nuestra población es muy pequeña a pesar de involucrar varias instituciones; la prevalencia del PFA tipo cam predominó en hombres, del lado derecho. El tipo pincer predominó en mujeres, del lado izquierdo. Este estudio está limitado por la amplia variación radiológica de la rotación femoral. Por otro lado, se aportan algunos datos sobre la prevalencia de deformidades de la cadera, previamente no registrada.

Abstract: Background: Femoroacetabular impingement (FAI) is a suggested diagnosis for pain in the hip in the absence of other apparent causes. It is thought to be a cause of progressive arthrosis of the hip. Our objective was to determine the prevalence of radiographic data of FAI in the adult population without hip pathology over a period of six months. Material and methods: Analytical, observational, multicentric, ambispective and transverse study based on digital X-rays analysis. Measurements of the lateral center-edge angle of Wiberg, acetabular inclination, Tönnis angle and the neck shaft angle of the proximal femur were made; a pistol grip deformity of the femoral head, the triangular index and the shape of the coxofemoral joint were also evaluated. Results: From a total of 212 hips evaluated, 104 were in males and 108 in females, with an average age of 42.81 years; 21 had a pistol grip deformity and a positive triangular index for cam type. The pincer type was found in 12 hips. Discussion: In this multicentric study, the FAI cam type predominated in men on the right side; the pincer type predominated in women on the left side; this is similar to what has been reported in other populations. This study is limited by the wide variation in the femoral rotation; as an advantage, it was randomly carried out and provides some data on the prevalence of deformities of the hip, not previously registered.

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Femoroacetabular impingement (FAI) syndrome is a frequent cause of pain and in recent years considered to be a precursor of premature hip osteoarthritis. The structural abnormalities which characterize FAI syndrome, such as the cam-type deformity, are associated with morphological alterations that may lead to hip osteoarthritis. The aim of this study was to determine the prevalence and topographic and morphometric features of the cam deformity in a series of 326 femur specimens obtained from a Mexican population, as well as changes in prevalence in relation to age and gender. The specimens were subdivided into groups according to gender and age. A standardized photograph of the proximal femur of each specimen was taken, and the photograph was used to determine the alpha angle using a computer program; the location of the lesion was determined by quadrant and the morphometric characteristics were determined by direct observation. The overall prevalence of cam deformities in the femur specimens was 29.8 % (97/326), with a prevalence by gender of 35.2 % (64/182) in men and 22.9 % (33/144) in women. The mean alpha angle was 54.6° ± 8.5° in all of the osteological specimens and 65.6° ± 7.5° in those specimens exhibiting a cam deformity. Cam deformities were found topographically in the anterior-superior quadrant of the femoral head-neck junction in 86.6 % (84/97) of the femurs. Deformities were found in 28.2 % of the right femurs and 31.3 % of the left femurs. The prevalence of cam deformity was higher in the femur specimens of young men and in those of middle-aged and older women. There were no significant differences in this deformity in relation to the alpha angle according to age and gender.

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BACKGROUND: There is a lack of uniformity in the diagnostic criteria for femoroacetabular impingement (FAI), and few studies discuss the prevalence of radiographic changes in asymptomatic individuals. These factors make it difficult to establish a natural history of this disease. The aim of this study was to assess the prevalence of radiographic signs of CAM and Pincer FAI in an asymptomatic population. METHODS: A cross-sectional study was performed from July 2013 to December 2013. A total of 185 subjects were analysed. INCLUSION CRITERIA: no history of hip pain or orthopedic disease; and being 20-60 years old. EXCLUSION CRITERIA: athletically active; or patients who would not allow acquisition of appropriate radiographs for analysis. Radiographs were obtained in anteroposterior and Dünn 45° view to access: alpha angle (AA), triangular index (TI), crossover sign (CS), lateral-centre edge (LCE) angle and acetabular index (AI). RESULTS: Median age was 34 years (27-49.5) and FAI was present in 53% of all subjects. 32.44% (60) was the overall CAM-type prevalence and 42.7% (79) the overall Pincer-type prevalence. Only 2 subjects presented the 3 overcoverage signs (AI, LCE and CS). An association was noted between the presence of AI <0° and the LCE >40° (p = 0.05). CONCLUSIONS: Our study established a higher prevalence of radiographic markers of FAI in an asymptomatic population.

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